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Articles
Subscribers Give Delta Dental High
Marks in Annual Survey
Customer Service Featured in Industry
Publication
How Benefits Connection Helps Our Practice:
Barbara Heesemann, Dr. John Mully's Office
New Fee Schedules for Delta's Advantage
Program
Golf Outing Winners Announced
Patients, Students, Dentists Benefit
from Recent Foundation Grants
COB Policy for Processing Oral Surgery
Claims
October Dental Seminar on Preventing,
Detecting Oral Cancer
Reminder on Right Ways to Coordinate
Benefits
Delta Dental Days Scheduled
Delta Dental, Dr. Sydell Receive
Awards at NJDA Convention
You Can Help Paper Claims Process
Faster
Helpful Hints for Submitting Claims
Subscribers Give Delta Dental
High Marks in Annual Survey
More than 9 in 10 subscribers are satisfied with
Delta Dental of New Jersey, according to our 2005
member survey. Brownstone Information Resources conducted
the survey, which was mailed to 6,000 randomly selected
subscribers last October.
Subscribers identified several reasons for their
overall satisfaction. Favorable comments about their
Delta Dental experience included “no paperwork,” “quick
processing of claims,” “ease of usage,” “number
of providers,” and “Customer Service
is very helpful.”
Subscribers continued to rate highly the quality
of participating dentists and access to participating
dentists. More than 9 in 10 are satisfied with their
dental care. Nearly 9 in 10 use participating dentists,
95% would return to their Delta Dental dentist, and
90% would recommend their Delta Dental dentist to
others.
Delta Dental’s Customer Service and claims
processing services also received high marks by subscribers.
More than three in four participants are “satisfied” to “very
satisfied” with the courtesy of Customer Service
agents, subscribers’ ability to reach a Customer
Service agent, and the accuracy of Customer Service’s
response. Most are also “satisfied” to “very
satisfied” with the timeliness and accuracy
of claims. Some comments include “claims are
taken care of promptly,” and “I have
never had a problem where a claim was unpaid.”
Subscribers also rated highly their communications
with Delta Dental. Most felt they received clear
information about their coverage, and are satisfied
with the Explanation of Benefits (EOB) statements.
The number of subscribers who visit Delta Dental’s
Web site nearly doubled between 2002 and 2004. Most
visitors are “satisfied” to “very
satisfied” with the information available on
the site.
Survey information is used to benchmark our performance
in key attributes and make improvements.
Customer Service Featured in
Industry Publication
Delta Dental’s “award-winning emphasis
on good ol’ customer service” sets us
apart from many dental plans, according to an article
in the July 2005 issue of Managed Dental Care.
Delta Dental puts customers front and center, said
the article. “Relationships are key to the
success of what we do,” said Bruce Silverman,
Delta Dental’s senior vice president of claims
and customer service. The company works hard on its
relationships with benefits administrators, subscribers,
brokers and dentists. “We’re not just
marketing to them, we’re building relationships
so the client knows who to go to when there’s
an issue to be resolved,” said Silverman.
Managed Dental Care is a monthly newsletter for
dentists, benefit providers and others with an interest
in dental care. To read the full piece, go to www.deltadentalnj.com and
click “Read the article” in the “What’s
New” box.
How Benefits Connection Helps
Our Practice: Barbara Heesemann, Dr. John Mully's
Office
Barbara Heesemann couldn’t wait to start using
Delta Dental’s online Benefits Connection. “We
heard about it at a dental seminar and signed up
the minute we got back to the office,” says
Heesemann, office manager for Dr. John Mully’s
practice in Saddle Brook, New Jersey.
She now uses Benefits Connection to verify patient
eligibility and benefits, plus submit claims.
We asked her why. “It’s great! Just before
you called, a woman brought her two children in for
appointments. While the second child was having the
checkup, I was processing the claim for the first
child. I could literally tell the mom that the visit
was paid in full.” Benefits Connection enables
Dr. Mully’s practice to provide timely benefits
information to patients.
Benefits Connection often resolves potential problems
while patients are still in the office. “It’s
always saving us,” says Heesemann. “The
other day we couldn’t pull up a patient’s
records. It turned out he has a hyphenated name.
