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Articles
Delta Dental Program Strives to Prevent
Child Abuse
April is National Child Abuse Prevention Month
Tips for Identifying Signs of Abuse
Reporting Abuse
Tips for Preventing Fraud - What Can You Do?
June Golf Outing to Support Special Olympics
Deadline Nears for Employer Compliance Under HIPAA
Have You Returned Your Business Associate Agreement?
Answers to Your Frequently Asked Questions
What Every Traveler Should Know to Protect Oral Health
Teachers, School Nurses and Anyone Interested in Educating Children
About Dental Health: Wisdom Tooth Now Online
Web Site Brings Information to Your Desktop
Delta Dental Program Strives
to Prevent Child Abuse
The news media recently reported on several horrendous
cases of child abuse in New Jersey. The real tragedy
is that these are not isolated stories. In New Jersey
alone, more than 50,000 reports of child abuse and
neglect are made each year.
Who knows how many cases are not reported?
Delta Dental is working hard to protect children
who may be victims of abuse. The Delta Dental Foundation
offers its PANDA (Prevent Abuse and Neglect through
Dental Awareness) educational program to those who
are in regular contact with children.
PANDA 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 PANDA 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.
PANDA 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.
"We are deeply concerned about the number of
child abuse and neglect cases reported in the state,
which don't even include the many cases that go unreported," said
Lawrence A. Dobrin, D.M.D., a forensic dentist with
a practice in Roselle Park, New Jersey and a spokesperson
for the PANDA Coalition. "We strive to empower
those in authority with the knowledge and resources
for reporting cases of suspected abuse, to help the
many children who are often defenseless."
The PANDA presentation is a one-time, one- to three-hour
slide program and workshop conducted by Dr. Dobrin
or another trained speaker. If you are interested
in attending a presentation or scheduling one for
your group, please call (973) 285-4059.
April is National Child Abuse
Prevention Month
"Nationwide, reports show that more than 879,000
children are victims of child abuse and neglect and
approximately 1,200 children die from maltreatment,
many at the hands of those who are supposed to protect
them," wrote President George Bush last April
in his Presidential Proclamation announcing National
Child Abuse Prevention Month.
"Every April, communities across the country
join to raise public awareness about child abuse,
to provide information about how to prevent it, and
to assist families in need of support, recovery,
and encouragement," wrote the President.
Delta Dental is an annual sponsor of the Prevent
Child Abuse-New Jersey (PCA-NJ) Blue Ribbon Campaign,
which takes place each April during National Child
Abuse Prevention Month.
PCA-NJ, with the help of hundreds of volunteers,
distributes more than 300,000 blue ribbons throughout
New Jersey. The ribbons remind people of the tragedy
of child abuse and what they can do to help prevent
it.
For more information on PCA-NJ or to learn about
becoming a volunteer for the Blue Ribbon Campaign,
please call (800) CHILDREN, or visit PCA-NJ's Web
site at www.preventchildabusenj.org.
For information about other programs to prevent
child abuse, visit the U.S. Department of Health
and Human Services' National Clearinghouse on Child
Abuse and Neglect Information at www.calib.com/nccanch.
.
Tips for Identifying Signs
of Abuse
According to Prevent Child Abuse - America, children
who are abused may show physical and behavioral signs.
Abused children may seem:
- Nervous around adults or afraid of certain adults
- Reluctant to go home (coming to school early
or staying late, for example)
- Very passive and withdrawn - or aggressive and
disruptive
- Tired a lot, or they may complain of nightmares
or not sleeping well
- Fearful and anxious
Abuse is a pattern of adult behavior that is preventable
with proper support and education. "The purpose
of identifying and reporting suspected abuse is not
to remove a child from their home, but to stop the
abuse," said Dr. Dobrin.
Reporting Abuse
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 Office of Child Abuse Control child-abuse
hotline, which is available 24 hours a day, 7 days
a week, at (800) 792-8610 (TTY/TDD for the deaf
is available at 800-835-5510).
