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Articles
Credentialing Comes Soon to NJ, Winds
Down in CT
Where to Get Help
Holiday Closings
Delta Dental, Diverse Dental Services Provide
E-Claim Training Session
Year 2000 Readiness Disclosure
More Information Available Via Automated Voice
Response Unit
To Connect with a Person
Student Verification Time
Meet Us in the Big Apple
Have You Received Your Handbook?
Reminder for NJ Advantage and Preferred Doctors
Reminder for Specialists
Practice Wise: Boosting Case Acceptance
NJ, CT Welcome 126 John Hancock Employees
to DeltaUSA
EDI Primer Now Available
Credentialing Comes Soon to NJ,
Winds Down in CT
All participating Delta Dental dentists in New Jersey
will soon receive a packet of information in the
mail called the "Delta Premier Dentist Credentialing
Profile and Facility Survey." (In order to avoid
duplication, dentists who participate in Delta Preferred
Option or Delta's Advantage Program will receive
the credentialing packet for those programs and not
a separate Delta Premier packet.)
This mailing is critical because it marks the beginning
of Delta Dental's dentist credentialing process in
New Jersey.
We recently completed credentialing all 2,000 Delta
Dental Participating Dentists in Connecticut.
Why have we begun credentialing now? "Many of our
employer groups include credentialing as a standard
part of their proposal request and decision-making," says
Bruce Silverman, Senior Vice President of Claims
for Delta Dental Plan of New Jersey. "They want to
know the credentials criteria we apply to our Participating
Dentists, and how we ensure that dentists meet those
criteria. Also, corporations are looking for more
accountability from us regarding their dental costs."
The process of verifying credentials is conceptually
consistent with patient protection laws supported
by organized dentistry. Medical carriers have
been required to check the credentials of their
participating doctors for many years.
The credentialing questionnaire will ask for
general office information and specific information
about your dental licenses, specialty certifications,
insurance coverage and infection control policies. A
separate questionnaire must be completed for
each dentist in your practice.
The questionnaire also requires that each dentist
submit copies of the following documents:
- Current dental license
- Controlled drug substance certificate (state)
- Drug Enforcement Administration certificate
(federal)
- Malpractice insurance binder page showing coverage
amounts (Delta Dental requires minimum limits of
$1 million per claim and $3 million aggregate)
The questionnaires will be reviewed by Delta Dental's
Credentialing Committee, which will contact you if
additional information or clarification is required.
Where to Get Help
If you have questions regarding credentialing, please
contact our Credentialing Department at (888) 203-6993.
If your office needs in-person assistance to complete
the credentialing paperwork, our dental network coordinators
are available to help. Dental network coordinators
include:
- Bea Buccos, serving northern New Jersey and
Fairfield County, Connecticut; (888) 396-6641;
- Angela Roth, serving Connecticut except Fairfield
County; (860) 659-1767; or
- Charlene Yurko, serving central and southern
New Jersey; (888) 396-6641.
Holiday Closings
Delta Dental's offices will be closed for Thanksgiving
November 25 and 26; December 24 for Christmas; and
December 31 for New Year's. You can obtain answers
to most frequently asked benefits questions even
during the holidays using our automated voice response
system. The voice response unit operates 24 hours
a day, seven days a week. To access the system, just
call Customer Service at (800) 452-9310.
Delta Dental, Diverse Dental
Services Provide E-Claim Training Session
With the popularity of electronic claim processing
on the rise, a growing number of dental practices
want to know how to better integrate this technology
into their offices. Delta Dental Plan of New Jersey
and our newest MVP (practice management vendor participant),
Diverse Dental Services, recently offered a free
training session for current Dentrix practice management
software users. Forty-two people from practices throughout
New Jersey attended.
The session addressed what a dental practice should
know to avoid errors in submitting electronic claims
using Dentrix software, from what to do when x-rays
are required to a discussion of New Jersey regulations
regarding electronic claims.
Presenters included Mary Morrison and Jamie Yanez,
independent certified trainers for Dentrix dental
systems; Monica Gelinas, president of Diverse Dental
Services, an independent Dentrix reseller; and Betty
Hill, Delta Dental's EDI Administrator. Carol Granrath
and Monique Merk, independent certified trainers
for Dentrix dental systems, were also on hand to
answer questions.
Another e-claim training session is being planned
for Dentrix users in southern New Jersey. For information,
contact Betty Hill at (973) 285-4035.
Year 2000 Readiness Disclosure
We're pleased to report that Delta Dental Plan of
New Jersey is substantially Year 2000 compliant.