He suggested we try it with a hyphen, and it went
through. Being able to take care of this while he
was still at my desk saved him time and us time.”
Benefits Connection also helps with Coordination
of Benefits (COB), Heesemann adds. “I had a
patient where Delta Dental was his second carrier.
Although the claim came up pending, I could still
tell him about what his benefits covered, including
his lifetime maximum. I could give him a big piece
of the puzzle. Benefits Connection is head and shoulders
above anything else I’ve ever seen.”
Benefits Connection enables dental offices to verify
patient benefits and eligibility, check claim status
and file claims online. The service is available
24 hours a day, seven days a week, at www.deltadentalnj.com;
click “Dentists” and then the “Logon” button
in the Benefits Connection Logon box.
If you’ve never used Benefits Connection,
click “Register Now” in the Benefits
Connection Logon box to get started. To see what’s
available through Benefits Connection, click “Benefits
Connection Demo” and try the online demonstration.
New Fee Schedules for Delta's
Advantage Program
New fee schedules were recently mailed to all New
Jersey dentists participating in Delta’s Advantage
Program. The new fees became effective July 1 for
all Delta’s Advantage Program groups. For information
on how to become a participating dentist in Delta’s
Advantage Program, please call our dental network
coordinators at (888) 396-6641.
Golf Outing Winners Announced
The Fifteenth Annual Delta Dental Classic, which
raises funds for Special Olympics New Jersey (SONJ),
took place in June at Fiddler’s Elbow Country
Club.
Contest winners include:
1st Place Low Gross (Women): Margie
Petrone
1st Place Low Gross (Men):
Jim Schulz
1st Place Gross Team:
Dave Lance, Jr.
Ed Gunther
Robert Toth
Gary Mini
While contributions for this year’s event
are still being tallied, we are confident the proceeds
will reveal that over the past 15 years the Delta
Dental Classic has raised more than a half million
dollars for SONJ. SONJ is dedicated to empowering
individuals with mental disabilities to become physically
fit, productive, and respected members of society
through sports training and competition. Special
thanks to all of our participants and sponsors.
Patients, Students, Dentists
Benefit from Recent Foundation Grants
- Catto Elementary School in Camden, New Jersey,
celebrated a day of oral health education.
- The Newark, New Jersey, Public Schools will begin
training high school students for dental careers.
- Six students at Bergen Community College and
six at Middlesex County College in New Jersey received
scholarships to continue their education in dental
hygiene.
These were all made possible by recent grants from
the Delta Dental of New Jersey Foundation.
The grant to Catto Elementary School enabled the
school to purchase supplies and educational materials
for its “Let’s Learn About Dental Health“ program
for students and their families. Health education
is an important component of the school’s community
outreach program. The program provides basic tools
and information for families in this underserved
community so they can improve their oral health.
The Newark Public Schools will use the Foundation
grant to buy equipment and supplies for its new Allied
Health Science Academy. The Academy is an innovative
education program. Situated in one of Newark’s
high schools, the Academy will prepare high school
students for careers in dental assisting, dental
technology, and dental hygiene.
The Foundation funds education for current and future
oral-health practitioners. Besides its community
college scholarships, the Foundation recently contributed
to the Bloomfield (New Jersey) Health Careers Foundation.
This provides scholarships to high school students
pursuing careers in dental assisting and dental hygiene.
The Foundation also funds the Allied Dental Education
Scholarship Program at the University of Medicine
and Dentistry of New Jersey (UMDNJ), as well as continuing
education programs for dentists through UMDNJ.
The Foundation also provides financial support for
programs that help underserved populations gain access
to dental care. It recently awarded a grant to fund
a school-based dental clinic at the Katherine Brennan
School in New Haven, Connecticut. The dental clinic
has a dentist and several dental hygienists on staff.
This school’s clinic provides dental care for
children in this underserved area who would otherwise
go without care.
The Foundation supports programs and facilities
that provide dental education to physically and developmentally
disabled children and adults. Its grant to the Arc
of Greater Enfield, Connecticut, is being used to
revamp the oral hygiene curriculum at Camp Shriver.
