Articles

Federal Government Requires NPI Numbers By May 23
Two, One, or None: How Many NPIs Do You Need?
Web Site Redesigned for Brand
Please Help Us Answer Your Call Quickly
Doncasters Joins Delta Dental
Members Satisfied with Delta Dental
Grants Offered to NJ Abbott Schools for Oral Health Education
Claims, Customer Service Quality Remain High in 2006
Seventeenth Annual Delta Dental Classic Almost Here!
Delta Dental to Attend Dental Conferences
P.A.N.D.A. Program Helps Dentists, Others Fight Child Abuse
Checklist for Submitting Claim Forms

Federal Government Requires NPI Numbers By May 23

The deadline to obtain your National Provider Identifier Number (NPI) is May 23. The NPI is a unique federal identification number that dentists and other health care providers will use for administrative and financial transactions.

If you already have your NPI number, please send it to us as soon as possible. For your convenience, you may download our NPI Fax Form from our Web site. Go to www.deltadentalnj.com. Click “Dentists,” then “NPI Information” and “NPI Fax Form.” Please print the form, complete it and fax it to (973) 285-4192. Or you may mail it to our Professional Relations Department, Delta Dental of New Jersey, P.O. Box 222, Parsippany, NJ 07054. If you have questions, please contact your Dental Network Coordinator at (888) 396-6641. 

Why You Need an NPI Number
You need an NPI if you:

•  Submit electronic claims or attachments, or
•  Use the Internet to verify patient eligibility or check claim status.

The New Jersey Department of Banking and Insurance has developed a bulletin that details your NPI requirements. We have reprinted the bulletin on pages 2 and 3.

Two, One or None: How Many NPIs Do You Need?

As the May 23 deadline for using NPIs on electronic transactions draws nearer, there is still much confusion about the different types of identifiers and which are required to ensure compliance with NPI regulations.

There are two basic types of NPIs available: individual, and organizational.

Individual NPIs, also known as Type 1 NPIs, are for health care providers, such as dentists. Organizational or Type 2 NPIs are for use by incorporated businesses, such as group practices and clinics. Organizational NPIs can also be assigned to subparts. Subpart NPIs are given to components of organizations, such as owned laboratories. Subparts are not as common in dentistry as they are in other areas of health care such as hospitals, but are worth noting.

Which NPI is right for you? It depends on how you bill for services.

If you submit claims or claim attachments electronically, or if you use the Internet to verify eligibility or check on the status of claims, you are required by federal law to obtain an NPI. Even if you do not do any business electronically, you should get an NPI and share it with the specialists to whom you refer patients to make it easier for them to bill for services.

All dentists involved in electronic transactions should apply for an individual NPI. If you submit claims as an individual and receive payments in either your name or under your Social Security number (or other identifier unique to you as an individual), the individual NPI is the only number you’ll need.

Organizational NPIs are needed for corporations and other business entities that want payments made to their business or corporate names or under their tax identification numbers (TINs). On a claim, the organizational NPI identifies the payee, and will usually be submitted in conjunction with an individual NPI to identify the dentist who rendered treatment.

Say, for example, you and your partners own Valley Dental Center with five dentists on staff. Your office submits claims as Valley Dental Center, Inc. To continue submitting claims and receiving payments from carriers under your corporate name, you’ll need to apply for an organizational NPI. All five of the treating (rendering) dentists in your practice group should also apply for individual NPIs. Once everyone has their numbers, they should be used consistently on electronic claims to ensure efficient, accurate payment and HIPAA compliance.

To find out more information about NPI compliance, visit the official government NPI Web site at www.cms.hhs.gov/NationalProvIdentStand/.

Web Site Redesigned for Brand

Our Web site now has a new look to match our branding. Its improved home page descriptions make it a snap to find what you need. Check us out at www.deltadentalnj.com. Use the navigation bar on the left to find the Web features right for you!

Please Help Us Answer Your Call Quickly

It happens. You’re on the phone with us and you’re interrupted. Maybe a patient needs assistance, or wants to book an appointment. You put us on hold, thinking it will take only a few seconds. But it takes longer. What should you do?

Please know that we don’t mind if you need to hang up. In fact, we prefer it. This way we can help other callers, and keep wait times short for everyone. 

We strive to answer every call within 45 seconds. We can do it, with your help.

When an interruption occurs, just tell us “Gotta go!” instead of “Please hold.”

Doncasters Joins Delta Dental

Delta Dental is glad to welcome a new group, Doncasters, Inc., effective April 1. Doncasters is located in Farmington, CT and comes to us with 950 members. Their group number is 4638.

