Articles

NEA Offers Discounts on Electronic Attachments for Participating Dentists
Dental Practice Raves about Benefits Connection
Five Tips to Coordinating Patient Benefits
Congratulations Dr. Ryan and Dr. Isolo!
Reminder: Please Send Us Your NPI Number
Delta Dental Issues Urgent Call for Attention to Oral Health in Healthcare Reform Debate

NEA Offers Discounts on Electronic Attachments for Participating Dentists

Are you looking for an easy, effective and inexpensive way to submit your dental claim attachments? For less than one dollar per day, you can transmit an unlimited number of attachments via the Internet with National Electronic Attachment’s (NEA) FastAttach system. FastAttach allows dentists to electronically transmit dental x-rays, EOBs, perio charts, intra-oral pictures and narratives to more than 260 payers for claims payment.

NEA is offering a limited-time discount for Delta Dental participating dentists. Registration is just $50 instead of the regularly priced $200 fee.

To join the thousands of other dentists already using this system for quick claims processing, visit their Web site at www.welcometonea.com and enter DDNJWEB in the promotion code box. This special offer, sponsored by NEA and Delta Dental of New Jersey, provides 75% off the regularly priced $200 registration fee. Registration includes software, installation, training and unlimited telephone support. For more information, call (800) 782-5150, extension 2. This offer expires October 31, 2007.

Dental Practice Raves about Benefits Connection

Lisa Guignard heard about Benefits Connection at a Delta Dental Days program last fall. Guignard manages the front desk, scheduling and billing for her brother, Dr. David Guignard, who has a dental practice in Landing, NJ.

“The explanation and presentation about Benefits Connection were great,” she recalls. “I started using Benefits Connection that day, and it turned out to be even better than it sounded!”

Benefits Connection provides online access to detailed information about subscribers’ eligibility and benefits. Dentists can also use it to submit claims and track claim status online.

Guignard checks patient benefits and eligibility with Benefits Connection. She also uses it to submit predeterminations of benefits and claims. Even though the office uses a practice management system, Guignard prefers submitting claims through Benefits Connection rather than electronically. Having to enter claim information into both Benefits Connection and the practice management system isn’t a problem, she says. “We thought it might be cumbersome at first, but it really isn’t. It’s extremely simple to do, and worth the effort.”

She adds, “Benefits Connection is very straightforward. Within 15 seconds of submitting a claim, we usually find out what Delta Dental will pay and what the patient should pay.” Most claims submitted online using Benefits Connection are immediately adjudicated. “It’s great for us because we can tell patients exactly what they owe upfront. We can bill instantly.”

Benefits Connection also simplifies claim tracking. “I just print out a log of the claims I submit at the end of every day,” says Guignard. “Plus, I can check online to see that our claims went through. I know I’m not sending claims into an empty vacuum.”

Guignard says the practice participates with other dental insurers, but in her opinion no one has a site as easy to use as Benefits Connection. “The site is set up beautifully. I’m new to this business, and I was able to use it instantaneously. I now use it all the time.”

To start taking advantage of all that Benefits Connection has to offer your practice, go to www.deltadentalnj.com. Click “Dentists” and “Benefits Connection.” Then click “Register Now” and follow the onscreen prompts.

Five Tips to Coordinating Patient Benefits

We are frequently asked about the correct way to coordinate benefits. Here are some tips, which apply in most coordination of benefits situations:

Is your patient covered as subscriber or dependent? The benefits of the plan that covers the covered person as an employee, member, subscriber or retiree is determined before those of the plan that covers the covered person as a dependent.

Whose birthday comes first? Coordination of dental benefits for dependents in most cases (but not always) follows the birthday rule. This means that the dental plan for the parent whose birthday (month and day) is earlier in the calendar year provides the primary coverage. (Delta Dental has a small number of groups that determine the primary carrier by the gender rule.)

Who has custody? In cases of divorce, we will follow the responsibility as documented in the divorce decree. If the responsibility is not documented, the parent with custody is usually primary, the stepparent is usually secondary and the non-custodial parent is usually tertiary (third). If the parents have joint custody, then the parent with the birthday earlier in the calendar year usually has primary coverage, unless stated otherwise.

Is the patient undergoing complex oral surgery? For most complex oral surgery procedures, such as removal of impacted wisdom teeth and the procedures associated with this, the medical plan is generally the primary plan when those procedures are covered under that plan, unless otherwise agreed upon by the contract holder. In some cases, Delta Dental is primary for oral surgery procedures. Please see Delta Dental’s Web site for a current list of the over 100 groups for whom Delta Dental is primary. Go to www.deltadentalnj.com. Click “Dentists” and “Delta Dental as Primary for Oral Surgery” under Professional Services.”

Is the patient covered by two medical and two dental plans? For coordination of benefits when there are two medical and two dental plans (for example, an eligible dependent) and the group follows the Birthday Rule:

• Member A is the parent whose birthday month and day is first in the calendar year.
• Member A's medical plan would be primary, and then Member A's dental plan would be secondary.
• Member B's medical plan would be third, and Member B's dental plan would be fourth.

