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Articles
Delta Dental Receives High Ratings from
Benefits Managers Annual Survey
Subscriber Satisfaction Survey Under Way
Delta Dental Receives 'AA-' Rating from Standard & Poor's
Golf Outing Raises $55,000 for Special Olympics
Mark that Date!
New Jersey Adopts Tough New Insurance Fraud
Law
Flagship Section of Web Site Expanded
Compliance Information Centralized
Captain Supertooth Begins Statewide Tour in February
HIPAA Readiness Statement and Transaction Contingency Plan
Do Your Employees Get Subscriber News?
Holiday Closings
Delta Dental Receives High
Ratings from Benefits Managers Annual Survey
Nine out of ten benefits managers said their companies
are "extremely satisfied" or "very satisfied" with
Delta Dental overall, and eight in ten felt their
employees are "extremely happy" or "very happy" with
Delta Dental.
Those are among the findings of the 2003 Benefits
Managers' Satisfaction Survey, conducted by Brownstone
Information Resources, Inc. for Delta Dental. The
survey, conducted annually, tracks benefits manager
and member satisfaction levels with Delta Dental.
Brownstone conducted 250 telephone interviews with
benefits managers in New Jersey and Connecticut.
According to the survey:
- More than nine in ten benefits managers would
recommend Delta Dental to other administrators.
- Of the benefits managers who contacted Marketing
Services in the past year, nine in ten found Marketing
Services to be "Extremely Helpful" or "Very Helpful."
More than eight in ten benefits managers said the
following statements describe Delta Dental "Extremely
Well" or "Very Well":
- Claims are processed accurately
- Claims are processed quickly
- Employee/member can choose own dentist
- Monthly billing is accurate
- Billing issues are handled accurately, quickly
by Billing Department
- Customer Service agents are courteous/pleasant/empathetic
- Eligibility changes, additions, deletions are
processed accurately, quickly
The survey also tracks how much time benefits managers
spend assisting employees or members with claims
or problems. More than nine in ten said they spend "about
the right amount of time" or "less time than expected" providing
assistance. Almost nine in ten benefits managers
said they spend less than one hour per week assisting
employees/members with claims or problems.
The survey also looked at factors that influence
a company's dental carrier selection. Important factors
identified by benefits managers included size of
dental network, plan flexibility, ease of administration,
few complaints from employees and cost. When asked
what other factors were important, about one in ten
added reputation and past experience. While only
about one in four managers feels that "Non-profit
status" is an "Extremely Important" or "Very Important" factor
in selecting Delta Dental, about half feel that contributions
of the Delta Dental Foundation are important.
Subscriber Satisfaction Survey
Under Way
Delta Dental takes customer service seriously. As
part of that commitment, each year we commission
an independent market-research firm to conduct a
survey of subscribers and benefits managers to measure
our performance.
Our fall 2003 subscriber satisfaction survey was
recently mailed. Brownstone Information Resources
is administering the survey to a random sampling
of 6,000 subscribers. We would appreciate it if you
could remind employees that if they are contacted
to participate, to please complete the questionnaire
and return it to Brownstone as soon as possible.
Their feedback is critically important to us.
Survey results will be published in 2004. Thank you
for your help!
Delta Dental Receives 'AA-'
Rating from Standard & Poor's
Standard & Poor's recently affirmed Delta Dental
Plan of New Jersey's AA- counterparty credit and
financial strength ratings for the fourth consecutive
year. The analysis was based on the company's extremely
strong capitalization, excellent earnings and good
business position.
Standard & Poor's predicts a stable outlook for
Delta Dental, New Jersey's and Connecticut's leading
dental benefits carrier.
"Four years of high ratings from Standard & Poor's validates the merits
of our extensive dental provider networks and our approach to quality and customer
service," said Delta Dental President and CEO Walter VanBrunt. "We understand
that accessibility, value and cost containment are of paramount importance
to our customers, especially in a challenging economy. The S&P ratings
confirm that we are a strong company to do business with."