In Connecticut:
- Contact the CARELINE, which operates 24 hours
a day, 7 days a week, at (800) 842-2288.
Tips for Preventing Fraud
- What Can You Do?
In every profession or business, there are some
who try to take advantage of the system. The
provision of healthcare services is no different,
and you should be alert to protect against dental
benefits fraud.
There are several ways to limit opportunities for
healthcare providers (including dentists) from committing
fraud. The following procedures can also protect
you from becoming a victim.
* Never sign a blank claim form.
* Keep detailed records of the treatment you receive
and the amounts that you pay.
* Ask your healthcare providers what fees they charge.
* Know your benefits.
* Review your Explanation of Benefits statements
carefully.
* Question your healthcare provider and ask for
clarification if you see problems or inconsistencies
on your bills.
* Obtain detailed bills for services and check them
closely for accuracy.
* Make sure "free services" aren't charged
to your benefits provider.
* Keep your benefits identification number secure.
* Be aware that if someone says they can bill your
benefits program so that an uncovered treatment is
paid for, you are being pulled into an illegal scheme. You
could lose your coverage or your job, or be arrested,
fined or jailed.
* Contact the authorities if you think you have
knowledge of, or have been involved in, a fraud.
If you think you have knowledge of or have been
involved in a fraud, contact the benefits provider
listed on the Explanation of Benefits statement.
Most benefits providers also have Web sites that
contain specific instructions for reporting fraud.
Delta Dental Plan of New Jersey can be reached at
reportfraud@deltadentalnj.com. Delta Dental
also has a Fraud Hotline at (888) 696-3262.
In the State of New Jersey you can also contact
the Office of Insurance Fraud Prosecutor (OIFP) at
www.njinsurancefraud.org, or at (877) 55-FRAUD (37283). The
OIFP keeps all tips anonymous and strictly confidential. In
the State of Connecticut, contact the Connecticut
Department of Insurance/Insurance Fraud Unit, P.O.
Box 816, Hartford, CT 06142-8016; www.state.ct.us/cid/;
or at (860) 297-3933.
June Golf Outing to Support
Special Olympics
Delta Dental Plan of New Jersey is a proud sponsor
of Special Olympics New Jersey (SONJ), a non-profit
organization that provides athletic training and
competition for children and adults with mental retardation.
The thirteenth annual Delta Dental Golf Classic,
which raises funds for SONJ, is June 4, 2003, at
Fiddler's Elbow Country Club in Bedminster, NJ. Last
year's Classic raised $55,000 for SONJ.
For information about SONJ, go to www.sonj.org.
To request information about the Delta Dental Classic,
call (973) 285-4059 or e-mail jappaluccio@deltadentalnj.com.
Deadline Nears for Employer
Compliance Under HIPAA
The Health Insurance Portability and Accountability
Act of 1996 (HIPAA) requires healthcare plans, healthcare
clearinghouses and certain healthcare providers to
establish standards that protect the privacy of individually
identifiable health information, or Protected Health
Information (PHI).
These rules also affect many employers, in their
role as self-insured plan sponsors. Employers who
use Delta Dental to handle the dental claim payment
function for their self-insured dental plans are
subject to HIPAA and must follow the regulations
by the deadline for complying with HIPAA's Privacy
Rule, April 14, 2003.
What is PHI?
Information in any form that is created or used
by a
"covered entity" and relates to the past,
present, or future physical or mental health of a
person, or the care given to the person or payment
for health services, and identifies that person,
or could reasonably be used to identify the person,
is PHI.
Examples of PHI include a person's name, address,
Social Security number, date of birth, telephone
number, x-rays, services rendered, amounts charged
and amounts paid.
What is a "covered entity"?
Covered entities include certain health care providers,
health plans and health care clearinghouses. Delta
Dental is a covered entity under HIPAA. Many employers,
as self-insured plans, gather and hold protected
health information, and may be subject to HIPAA rules.
