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Articles
Why Submitting Eligibility Changes Online
is a Great Idea
New Software Turns Paper Claims Electronic
2004 Annual Report Published
2004 Cost Containment Report Released
Do Your Employees Know About Delta Dental's
Free Online Newsletter? Use the Flyer to Get the Word Out!
Eat Right, Exercise and...Floss?
Data Reveals Dentists' Best Tool for Kids' Oral Health
Delta Dental of New Jersey Donates $35,000 to Henry J. Austin Health Center
Golf Outing Results Available Next Issue
Why Submitting Eligibility
Changes Online is a Great Idea
1. It's convenient. There's no paper to handle,
and no need to leave your desk in search of a fax
machine. Everything can be managed right from your
computer.
2. It's user-friendly. The system will guide you
step-by-step through the submission process. It
even lets you know if you've forgotten anything!
3. It simplifies record keeping. You can easily
view submissions and profiles, and print out reports.
4. It's secure. Information is password-protected
and safeguarded against unauthorized access.
5. It's fast. Benefits changes take effect in 24
hours, or less.
6. It's easy to register. It takes just a few minutes
to get your password from Premium Billing. Call (973)
285-4144 anytime Monday through Friday from 8 a.m.
to 4:30 p.m. Then, go to
www.deltadentalnj.com, click "Employers," and sign
into the Administrator's Logon area. You're ready
to go!
Sidebar: Important Reminder about Passwords for Submitting
Eligibility Changes Online
Delta Dental takes many precautions to protect the
privacy of our subscribers.
Anyone who submits eligibility changes online to
Delta Dental requires a password for security. If
a new person takes over submitting eligibility changes,
a new password must be assigned. The password for
the previous benefits administrator must be deactivated.
New benefits administrators should contact their
service coordinator to have their name added to the
account. Once that occurs, benefits administrators
should contact Premium Billing at (973) 285-4144
to obtain their password.
New Software Turns Paper Claims
Electronic
In 2004, Delta Dental’s data entry operators
keyed more than 1 million paper claims into our system.
The process is now much easier, thanks to new optical
character recognition (OCR) software that went live
last October.
The way it works is first, every paper claim is scanned.
Each operator can scan more than 1,000 claims per
hour. Then the OCR software, developed by Recognition
Research Incorporated (RRI), automatically lifts
critical information from each claim and loads it
into Delta Dental’s claims database.
In most cases, little or no operator intervention
is required. “RRI essentially transforms a
paper claim into an electronic claim,” says
Georgann Magaw, Manager, Claims.
About 55% of claims submitted to Delta Dental are
paper claims. The other 45% are electronic claims,
submitted by dentists online or via dental practice
management software.
RRI means that 100% of all claims, including paper
claims, become “electronic.” Electronic
claims, which cost less to process and process faster
than paper claims, help contribute to both cost containment
and service improvements.
2004 Annual Report Published
Delta Dental's 2004 Annual Report – Celebrating
35 Years of Serving Our Community - is now
available. The report highlights how Delta Dental
has made oral health history since our founding
in 1969. We continued making history in 2004. Milestones
featured in the 2004 Annual Report include:
- Standard & Poor’s “AA-” rating
for the fifth consecutive year. This rating,
from one of the world’s preeminent providers
of credit ratings, indicates Delta Dental has
a high level of financial strength.
- Receiving the first “Internal Customer
Service Operation of the Year” award from
the Garden State Chapter of the International
Customer Service Association. In addition,
subscribers rate us highly in customer satisfaction
surveys year after year.
- $2 million grant to the University of Medicine
and Dentistry of New Jersey to establish the
Delta Dental Educational Conference Center. In
addition, our Foundation supported numerous oral
health programs in schools and communities throughout
New Jersey and Connecticut.
To order your copy of the 2004 Annual Report, visit
our Web site at www.deltadentalnj.com, click "Our
Company" on the left navigation bar, then "Annual
Report." Complete the order form on the screen. The
Annual Report will be mailed to you.
2004 Cost Containment Report
Released
Delta Dental’s cost containment programs saved
groups more than $170.6 million in 2004. We also
paid a record $409.1 million in claims in 2004.
These are among the findings of our 2004 Cost Containment
Report.
Delta Dental of New Jersey reports cost containment
savings in eight key areas:
1. In-Network Savings - Reduction of billed
charges to reflect the participating dentist's filed
fee with Delta Dental, the maximum fee level approved
for a DeltaPremier dentist, or the maximum charge
approved under a PPO program. Represents savings
from utilization of network dentists.