Standard & Poor's analysis noted that Delta Dental
is extremely well capitalized, which allows for both
flexibility and growth. According to the report,
Delta Dental's membership is expected to increase
in 2003. "We will continue efforts to upgrade our
customer service systems to ensure we are providing
the best service using leading-edge technology," said
VanBrunt.
A nationwide poll conducted in 2002 found that demand
for employer-sponsored dental benefits remains high,
despite overall concerns with the nation's healthcare
system. Studies have also shown that when employees
maintain a higher level of oral health, their employers
experience cost and productivity benefits. Companies
who contract with Delta Dental to offer benefits
are partnering with a financially secure entity,
and also offering their employees a quality, highly
valued product.
Golf Outing Raises $55,000
for Special Olympics
The Thirteenth Annual Delta Dental Classic, which
took place in July at Fiddler's Elbow Country Club,
raised $55,000 for Special Olympics New Jersey (SONJ).
Since the Delta Dental Classic began in 1991, it
has raised more than $410,000 for SONJ.
SONJ is dedicated to empowering individuals with
mental retardation to become physically fit, productive
and respected members of society through sports training
and competition.
Contest winners include:
1st Place Low Gross (Ladies): Leslie Ann Skurla
1st Place Low Gross (Men): Darrin Joscelyn
1st Place Gross Team: Peter Louie, Fred Sterritt,
Tom Morgenstern, Jim Schulz
Special thanks to all of our participants and sponsors.
Mark that Date!
The Fourteenth annual Delta Dental Golf Classic
will take place on June 23, 2004, at Fiddler's Elbow
Country Club in Bedminster, New Jersey. The golf
classic benefits Special Olympics New Jersey. More
details will follow shortly.
New Jersey Adopts Tough New
Insurance Fraud Law
On June 9, 2003, New Jersey Governor James McGreevey
signed into law a comprehensive reform package relating,
among other things, to insurance fraud. The new law
is L. 2003, Chapter 89. It is accessible on the Web
at http://www.njleg.state.nj.us/2002/Bills/PL03/89_.HTM.
The new law creates a new crime of "insurance fraud." In
brief, any person (including an insured or a licensed
practitioner) who knowingly makes or causes to make
a false or misleading statement of material fact
to an insurance company (including medical and dental
insurers, automobile insurers and professional liability
insurers as well as self-funded plans and the State
Health Plan) is guilty of "the crime of insurance
fraud" if such statement is made in connection with
any of the following: a claim for payment or reimbursement;
an application for coverage; and any payment made
or to be made in accordance with the terms of an
insurance policy. L.2003,
c.87, §
73 (codified at N.J.S.A. 17:33A-33).
The new law recites that it is intended to aggressively
confront the problem of insurance fraud by facilitating
the detection, investigation and prosecution of such
fraud. L.
2003, c.87, § 71(b). Among the features
of the bill are provisions that make it a second
degree crime: "if the person knowingly commits five
or more acts of insurance fraud, including acts of
healthcare claims fraud, . . . and if the aggregate
value of [the benefit] obtained or sought to be obtained
is at least $1,000." L.2003,
c.89, §
73(b) (codified at N.J.S.A. 17:33A-33(b).)
In determining whether the $1,000 threshold has
been met, the amounts involved in separate claims
may be aggregated and the fraud need not have succeeded;
the amounts involved in attempted (unsuccessful)
frauds are also includible. This means that a covered
person and/or practitioner who submits five claims
with knowingly misleading or false information material
to the claim ("material" means it's relevant -- an
incorrect address which is irrelevant to the insurer's
action would not be material) of $200 each could
be convicted of a second-degree offense. Second-degree
theft offenses in New Jersey are serious crimes;
previously, $75,000 was the minimum threshold to
constitute a second-degree theft.
The clear message is that the State of New Jersey
will be tough on persons who engage in a pattern
of insurance fraud, even if the claims are relatively
small. Although there must be five frauds to constitute
a pattern, they can all occur in one claim form,
e.g. a claim for five separate services that deliberately
misrepresent the fees charged or services actually
rendered. L.2003,
c.89, § 73(b) (codified at N.J.S.A. 17:33A-33(b).) The
crime is a third-degree offense if there are fewer
than five claims or if the $1,000 threshold is not
met.