By using these guidelines, you can help prevent incorrect coordination of benefits claims and ensure more timely benefit payment.

Congratulations Dr. Ryan and Dr. Isolo!

Dr. Lawrence Ryan and Dr. Eugene Isola were the winners of the Delta Dental drawing at the New Jersey and Connecticut dental meetings.

Each received a $250 gift card. The drawing was open to dental offices not currently submitting electronic claims to Delta Dental.

Dr. Ryan, who practices in Marlborough, CT, won the drawing at the Connecticut State Dental Association meeting in May. Dr. Isola, who practices in Old Bridge, NJ, won the drawing at the New Jersey Dental Association Annual Convention in June. 

Electronic claims offer many advantages to dental offices. Payment is about 50% faster than with paper claims. They also eliminate envelope and postage costs, and save staff time. 

For more information about the benefits of electronic claims, visit our Web site at www.deltadentalnj.com. Click “Dentists” and “Electronic Claims Submission.” Or contact your Dental Network Coordinator at (888) 396-6641 (NJ) or (860) 635-3152 (CT).

Reminder: Please Send Us Your NPI Number

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires “covered entities” to use their unique National Provider Identifier (NPI) number when submitting health information electronically. If your practice submits electronic and online claims, you are a covered entity, and must use your NPI number when submitting claims.

We need your NPI number on file before we process your first online or electronic claim using the NPI. To avoid claims processing delay, please complete the NPI Fax Form (available on our Web site at www.deltadentalnj.com; click “Dentists,” “NPI Information” and “NPI Fax Form”) and fax it to us at (973) 285-4192.

In addition, using an NPI on paper claims will aid in streamlining the processing of claims. The newest version of the claim form developed by the ADA now has places for both the rendering and billing dentists’ NPI

Delta Dental Issues Urgent Call for Attention to Oral Health in Healthcare Reform Debate

As lawmakers grapple with the challenge of transforming the nation’s healthcare system, we are urging them to consider oral health in the discussion.

“Oral health should not be neglected in the debate over fixing the healthcare system,” said Walt VanBrunt, president and CEO of Delta Dental of New Jersey. “Dental professionals already know that oral health is an integral part of overall health. We want to make sure that policymakers understand the importance of preserving and enhancing the ability of New Jersey and Connecticut residents to access dental care.”

To elevate the position of public oral health in the healthcare debate, we’ve developed a series of principles that are currently being shared with state and federal policymakers across the nation. Without offering specific recommendations, the principles provide background on how dental benefits work and the market conditions required to maintain their role in helping to improve access dental care. 
The principles are as follows:

Dental is an inseparable part of health and overall wellness. The mouth is part of the body, and dental benefits promote not just dental health but overall health and well being. According to the Academy of General Dentistry, more than 90% of all systemic disease including diabetes, cancer and stroke has oral manifestations that are detectable during oral exams. A growing body of evidence also suggests control of caries and periodontitis can improve health outcomes.

Dental is different; third-party dental carriers add value. While dental health is integral to overall health, the dental delivery system remains vastly different than medical.

Dental coverage helps millions of Americans access dental care. 164 million Americans currently enjoy the benefits of consumer-oriented and effectively administered dental benefits with stable and predictable premiums.

Everyone deserves dental coverage. Not everyone has it. Despite the success of dental benefits in promoting oral health and overall health, nearly half of all Americans still lack dental coverage. Soaring medical costs threaten to exacerbate the problem.

The policy implications that follow these observations are summarized below, and include:

1. Any legislative and/or regulatory approach that adds to the cost of administering or obtaining dental benefits and/or hinders the development of alternative plan designs will have the unintended effect of reducing the number of Americans with access to dental coverage.

2. Dental carriers should be encouraged in their efforts to develop and enforce policies and innovative plan designs. 

3. Dental coverage should not be neglected in the debate over how to fix healthcare.

4. Dental benefits should be included as part of any reform proposal that: strives to increase access to care for those not already covered; expands or builds upon existing programs that successfully provide dental benefits; relies on qualified, experienced dental administration (including stand-alone dental carriers) to deliver appropriate, necessary services; does not undermine healthy competition in the dental benefits marketplace; does not reduce employers’ and/or individuals’ capacity to continue sponsorship of existing dental benefits; does not jeopardize the tax-advantaged status for those who sponsor and/or pay the cost of their own dental coverage; and preserves at least the current portion of healthcare expenditures committed to dental treatment and coverage.

5. Reform proposals should not: erode existing, comprehensive dental benefit programs currently prevalent in the group benefits marketplace; be administered by a single-payer, government-sponsored agency that eliminates the important role of third party administration; exclude stand-alone dental carriers from competing with full service health for government and/or publicly sponsored contracts; erect higher, more costly barriers to the development and offering of program administration; or reduce the current portion of healthcare expenditures committed to dental treatment and coverage.

“We want to be part of the solution,” said VanBrunt. “These principles reflect the mandate we feel as the nation’s leading dental benefits carrier, and we are committed to making certain that all Americans enjoy the oral health they deserve.”