Here at Delta Dental, we define Year 2000 compliant
as being able to perform our contracted services
with the same quality and accuracy before, during
and after the Year 2000. We will continue to test
our computer systems so you can be confident you'll
receive the same high level of service after the
new year as you do now.
For more detailed information, read our Year
2000 Readiness Disclosure.
More Information Available Via
Automated Voice Response Unit
The newest improvements to Delta Dental's Voice
Response Unit (VRU) are ready and waiting for your
call.
The VRU provides dentists, subscribers and benefits
managers with automated answers to frequently asked
questions 24 hours a day, seven days a week. Now,
the VRU enables callers to find out more than ever
before about a claim's status. With the new enhancement,
callers can find out when Delta Dental received the
claim, where it stands in the payment process and
approximately when the payment should be sent. In
many cases callers can also learn why a payment may
be delayed, and find out where to send the necessary
information to continue processing the claim.
The VRU also provides automated answers to questions
about subscriber benefits, eligibility, deductibles,
group number, plan maximums, deductibles and provider
lists.
To access the VRU, call Delta Dental Customer Service
at (800) 452-9310.
To Connect with a Person
There are times when you find it is necessary to
speak to a live agent. Delta Dental's Customer Service
agents are on the job Monday through Friday from
8 a.m. to 5 p.m. To connect with one, simply dial
our Customer Service number at (800) 452-9310. When
the recording begins, hit * on your touch-tone phone.
(You don't need to wait for the list of options to
finish.) You will be connected with the next available
Customer Service agent.
Student Verification Time
Just a reminder: Many Delta Dental plans require
college-age dependents to verify their status as
full-time students when they file their first claim
of the new school year. Examples of student documentation
include:
- A copy of a paid tuition statement;
- A registrar's certificate of grades showing at
least 12 credits; or
- A current validated student ID card.
All documents should reflect the school year that
corresponds with dates of treatment provided. Please
include the appropriate documentation with the claim
form.
Meet Us in the Big Apple
Delta Dental will be exhibiting at the Greater New
York Dental Meeting November 26 through December
1 at the Jacob K. Javits Convention Center. Visit
us at booth #1039, which we'll be sharing with Delta
Dental of New York. Hope to see you there!
Have You Received Your Handbook?
Delta Dental distributed the newest edition of its
Participating Dentist Handbook earlier this year.
You should have received your copy on or about April
1. Please contact your dental network coordinator
immediately at (888) 396-6641 if you have not received
your new handbook because it is a valuable resource
and explains our current processing policies as well
as other policies and procedures you should be familiar
with in submitting claims to Delta Dental.
The handbook outlines the new DeltaUSA processing
policies, which participating dentists must honor.
It also identifies those processing policies where
Delta Dental Plan of New Jersey, Inc. has determined
to deviate from the uniform DeltaUSA processing policies.
We literally dedicated years to the development of
these processing policies in an effort to update
them and to maintain consistency with other Delta
Dental plans wherever appropriate. Our effort included
substantial input from practicing dentists in New
Jersey and nationwide.
Some of the revisions will result in increased payments
to our participating dentists. For example, we will
be seeking to expand the Sealant coverage by increasing
the maximum age of covered persons from 14 to 15,
unless the group insists upon lesser coverage. We
will be covering guided tissue regeneration and recementation
of space maintainers. Also, we will be moving toward
paying full mouth debridement at the preventive and
diagnostic level. An important objective of the DeltaUSA
processing policies is to provide consistency in
the processing of claims by Delta Dental Plans throughout
the country, which we believe is a significant benefit
to our participating dentists. This objective supports
our goal to increase the effectiveness of our dental
coverage and to satisfy the needs of our covered
groups, which demand accountability. We anticipate
that the DeltaUSA processing policies will also expand
the number of persons whom we cover by maintaining
our ability to compete and deliver coverage with
as little state-to-state variation as is feasible.
With these changes to our processing policies, we
believe that the national Delta Dental system, with
more than 115,000 participating dentists nationwide,
will be stronger and better able to continue to increase
our coverage here in New Jersey and Connecticut,
and elsewhere. We thank you for your participation
and as always will consider any suggestions you may
have for improving our policies or procedures to
continue to increase the attractiveness of our dental
coverage and to provide our covered persons additional
incentives to utilize our participating dentists.
Reminder for NJ Advantage and
Preferred Doctors
All Advantage and Preferred dentists in New Jersey
were recently mailed a supplement to their participation
agreement, called the "PPO Supplement To Participation
Agreement."
Please sign and return the supplement to:
Delta Dental Plan of New Jersey, Inc.
Attn: Professional Relations Dept.