Please note that Delta Dental does not use Social Security numbers, but rather unique identification numbers, for Doncasters. Please check with members for their unique ID before contacting Delta Dental for information or submitting claims for benefits.

Members Satisfied with Delta Dental

More than 9 in 10 members are satisfied with Delta Dental, according to our 2006 Member Satisfaction Survey.

Here’s how members rated our performance in 2006:

Percentage that rated Delta Dental's performance "very satisfied," "satisfied," or "neutral" in the following key areas::

• Delta Dental overall - 93%
• Overall value for price paid - 87%
• Customer Service -  94%
• Access to dental care -  93%
• Quality of dental care - 95%

Members are also highly satisfied with the care they receive from their participating Delta Dental dentist. 95% would return to their participating Delta Dental dentist, and 92% would recommend their Delta Dental dentist.

Brownstone Information Resources, an independent market research firm in Morristown, New Jersey, conducted the survey.

Grants Offered to NJ Abbott Schools for Oral Health Education

Our Foundation is offering its first Oral Health Education Initiative Grants to elementary schools in New Jersey Abbott school districts. The grants will be used by schools to start an oral health education program in their third-grade classes for the 2007-2008 school year. 

Three schools, each from a separate district, will be chosen to receive a grant of up to $5,000 to fund the programs.

To apply, each school must develop an oral health education program that includes 10 monthly activities. The program should help children understand:

•  Why it is important to maintain proper daily oral hygiene
•  How to brush and floss properly
• The function of the dentist and hygienist
• The relationship between oral health and food choices
• The relationship between oral health and overall health.

The programs can include monthly activities such as an oral health bulletin board, a field trip to a dentist's office, or reading a book about oral health.

"With dental decay one of the most common chronic infectious diseases among U.S. children, according to the CDC, it is unfortunate that New Jersey's educational curriculum does not include specific dental education guidelines past the second grade level," says Foundation Vice President Diane Belle. "Through Delta Dental's grant initiative, we hope to bring attention to the importance of comprehensive oral health education, and work with educators to instill good oral health habits early that children can take with them into adulthood."

According to the American Dental Association, tooth decay is increasingly a disease of children from low-and modest-income households. The Centers for Disease Control and Prevention (CDC) states that almost 50% of childhood tooth decay cases remain untreated. Untreated tooth decay can cause a child pain, dysfunction, to be underweight, or to have a poor appearance. It can greatly reduce a child's capacity to succeed in school and in other aspects of life.

The good news is that through proper oral hygiene and nutrition, childhood tooth decay can be prevented.

The new school nutrition law requires most New Jersey schools to ban soda and junk foods, and teach better eating habits starting September 1. These new nutrition guidelines will not only aid in the fight against childhood obesity, but will also benefit children's oral health.

"Delta Dental welcomes the opportunity to further educate children, especially those who are underserved, about the importance of maintaining oral health and its close relationship to overall health and well being," says Belle.

The Delta Dental Oral Health Education Initiative Grant is open to all New Jersey Abbott elementary schools that include third grade. Delta Dental will accept applications until June 16, 2007. Grant recipients will be notified before July 31, 2007. For more information, contact Kimberly Elmore at (973) 944-4555.

Claims, Customer Service Quality Remain High in 2006

Delta Dental maintained excellent service levels in 2006, according to our 2006 Operations and Customer Service Reports. Here is a snapshot of some of our 2006 statistics.

Total number of claims received
2.9 million

Number of electronic claims received
1.5 million (52% of all claims)

Average claims turnaround time
7.2 business days
99.82% processed within 30 business days

Accuracy rates
Key accuracy measures (clerical accuracy, payment accuracy and dollar accuracy): 99.4% or higher

Seventeenth Annual Delta Dental Classic Almost Here!

Spring is here, which means it’s only a short time until tee time at the Seventeenth Annual Delta Dental Classic. The golf event benefits Special Olympics New Jersey.

It takes place on June 20 at Fiddler's Elbow Country Club in Bedminster, New Jersey - one of the finest golf courses in New Jersey. It also allows you to network with other important players in the dental service industry and most notably, to help a truly worthy cause. The Delta Dental Classic has raised more than $553,000 for Special Olympics New Jersey.

For information, contact Jennifer Appaluccio at jappaluccio@deltadentalnj.com. Be sure to mark the date!