According to Workforce: HR Trends & Tools for
Business Results, any company with at least 50 employees
offering self-insured health benefits to them must
comply.
What is the Privacy Rule of HIPAA?
The Privacy Rule requires covered entities to take
reasonable steps to limit the use, disclosure, or
requests for PHI to the minimum necessary to accomplish
the task. This means that covered entities (including
self-insured (ASO/ASC) employers sponsoring health
plans) should request, use, and disclose the least
amount of health information needed to get the job
done.
How will the Privacy Rule affect employers?
Employers who are fully insured will be affected
by the privacy regulations because insurance companies
will no longer be able to share most PHI without
an express written authorization from the patient
to give the insurer permission to release information
to the employer.
Self-insured employers will need to review how they
collect, store and use PHI in their day-to-day operations,
and take steps to minimize the amount of PHI asked
for, used and shared within the company in doing
their work.
According to Gillian Flynn, writing in Workforce:
HR Trends & Tools for Business Results, "The
idea is to create a firewall between the plan and
the employer, so protected health information that
the plan has access to is not communicated to the
employer for employment-related purposes. For example,
someone who operates the plan might become aware
that an employee is receiving healthcare services
for cancer or a mental-health problem. That information
cannot be communicated to the employer because it
might have an impact on a promotion decision or compensation
decision."
Employers will also need to amend their ERISA plan
to reflect the need for a firewall.
What are the penalties for non-compliance?
Companies that do not comply with HIPAA's Privacy
Rule are subject to civil penalties up to $100 per
violation, up to $25,000 per calendar year for the
same violation, as well as possible criminal penalties.
Where can employers get more information about HIPAA's
Privacy Rule?
Copies of Standards for Privacy of Individually
Identifiable Health Information can be downloaded
from the U.S. Department of Health and Human Services
Offices for Civil Rights, at www.hhs.gov/ocr/hipaa/finalreg.html.
Have Your Returned Your Business
Associate Agreement?
Some employers recently received Business Associate
Agreements from Delta Dental, as part of our HIPAA
compliance efforts. If you received one, please complete
it and return it as soon as possible to: Mark Nadeau,
Vice President, Marketing, Delta Dental, P.O. Box
222, Parsippany, NJ 07054.
This should be completed by March 15, 2003.
If you received a Business Associate Agreement and
have questions about it, please contact our Compliance
Manager, Judy Libert-Jones, at compliance@deltadentalnj.com
or by calling (973) 285-4000.
Only employers who are self-funded where Delta Dental
acts as their business associate must complete a
Business Associate Agreement. Employers whose
plans are fully insured do not have to complete the
Business Associate Agreement because Delta Dental,
as the covered entity, will be responsible for protecting
the privacy of the claim information entrusted to
us as an insurer to process and pay.
Answers to Your Frequently
Asked Questions
Customer Service recently provided the answers to
these most-asked questions from subscribers:
When subscribers send questions to Customer Service,
what type of information should they include?
Please remind members that, for security reasons,
they should use the "Contact Customer Service
Form" in the Benefits Connection area of our
Web site whenever sending messages with confidential
information to Customer Service. Information submitted
on this form is protected and encrypted, which means
it cannot be read by unauthorized persons as it travels
over the Internet.
Subscribers should provide all pertinent information
with their inquiries, and be very specific. The subscriber's
Social Security number is important because it's
how we identify each person in our system. If subscribers
prefer, they may provide their full name, date of
birth, and group number rather than their Social
Security number. Also, they should include a daytime
phone number so we can follow up if necessary.
When will subscribers receive a response to their
Web inquiry?
Customer Service responds to Web inquiries within
24 hours. Web inquiries received on weekends and
holidays are responded to the next business day.
How can subscribers order claim forms?
Claim forms can be downloaded from our Web site,
at www.deltadentalnj.com. Click "Forms" on
the navigation bar on the left side of the screen.
(Please note that subscribers may not need a form.
Many dentists now file claims directly to Delta Dental
online or electronically.)
How can subscribers get information about their
benefits coverage or check their claim status?