P.O. Box 222
Parsippany, NJ 07054
If you did not receive the supplement, please contact
your dental network coordinator toll free at (888)
396-6641.
Reminder for Specialists
Many patients covered by Delta's Advantage Program
and DeltaPreferred Option now have expanded access
to specialists (Endodontists, Oral Surgeons, Orthodontists,
Periodontists and Prosthodontists) who participate
with Delta Dental in the DeltaPremier program.
The expanded specialty access feature was made available
to new groups starting March 1 and current groups
on their renewal date.
Until an existing group renews, the current applicable
DeltaPreferred Option table of allowances remains
in effect for specialists. We expect all groups will
transition to the expanded specialty access feature
by next year.
During the transition period, we recommend that
you submit a predetermination of benefits for any
treatment plan exceeding $300 to ascertain whether
the expanded specialty access feature is effective
for your patient.
For more information, please contact our Professional
Relations Department at (973) 285-4064.
Practice Wise: Boosting Case
Acceptance
Have you ever felt that you were out of sync with
your team? Did it feel like you were tuned into AM
while they were on FM? Miscommunication within a
team costs your practice time, money and emotional
satisfaction.
Treatment planning and case presentation are two
areas that are particularly impacted by miscommunication.
In order to get on the same wavelength with your
team, you must share common beliefs about patient
care.
Take this quick test with your team to discover
your and their core beliefs:
T F Patients only want to fix those things that
are broken
T F If you are not experiencing pain, you shouldn't
replace a restoration
T F Patients want the very best dentistry can offer
T F People love to buy
T F Everyone wants to look good/have a great smile
T F Dentistry is too expensive
T F Insurance will not buy total health
T F You should only perform procedures insurance
covers
T F Hygienists should not inform patients of their
dental needs
T F Patients will move forward with treatment only
if we influence them
T F You should present cosmetic options to every
patient
T F Intra-oral cameras are nice, but not necessary
in educating a patient
T F It's the staff's responsibility to gauge if a
person can afford dental care
T F As a profession, dentists are not repair people;
they are artists, scientists, designers and architects
T F We can consistently design a health and wellness
plan for our patients.
With proper alignment of beliefs, systems and goals,
your team can achieve a high rate of treatment acceptance.
--Vicki McManus
Free by Fax: Audiocassette interview with
Dr. John Wilde, associate editor of The Profitable
Dentist newsletter, and Vicki McManus, RDH, director
of Fortune Practice Management® - Connecticut
and author of the collaborative book FUNdamentals
of Outstanding Dental Teams. This 45-minute interview
is packed with ideas to move your practice to the
next level. Fax your letterhead to (203) 272-6435,
or call (888) 347-4785 or email fpmvicki@compuserve.com to
receive your free copy.
NJ, CT Welcome 126 John Hancock
Employees to DeltaUSA
We are pleased to report that John Hancock employees
in New Jersey and Connecticut are now covered under
DeltaUSA, the national dental benefit program offered
by all Delta Dental Plans.
DeltaUSA is designed to meet the needs of employers
with locations in more than one state that desire
claims administration and services at a single site.
As a participating dentist of Delta Dental Plan
of New Jersey, you are automatically part of the
nationwide DeltaUSA network of dentists. This program
is being administered by Delta Dental Plan of Massachusetts.
You should send all John Hancock claims to:
Delta Dental Plan of Massachusetts
P.O. Box 9695
Boston, MA 02114-9984
(800) 451-1249, ext. 1166
EDI Primer Now Available
The National Dental EDI Council (NDEDIC) has published
a revised edition of its "EDI Primer for the Dental
Office,"
a complete introduction to electronic data interchange
(EDI) developed specifically for dentists. The Primer
is written in straightforward, non-technical language.
It includes:
- An introduction to computerizing your office
- Explanations on how EDI works
- Case studies of dental offices that made the
change
- Answers to frequently asked questions
- Guidelines for purchasing hardware and software
- Resources available to help you make the transition
Dr. Barry Freydberg, a full-time general dentist
and one of the foremost lecturers on automation in
dentistry, said this about the Primer: "I would recommend
the EDI Primer for every dental office before they
become involved with electronic claims. The Primer
provides the answers to the questions you just don't
know to ask as well as a look into our immediate
future."
NDEDIC is an organization dedicated to promoting
the use of electronic commerce in the dental-benefits
industry.
The Primer costs $18.95 for NDEDIC members
and $24.95 for non-members, plus $4.50 shipping
and handling. To order, contact NDEDIC at (602)
266-7740, or visit its website at www.ndedic.org.
Disclaimer: The views of NDEDIC are not
necessarily the views of Delta Dental Plan
of New Jersey.
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