A similar provision has been on the books for healthcare
claim fraud of licensees for the last five years.
The State of New Jersey has increasingly utilized
that law since its enactment. This law complements
the healthcare claim fraud law, increases the stakes
for both practitioners and non-practitioners, and
expands it beyond health insurance.
The new law has also "upped the ante" against insurance
fraud by creating a system to provide financial rewards
to those individuals who provide "information leading
to the arrest, prosecution, and conviction of persons
or entities who have committed healthcare claims
fraud, insurance fraud or any other criminal offense
related to an insurance transaction." L.
2003, c.89, § 74(d) (codified at N.J.S.A. 17:33A-34(d).) Patients
who suspect their provider is overbilling, office
staff who suspect upcoding, or former employees who
have pertinent information about similar misconduct
can now receive a reward of up to $25,000.
Now, more than ever, we encourage dentists and
insureds to review claim preparation and submission
practices to assure that claims are accurate and
that everyone understands the stakes involved in
submitting false information to dental or medical
carriers (as well as other carriers such as automobile
insurers and professional liability insurers).
This is not legal advice. We recommend that
you confer with your legal counsel for advice concerning
this and other laws.
Flagship Section of Web Site
Expanded
We have expanded our Web site to provide information
for DeltaCare subscribers, participating dentists,
benefits administrators and brokers. The section
answers subscribers' frequently asked questions,
lists of key contacts for benefits administrators,
and much more.
To access information on DeltaCare, go to www.deltadentalnj.com
and click "Flagship" on the navigation bar on the
left side of the screen.
DeltaCare is a dental HMO-type program, underwritten
and administered by Flagship Dental Plans, a wholly
owned subsidiary of Delta Dental Plan of New Jersey,
Inc.
Compliance Information Centralized
Delta Dental has recently updated our Compliance
section on our Web site. Features of the Compliance
site include:
- HIPAA information, including our Notice of Privacy
Practices, HIPAA Progress and Status, Readiness
Statement and Transaction Compliance, as well as
related Web sites and FAQs from the Office of Civil
Rights.
- Print-ready compliance forms, including authorization
forms for subscribers to sign in order for Delta
Dental to release protected health information
(PHI) to third parties, and Plan Sponsor's Certification
forms A and B (in order for the sponsor to request
and/or receive PHI for plan administration activities).
- Department of Labor (DOL) regulations, including
information about our benefit determination and
appeal process, and FAQs from the DOL.
- State Notices of Privacy Practices
- New Coordination of Benefits provisions
- New Jersey Prompt Payment Requirements
To access the new "Compliance" section of our Web
site, go to www.deltadentalnj.com and click "Compliance" on
the home page.
Captain Supertooth Begins
Statewide Tour in February
Delta Dental's Captain Supertooth rides again! Each
year in February-throughout National Children's Dental
Health Month--the caped superhero of dental hygiene
visits school children to promote the importance
of early preventive dental care and teach them proper
oral care.
In addition, Captain Supertooth made 11 appearances
in October 2003.
The Captain Supertooth program is part of Delta
Dental's ongoing initiative to spread the word that
oral health is vital for good overall health.
Captain Supertooth visits schools armed with a larger-than-life-sized
toothbrush and other fun props. During the 20-minute
program, the Captain shares helpful "teeth" tips,
such as using toothpaste in a pea-sized amount on
a soft-bristled toothbrush, remembering "don't rush
when you brush" by brushing for at least one minute,
eating a balanced diet, and visiting their dentist
for regular check-ups. The program is geared for
children in kindergarten through second grade, and
is provided by Delta Dental as a free public service.
Since the program began in 1990, Captain Supertooth
has instructed more than 36,000 New Jersey children
about proper dental care. For the first time, in
2004 Captain Supertooth will also visit schools in
Connecticut. Captain Supertooth programs will take
place at 21 schools in New Jersey and 10 in Connecticut.
Because of the high demand for this program, there
is a waiting list. For more information, call Delta
Dental at (973) 285-4059.