They may go to Benefits Connection, at www.deltadentalnj.com.
Click "Subscribers" and go to the Benefits
Connection Logon box. Please note that Benefits Connection
is the best way to determine what the coverage is
for each procedure. Customer Service cannot predetermine
exactly what will be paid for a procedure.
What Every Traveler Should
Know to Protect Oral Health
When you make your vacation plans, probably one
of the last things on your mind is your oral health.
But even on vacation, people face the possibility
of a dental emergency, which can put a serious damper
on any holiday.
"When you're preparing to travel, taking a
few simple precautions before you leave can potentially
eliminate dental emergencies and long-term damage
to your oral health," said D. Scott Navarro,
D.D.S., Dental Director, Delta Dental Plan of New
Jersey.
Dental emergencies can happen any time, ranging
from painful toothaches to broken, loosened or knocked-out
teeth. When it comes to dental pain or trauma, seeking
immediate care can be critical to maintaining oral
health and possibly saving your teeth.
If you're going to be away from home for an extended
period of time or traveling overseas, try to schedule
a dental exam so that problems can be addressed before
you go. Jot down your dentist's full name, address,
telephone number plus any significant information
about your oral health, and tuck the information
into your wallet. Also be sure to carry your dental
benefits policy number and Delta Dental's phone number.
Our Customer Service number is (800) 452-9310.
Another helpful resource is Delta Dental's Web site,
at www.deltadentalnj.com, which you can access from
almost anywhere in the world. You can use it to find
participating dentists anywhere in the United States.
Just click "Find a Dentist" on the left-hand
navigation bar. You can also use our Web site to
access Benefits Connection, Delta Dental's online
resource for verifying your dental benefits. Just
click "Subscribers" and then log onto Benefits
Connection.
"Someone experiencing a blow to a tooth or
severe tooth pain should contact a dentist right
away rather than waiting until they return home," Dr.
Navarro stressed. "Generally, the long-term
prognosis for many patients is determined by the
type of injury to the tooth and how much time elapses
before treatment."
Teachers, School Nurses and
Anyone Interested in Educating Children about
Dental Health: Wisdom Tooth Now Online
Wisdom Tooth, Delta Dental's free newsletter for
teachers and school nurses, recently went online.
The new online Wisdom Tooth will be published four
times a year--twice as frequently as the former print
version.
Wisdom Tooth's mission is to provide teachers, school
nurses, and others with valuable information related
to children's dental health. Each online edition
will feature ideas and strategies for incorporating
dental-health curricula in the classroom. It will
also identify helpful dental-health-related Web sites
that you can share with students.
Although Wisdom Tooth is written primarily for educators,
an online subscription is available to anyone who
requests it. Subscriptions are free.
To sign up for your free Wisdom Tooth subscription,
go to www.deltadentalnj.com and click on "Kid's
Club" at the bottom of the home page. Then enter
your e-mail address in the "Wisdom Tooth" subscription
box. You may unsubscribe to Wisdom Tooth at any time.
Web Site Brings Information
to Your Desktop
If you haven't visited our Web site lately (at www.deltadentalnj.com),
you may want to give us a click. Our dedicated "Employers" section
features tools and information to make your job easier,
including:
- A password-protected Administrator's area, where
you can securely submit all your eligibility changes
online. It's faster and easier than using the phone
or fax. To see for yourself, try our tutorial by
clicking "Online Submissions Demo."
- Information about new regulations affecting ERISA-governed
group health plans. The U.S. Department of Labor
recently announced new regulations governing claim
adjudication and appeals for group health plans
governed by ERISA. If this includes your group,
click "Compliance with New Laws" for
details about Delta Dental's procedures for complying
with the new regulations.
- How Delta Dental helps groups manage their benefits
costs. Our cost-management programs saved groups
more than $175 million in 2001. For details about
our efforts, click
"Cost Containment."
- Key contact information. To find out how to call,
fax, e-mail or write us, click "Key Contacts."
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