Delta Dental to Attend Dental Conferences

Delta Dental will participate in two major conferences for dentists this Spring:

• The 2007 annual Connecticut State Dental Association meeting at Mohegan Sun in Uncasville, Connecticut, on May 10-12; and
• The 2007 New Jersey Dental Association Annual Convention at the Taj Mahal in Atlantic City, New Jersey, on June 6-9.

Please drop by to see us at the Delta Dental booth!

P.A.N.D.A. Program Helps Dentists, Others Fight Child Abuse

• Every year there are 3 million reports of child abuse in the United States. Experts believe the actual instances of abuse are three times that number.
• Child abuse occurs at every socio-economic level, across ethnic and cultural lines, within all religions and all levels of education.

The signs of abuse aren't always obvious. That's why the Delta Dental Foundation offers its P.A.N.D.A. (Prevent Abuse and Neglect through Dental Awareness) educational program to those who are in regular contact with children. 

“P.A.N.D.A. provides dentists with detailed training on the physical and behavioral indicators of child abuse and neglect,” says Lawrence A. Dobrin, D.M.D., a dentist with forensic training and experience who practices in Roselle Park, New Jersey. Dr. Dobrin is a spokesperson for the P.A.N.D.A. Coalition. “P.A.N.D.A. also provides resources to guide them through procedures for reporting suspected abuse, and offers referral resources for families to help prevent abuse and neglect.”

P.A.N.D.A. was originally created for dentists, who are well positioned to detect child abuse. Two out of every three injuries occur to the head, face, and neck areas, which are readily visible during a dental exam. 

In recent years, the P.A.N.D.A. program expanded to include medical professionals, teachers, school nurses, youth group leaders, and other community group leaders who can assist in the fight to combat devastating patterns of abusive behavior.

P.A.N.D.A. presentations provide detailed information on physical and behavioral indicators of child abuse and neglect. They also teach how to report, whom to contact, and how to deal with the sensitive issues involved in filing a report of suspected abuse. 

Each P.A.N.D.A. presentation is a one- to three-hour slide program and workshop conducted by trained professionals. The presentation is approved for up to three continuing dental education hours, depending on the length of the session. The P.A.N.D.A. Coalition has members who are willing to present the program free of charge to dental or other interested groups with 10 or more members. For more information or to schedule a presentation in New Jersey, please call Delta Dental at (973) 944-4555. In Connecticut call the Connecticut State Dental Association at (860) 378-1800.

For information about other programs to prevent child abuse, visit the Child Welfare Information Gateway at www.childwelfare.gov. 

Sidebar: What Should You Do if You Suspect Abuse?

Dentists and other health care providers who suspect a child is being abused by law must report it. In New Jersey, you are immune from any criminal or civil liability as a result of filing the report if you have reason to believe that a child has been abused and immediately report it. Anyone who knowingly fails to report suspected abuse or neglect is subject to a fine up to $1,000 and/or six months in jail.

To report a suspected case of abuse or neglect:

In New Jersey: 
Contact your local Division of Youth and Family Services (DYFS) office between 9 a.m. and 5 p.m.; or

Contact the Child Abuse Hotline, which is available 24 hours a day, 7 days a week, at (877) NJ-ABUSE (652-2873). (TTY/TDD for the deaf is available at 800-835-5510).

In Connecticut:
Contact the Child Abuse and Neglect Hotline, which operates 24 hours a day, 7 days a week, at (800) 842-2288.

Checklist for Submitting Claim Forms

Before submitting a claim, please make sure you correctly and accurately:

•  Report every date that a dental service was performed on or a dental procedure was completed on.
• Report each dental service or procedure that was rendered.
• Report all other insurance carrier coverage and payments that cover these dental services.
• Disclose legibly and conspicuously on the face of the claim form, any intention to waive a patient’s copayment responsibility.
• Reflect any discounts extended to the patient for these services.
• Reflect any reduced fees that resulted from the use of coupons.
• Reflect only services actually being charged to the patient’s ledger.
• Indicate both the billing dentist and the treating dentist’s name and license number.
• Report only the actual dollars being collected for the services on the claim form. (Indicate if any of these services were “bartered” for.)
• Report the fees on the claim form that reflect your “usual fees.”

Also make sure that you:

• Performed every service or procedure that is being submitted for payment.

Failure to do any of the above may result in the violation of:

• The Delta Dental of New Jersey Participation Agreement
• The New Jersey State Board of Dentistry, Administrative Codes
• The New Jersey Insurance Fraud Prevention Act
• The New Jersey Health Care Claims Fraud Act (in Connecticut, the General Statutes of Connecticut)
• The Federal Health Care Claims Fraud Act