HIPAA Readiness Statement
and Transaction Contingency Plan
Delta Dental Plan of New Jersey is engaged in an
enterprise-wide project to meet Health Insurance
Portability and Accountability Act (HIPAA) mandates
governing the Standards for Electronic Transactions
and the Privacy of Individually Identifiable Health
Information. Delta Dental has identified and implemented
reasonable system changes, policies, procedures and
documentation necessary to comply with the final
Privacy Rule as it applies to dental benefit programs.
As each final rule is issued, Delta Dental will begin
another project cycle of assessment, planning and
implementation. Delta Dental will continue to commit
the resources and funding we believe is necessary
to meet the compliance deadlines.
To achieve a successful implementation of the new
HIPAA transaction and code sets regulation, Delta
Dental will continue to accept existing claim formats,
in addition to HIPAA compliant transactions, under
its contingency plan. During this time, Delta Dental
will continue to transition our providers to HIPAA
compliant transactions. Delta Dental will continually
monitor the situation and will make a determination
on how long to continue our contingency plan based
on the unique business environment of our service
area.
The new HIPAA transaction and code sets rules represent
the most sweeping change ever in the way electronic
healthcare claims are processed. Our decision to
accept noncompliant transactions reflects the increasing
likelihood that many healthcare providers will be
unable to meet the October 16, 2003, HIPAA transactions
and code sets regulation deadline. Noncompliance
with the HIPAA requirements could result in several
unintended consequences, the most important of which
would be a return to inefficient and costly paper
transactions.
According to a July 24, 2003 guidance issued by
the Department of Health and Human Services (HHS),
payers will not be penalized for accepting existing
transactions during a transition period as part of
their contingency plan provided they can demonstrate
good faith efforts in working with their providers
to facilitate compliance. Delta Dental has been working
closely with our trading partners to ensure a smooth
transition.
We believe we are compliant with the most important
of the covered transactions - Health Care Claims
(837), Eligibility Benefit Inquiry (270/271), Claims
Status Request and Response (276/277) and Benefit
Enrollment and Maintenance (834). There are some
transactions - Health Care Services Review, Request
for Review and Response (278), Payroll Deducted and
Other Group Premium Payment for Insurance Products
(820) and Health Care Claim Payment/Advice (835)
for which we have had no trading partner request
that we conduct these transactions. In addition,
testing of all of the transactions has been difficult
to complete, as many trading partners (mostly clearinghouses)
have not been able to test with all of their payers.
We fully expect, however, to see no adverse impact
on our claim adjudication or customer service processes,
as we work with our trading partners toward conducting
the HIPAA compliant transactions.
Delta Dental encourages any client who wishes to
send enrollment data to us using a standard 834 transaction
to contact their account executive or service coordinator
as soon as possible to schedule the necessary testing.
Delta Dental's Information Services personnel will
establish each client's testing schedule based upon
resource availability.
Do Your Employees Get Subscriber
News?
The online Subscriber News is a free monthly
publication for all Delta Dental Plan of New Jersey
subscribers. Each issue features information about
how subscribers can make the most of their Delta
Dental benefits. Subscriber News covers everything
from how to find a participating dentist, to where
to get detailed explanations about your family's
benefits, and much more.
In addition, Subscriber News features the
latest news in the areas of dental health and wellness.
Readers can find out how to keep their smiles healthy
between dental visits, what to do in a dental emergency,
and what dental science has in store for the future.
Subscriber News headlines are delivered to readers' e-mail inbox each
month. They can just click the link to read the full story.
Your employees can sign up for a free subscription
by going to www.deltadentalnj.com and clicking on "Subscribers." They
should enter their e-mail address in the "Subscriber
News" box on the right side of the screen. They may
unsubscribe to Subscriber News at any time.
Please note: We do not sell, rent, or disclose e-mail
addresses to third parties. Therefore, subscribers
will not receive unsolicited e-mail ("spam") as a
result of subscribing to Subscriber News.
Holiday Closings
Just a friendly reminder that Delta Dental will
be closed November 27-28 for Thanksgiving, December
25-26 for Christmas, and January 1-2 for New Year's.
Our online eligibility submission feature will not
be available on these dates.
You may submit eligibility changes online Monday
through Friday from 7 a.m. to 10 p.m. EST except
holidays.
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