Camp Shriver is a camp for 80 campers who are developmentally
disabled or have other related disabilities. The
oral hygiene curriculum teaches campers how to properly
care for their teeth.
COB Policy for Processing Oral
Surgery Claims
Most Delta Dental subscribers also have group medical
coverage. The vast majority of these medical plans
cover complex oral surgery procedures, such as removal
of impacted wisdom teeth. When a subscriber has the
procedure as a covered benefit under both their medical
and dental plans, the medical plan is generally primary.
For Coordination of Benefits, the order of Benefits
Determination is generally as follows:
1. Primary Medical
2. Primary Dental
3. Secondary Medical
4. Secondary Dental
There are some groups whose contract with Delta
Dental provides that we act as the primary payer
over medical for selected oral surgery procedures.
In those instances, we make payment as the primary
carrier.
When Other Insurance EOBs Are Required:
Order of Benefits,
Primary Plan for Oral Surgery:
EOB Attachment(s) Required
Where Delta Dental Is: for
Delta Dental Processing:
Primary Dental Coverage
Medical
Medical EOB
Primary Dental Coverage
Dental
None
Secondary Dental Coverage
Medical
Primary Medical EOB
Primary Dental EOB
Secondary Medical EOB
Secondary Dental Coverage
Dental
Primary Medical EOB
Primary Dental EOB
Effective January 1, 2006, in order to ensure that
Delta Dental pays the correct amount for oral surgery
procedures, a medical EOB will be required (unless
it has been determined that Delta Dental is primary)
even if the claim submission states that there is
no other coverage or fails to address it.
The procedure codes that require medical EOBs and
the documentation requirements for those codes can
be found on our Web site (www.deltadentalnj.com)
by clicking on Dentists, and then clicking on Required
Documentation Charts.
Dental offices can contact Customer Service at (800)
452-9310 to obtain a list of groups that have designated
Delta Dental as primary for the above procedures.
A participating dentist should contact Delta
Dental if:
- You are unable to get the information from the
patient’s medical plan because you are not
a participating provider in the medical plan.
- You have attempted to obtain the medical payment
information from the patient and after 60 days
have received no response within the timeframes
for carriers to respond under the Prompt Pay rules
(i.e., 30 days for electronic claims and 40 days
for paper claims).
To assist in those cases, Delta Dental requires
the following information:
- A copy of the claim submitted to the medical
plan and/or copy of patient’s financial ledger
indicating dates of submission to other plans and
follow-up;
- Medical insurance coverage information, including
medical carrier’s telephone number.
October Dental Seminar on Preventing,
Detecting Oral Cancer
Delta Dental’s next seminar for dentists features
Dr. Arnold Rosenheck, assistant dean of Hospital
Affairs & Institutional Development at the University
of Medicine and Dentistry of New Jersey (UMDNJ).
Dr. Rosenheck will present “Prevention and
Early Detection of Oral Cancer for the General Practice” October
19 at Doral Forrestal in Princeton, New Jersey.
The program is designed to provide the general dentist
with the ability to identify oral cancer, test for
it, and provide appropriate counseling to reduce
the risk factors associated with the disease.
The seminar includes a hands-on demonstration of
the brush biopsy. The brush biopsy is a new technique
useful in the general practice office for prevention
and early detection of oral cancer.
All participating dentists will receive invitations
to this seminar with details and registration information.
Please note that this is the same course that was
held in northern New Jersey on April 20. If you attended
that course, you cannot receive credit for the course
on October 19.
Continuing education credit for this seminar does
not imply New Jersey State Board of Dentistry endorsement
of any particular products or materials discussed
or demonstrated during the presentation.
Reminder on Right Ways to Coordinate
Benefits
Dentists must reveal other coverage for dental services
(including medical coverage where it covers dental
services) when submitting claims.
All information regarding other insurance
carriers must be correctly and completely disclosed
on the claim submission—both paper and
electronic.
Every dentist is responsible for correctly
completing the “other coverage” section
on claim submissions and providing the amounts
of any payments made by other carriers. Failing
to correctly provide other carrier coverage
or payments for dental services are some of
the unacceptable billing practices reviewed
during the claim verification process. Failure
to coordinate or report benefit information
can result in overpayments that are recoverable.