2. Contractual Limitations - Procedures denied
due to generally accepted dental practice or specific
contract limitations such as performance of a procedure
in excess of a frequency limitation. Also includes
reduction to payments due to Table of Allowance,
reduction to the levels upon which payments of non-par
dentists are based, and PPO tables (when non-PPO
dentists are utilized).
3. Eligibility Verification - Benefit denials
for procedures rendered during a period of patient
ineligibility under the plan.
4. Non-Covered Services - Benefit denials
for procedures excluded from coverage under the group
program.
5. Dentist Consultant Review - Procedures
which are not supported by diagnostic records or
within generally accepted standards of dental care
based on direct review or payment policy established
by Delta Dental's dental consultants. This includes
procedures for which Delta Dental will provide a
benefit allowance for an alternative procedure that
is within the generally accepted standard of care
given the diagnosis or treatment plan.
6. Optional Services - Benefit denials or
alternate benefit allowances for dental procedures
that are considered optional and may be performed
at the expense of the patient.
7. Non-Billable Services - Procedures that
are not chargeable to Delta Dental or billable to
the patient. Such charges may include component costs
of a more comprehensive procedure which do not warrant
a separate charge, and services denied as duplicate
submissions.
8. COB Savings - Claim dollars saved through
the application of coordination of benefit policies
in accordance with the group contract, including
non-duplication COB reductions (where applicable)
and an enforcement of order of benefit determination
rules.
To view the entire 2004 Cost Containment Report,
visit our Web site at www.deltadentalnj.com, click “Employers” and “Cost
Containment.”
Do Your Employees Know About
Delta Dental's Free Online Newsletter? Use the
Flyer to Get the Word Out!
Subscriber News is a free monthly publication
for all Delta Dental subscribers. Each issue is delivered
to their e-mail box and 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 their family's
benefits, and much more.
One way to communicate to employees about this free
newsletter is with a flyer. Delta Dental created
the layout for one, which is designed for easy photocopying.
All you need to do is photocopy and post on bulletin
boards, or distribute through interoffice mail.
If you would like an electronic copy of this flyer,
please e-mail dbelle@deltadentalnj.com.
Subscriber News headlines are delivered to readers' e-mail boxes each
month. Readers can just click the link to read the full story. You and your
employees will be happy to know that Delta Dental does not sell, rent, or disclose
e-mail addresses to third parties. Subscribers will not receive unsolicited
e-mail, or "spam," as a result of their subscription.
Eat Right, Exercise and...Floss?
Overall health begins around the gums
You know that white substance that builds up between
teeth and gums? It is loaded with bacteria, many
of which seem to be perfectly content to stay in
their neighborhoods and eat away at local surroundings
such as gums and jawbones. But some of these bacteria
are more adventurous; they can get into the bloodstream
and end up in exotic locales like lungs and arteries.
A growing body of scientific evidence indicates that
the bacteria responsible for gum disease can precipitate
or aggravate a number of systemic illnesses, among
them cardiovascular disease, diabetes, respiratory
illness, and pre-term labor in pregnant women.
If that isn’t enough to make you want to keep
a regular date with your dentist, consider this:
Many of these and other diseases also have symptoms
that initially show up in the mouth, offering early
warning signs of sometimes serious medical conditions.
In fact, more than 120 disease signs and symptoms
can be detected through a routine oral exam. Dentists
are often the first to detect cancerous or pre-cancerous
lesions in the mouth. They can often spot other diseases
as well, including anorexia and bulimia, hepatitis,
anemia and, in some cases, the presence of AIDS by
detecting oral infections that come from a compromised
immune system.
On its own, poor oral health can impact time away
from school and jobs. The Surgeon General reports
51 million school hours are missed each year due
to dental-related illnesses. For adults, more than
164 million work hours are lost each year due to
dental problems.
Doctors conclude that there is still much to learn.
But the findings so far underscore the importance
of regular, preventive dental care, and they emphasize
the key role that dental health plays in overall
health.
Sidebar: Oral Health Impact on Overall Health
According to the Surgeon General, "Oral health
is integral to general health. You cannot be healthy
without oral health." Illustrating the point
are statistics showing the prevalence of specific
diseases and ailments and their relations to oral
health:
- More than one in three people age 30 and older
have periodontal disease.
- Severe periodontal disease affects about 14%
of adults aged 45 to 54.
- Pregnant women with periodontal disease are seven
times more likely to give birth to a low-weight
or pre-term baby. Almost 20% of pre-term and low-weight
births can be linked to periodontal disease.
- Oral and pharyngeal cancers are diagnosed in
about 30,000 Americans annually; 8,000 die from
these diseases each year.