Knowingly submitting incorrect claim forms
to attempt to gain benefits is improper and
constitutes insurance fraud.
For more information, please refer to:
- New Jersey State Board of Dentistry, Administrative
Code [NJAC 13:30-8.10]
- The General Statutes of Connecticut
[Volume 7, Title 20, Chapter 379 Sec.
20-114]
- The Delta Dental of New Jersey Participation
Agreement
- The Delta Dental of New Jersey Dentist
Handbook for Participating Dentists,
Chapter 4, Form Completion, Chapter
7, Coordination of Benefits, and Chapter
11, Claim Verifications
Delta Dental Days Scheduled
Delta Dental Days are a series of free educational
seminars offered by Delta Dental to participating
dentists and their office staff. The next Delta Dental
Day programs are:
September 7, 2005
Renault Winery
Egg Harbor City, NJ
September 14, 2005
Meadow Wood Manor
Randolph, NJ
The half-day morning seminar covers:
- The different types of programs Delta Dental
offers
- Electronic claims—how to get started
and helpful tips
- Delta Dental’s compliance efforts
with HIPAA
- Delta Dental’s use of processing
policies in claims processing
- Preventing fraud and abuse
- How to use Benefits Connection to verify
patient eligibility and benefits on the Internet
to save your practice time, improve patient
relations, and improve your cash flow when
using it to submit claims
Participants will receive four continuing education
credits for attending. Registration information will
be sent out shortly. For more information, please
contact your dental network coordinator at (888)
396-6641.
Delta Dental, Dr. Sydell Receive
Awards at NJDA Convention
Delta Dental of New Jersey and our Chairman of the
Board, Dr. Gerald A. Sydell, were honored at the
New Jersey Dental Association Convention in June.
Delta Dental received a plaque from the New Jersey
Foundation of Dentistry for Persons with Disabilities.
The award recognized Delta Dental’s “contribution
to improve access to care for citizens who are disabled
or elderly.” The New Jersey Foundation of Dentistry
for Persons with Disabilities provides dental care
for elderly and mentally and physically disabled
people of all ages with disorders such as multiple
sclerosis. Delta Dental is a longtime supporter of
this and other organizations that help people with
disabilities access dental care.
Dr. Sydell received the NJDA’s Presidential
Award for Community Service. The award was presented “in
grateful recognition for his dedication to community
service and to the dental profession.” Dr.
Sydell is a past president of the Union County Dental
Society. He served as trustee of the NJDA as well
as a delegate to the American Dental Association.
In addition, Dr. Sydell served as a member of the
New Jersey Medicaid Drug Utilization Review Board.
He received the Union County Dental Society’s
President’s Award and the NJDA Service Award.
In 2001 he was recognized by the UMDNJ New Jersey
Dental School for outstanding contributions to the
college and dentistry. He has been elected to Fellowship
in the American College of Dentists and the International
College of Dentists.
Dr. Sydell currently serves on the Board of Trustees
of Matheny Medical and Educational Center. He is
a trustee of the New Jersey Foundation of Dentistry
for Persons with Disabilities and a member of the
UMDNJ-New Jersey Dental School Feasibility Study
Committee.
You Can Help Paper Claims Process
Faster
Delta Dental recently started using new software
that “reads” paper claims. The optical
character recognition software transforms paper claims
into electronic data, which can be processed more
quickly.
Please help us process your claims faster. Before
submitting paper claims to Delta Dental, check to
make sure you’ve avoided these common problems.
Illegible numbers. Print neatly so the system can
read every letter and number clearly. If you complete
claim forms by hand, please print (rather than handwrite)
all information.
Misaligned printing. If your claim form is computer
printed, please check that the form is lined up properly
in the printer. Misaligned claim forms can cause
the printer to print text on lines. When this happens,
the system can’t read it.
Unnecessary dollar sign and decimal point. If the
procedure cost is in dollars only (it includes no
cents), don’t include the dollar sign or decimal
point. Putting a decimal point followed by two zeroes
can delay processing of the claim if the computer
cannot read them.
Helpful Hints for Submitting
Claims
We recently asked our dental network coordinators,
Customer Service agents and claims processors, “What
are some of the most common questions you hear from
dental office managers?
Not surprisingly, claims questions are among
the most frequent. Here are the questions,
and their answers.
I keep hearing about the benefits of filing
electronic claims, but we’re not connected
to the Internet. Does this mean we are limited
to paper claims?
“Not so!” says Beth DeCapio, dental
network coordinator. “There’s a misconception
that electronic claims require Internet access, but
they don’t. They require a computer, modem
and phone line, which securely connects them to the
clearinghouse.” The clearinghouse collects
the claim information, screens it for proper format
and missing information, and delivers it to an electronic “mailbox” for
daily pickup by Delta Dental’s computer system.
A claim error (e.g., no Social Security number) is
transmitted back to the dentist by the clearinghouse.
If the claim contains no errors, the clearinghouse
transmits the claim to Delta Dental.
For more information on electronic claims,
visit our Web site at www.deltadentalnj.com;
click “Dentists” and “Electronic
Claim Submission.” Or, contact your dental
network coordinator at (888) 396-6641.
What is the appropriate use of the “Comments” or “Remarks” field
when submitting electronic and online claims?
One advantage of electronic and online claims is
that many claims can be automatically adjudicated.
However, any claim with comments cannot be automatically
processed. It must first be reviewed by an associate.
“We recommend using the comments section
only for information that actually is necessary
for processing the claim,” says Michelle
Mulhern, Director, Customer Service. “Adding
comments such as ‘Second submission’ or ‘Pay
claim within 30 days’ can actually delay
claim processing!”
Information that should appear in the comments
section includes:
- The NEA or Dentrix attachment number for diagnostic
material
- Orthodontic treatment
- Patient discounts/waiver of co-payments
- Any procedure requiring a narrative
- Accidental injury, including motor vehicle
and worker’s compensation
- Missing teeth
- Pre-treatment estimate (PTE) voucher number
(for electronic claims only)
Also, please write remarks only in the comments/remarks
section. Comments indicated anywhere else on the
claim could be missed.
What should we use as the date of service when
submitting claims for multi-step procedures, such
as crowns, bridges, dentures and root canal therapy?
Please use the insert date for crowns, bridges and
dentures, and the completion date for root canal
therapy.
Some dental offices use the start date as the date
of service, and enter a remark or an additional claim
line with the insert date or completion date. This
is not recommended, as it can delay processing.
How should we indicate missing teeth on claims?
“Missing teeth should always be indicated,” says
Peggy Marvin, Assistant Vice President, Claims. “This
is especially pertinent to periodontal, prosthodontic
or implant services procedures.” Item 34 of
the paper claim form includes a chart of the tooth
numbers with the instructions, “Place an ‘X’ on
each missing tooth.” Information on missing
teeth should be provided in the “Remarks” or “Comments” section
of electronic and online claims.
We obtained a pre-treatment estimate (PTE) voucher,
and now it’s time to file the claim. What
should we do?
Dentists often submit PTEs for patients who want
to obtain an estimate of what Delta Dental will cover
for their treatment. Dentists send any required diagnostics
at that time. Delta Dental evaluates the treatment
plan and diagnostics, and then sends the dentist
a PTE voucher indicating the benefits.
“We want the dentist to submit the actual
PTE voucher, rather than a brand new claim, when
the services have been completed,” says Lori
Acker, Assistant Vice President, Customer Service.
The PTE voucher should include the dates of services. “If
you don’t send the original voucher, our claims
processing system thinks you’re submitting
a brand new claim,” says Acker. Dental offices
that submitted diagnostics with their PTE may be
asked for those same diagnostics if they submit a
new claim. “If you submit the PTE voucher,
there is no need to resubmit diagnostics, and processing
will be faster,” she says.
Dentists may now submit for payment of a PTE online,
using the online claims submission feature in Benefits
Connection. Go to www.deltadentalnj.com, click “Dentists” and
log into Benefits Connection. You will need the PTE
voucher number in order to submit for payment.
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