- In a recent study, people with rheumatoid arthritis
(RA) were more than twice as likely to have periodontal
disease with moderate to severe jawbone loss as
those without RA. RA patients also averaged 11.6
missing teeth, compared to 6.7 in the control group.
Data Reveals Dentists' Best
Tools for Kids' Oral Health
A new analysis of dental claims data shows that
sealants and professional fluoride treatments are
playing a huge role in helping kids fight tooth decay.
The data from this recent analysis support what most
dentists recommend: Regular visits to the dentist
for cleanings and preventive care.
Analysts from the Data and Analysis Center (DAC)
tracked dental benefits claims from nearly 500,000
enrollees within the Delta Dental system from 1998
to 2003. The claims covered children and adolescents
6 to 15 years old who, after receiving sealants,
were 78% less likely to need fillings.
Children who also received up to five professional
fluoride treatments during the five-year period were
87% less likely to develop cavities. When kids with
sealants received more than five fluoride treatments
in the five-year period, they were protected from
new cavities in 93% of the cases.
"We've known for a long time that sealants are effective, but a boost of almost
16% from fluoride treatment is noteworthy," said Dr. Scott Navarro, dental
director, Delta Dental of New Jersey.
Dr. Navarro added that sealants were the ninth most
common dental procedure among children in 2003. That
figure comes from a separate review of claims for
patients in the 2- to 18-year age range. It showed
that 240,847 patients submitted claims for sealants
in 2003 and 1.3 million patients in the age range
submitted claims for fluoride treatment. The review
also indicates that some 2.2 million kids received
treatments such as fillings, extractions, crowns
and pulpotomies in 2003. Pulpotomy is a treatment
for deep decay that goes through the outer layers
into the heart of a tooth.
“The goal of preventive care is to try to avoid dental problems altogether," said
Dr. Navarro. "The encouraging news is that the recommended course of action
is simple - brush at least twice daily, floss once each day and visit your
dentist regularly."
If you do not currently cover sealants, contact your
Delta Dental account executive or broker for more
information on this valuable benefit.
The Data and Analysis Center is an investor-owned,
for-profit company of dental science experts and
business analysts who manage the country's most extensive
claims-based dental health data warehouse. The DAC
evaluates treatment outcomes based on evidence from
millions of dental insurance claims submitted from
every state in the nation.
Delta Dental of New Jersey
Donates $35,000 to Henry J. Austin Health Center
Delta Dental of New Jersey Foundation, Inc. recently
donated $35,000 to the Henry J. Austin Health Center
in Trenton, New Jersey. The health center has served
as the largest non-hospital based primary care provider
for the greater Trenton area for more than 30 years.
Henry J. Austin Health Center is especially known
for its outstanding dental services. Delta Dental’s
grant will be used to expand services in Trenton
for dental care for low-income patients during 2005.
Specifically, monies will be used for patient care
in the areas of extractions and dental prosthetics.
"At Delta Dental, it is part of our mission to support organizations such
as the Henry J. Austin Health Center that directly impact the oral health of
New Jersey’s underserved residents," said Walter VanBrunt , president
and CEO of Delta Dental of New Jersey Foundation, Inc.
"The health center is a wonderful resource for
area residents who cannot afford dental health care."
In 2004 Henry J. Austin Health Center served more
than 3,000 patients in its dental care program. Ninety
percent of the health center’s patients are
at or below 200 percent of the federal poverty income
level ($19,350 for a family of four). Many times
dental procedures, such as extractions and dental
prosthetics, cause low-income patients to have to
make unaffordable monthly payments to cover their
oral health care costs.
"The support we have received from the Delta Dental of New Jersey Foundation,
Inc. will help Henry J. Austin Health Center reach our goal of providing affordable
quality dental care to area residents in need," said Walter Isaacs, the
newly appointed CEO of Henry J. Austin Health Center.
The Henry J. Austin Health Center was established
in 1969 as the City of Trenton's Neighborhood Health
Center. In 1986, it gained status as a
private, non-profit 501 (c) (3) corporation to continue
services to the medically underserved population
of Trenton. Annually, the health center provides
comprehensive medical, dental, and other services
to more than 13,000 area residents.
Golf Outing Results Available
Next Issue
The Fifteenth Annual Delta Dental Classic took place
last month. The annual event raises funds for Special
Olympics New Jersey (SONJ). This year’s event
was on June 22 at the Fiddler's Elbow Country Club
in Bedminster, New Jersey.
The Delta Dental Classic, which began in 1991, has
raised more than $472,000 for SONJ.
Results will be published in the next issue of Newsletters.
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