Delta Dental Plan of New Jersey

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Newsletters - April 2003

Articles
Online Claims Grow in Popularity
Changes Announced to Automated Voice Response System
HIPAA Update
ADA HIPAA Resource
Just Two Months Until Tee Time at Delta Dental Classic
In-Net Program Could Result in Substantial Savings to Your Practice
CT Delta Dental Day Seminar April 23
Delta Dental Joins Fight Against Breast Cancer
What You Need to Know About Recent Changes in New Jersey Coordination of Benefits Regulation
Delta Dental Program Strives to Prevent Child Abuse
Reporting Abuse
April Is National Child Abuse Prevention Month
Important Policy Revisions
CT Dentist Submits 1 Millionth Electronic Claim to Delta Dental

Online Claims Grow in Popularity

Have you been thinking about trying Delta Dental's new online claims submission feature? "I would definitely recommend it," says Lisa Connelly, office manager for Dr. Gregg Wilcox in Brooklyn, Connecticut. Connelly started submitting claims directly to Delta Dental online in January, and now files about six claims a week online. "Online claims submission has a faster turnaround than paper claims," she says. "It's also easy to use."

Both participating and non-participating dentists may submit claims directly to Delta Dental online. Practically every type of claim that you submit by paper can now be submitted online, including:

Claims with dated services; no Coordination of Benefits (COB)
Pre-Treatment Estimates (PTEs) for non-dated services
Payment of a PTE (must have a PTE voucher number)

To submit an online claim, go to Delta Dental's Web site at www.deltadentalnj.com and click on "Dentists" on the right side of the page. This takes you to the Dentists section of our Web site. Log onto Benefits Connection. (If you're unfamiliar with Benefits Connection or are not registered for Benefits Connection, follow the online directions to register.) Select "Claims Submissions" and follow the step-by-step instructions on the screen.

For more information about online claims submission, go to www.deltadentalnj.com, click "Dentists" and log onto the "Benefits Connection Logon" box. A Q&A and user guide are available online.

Changes Announced to Automated Voice Response System

We are making changes to our automated voice response system in order to comply with Health Insurance Portability and Accountability Act (HIPAA) privacy provisions. Beginning on or about April 14, dentists must enter their PIN (personal identification number) in order to access automated information about patients' eligibility, benefits, claims information, remaining maximums and deductible information. This step ensures an additional measure of security.

You will obtain your PIN the first time you call our automated voice response system, at 800-452-9310 or the participating dentist toll-free number, after these changes go into effect in early April. Here's what will occur:

You will be prompted to enter your license number on your telephone keypad.
The system will prompt you to identify the state in which you practice. ("1" for New Jersey, "2" for Connecticut, "3" for Pennsylvania, "4" for New York, or "5" for all others. If you pressed "5" for all others, you will be asked to enter your two-letter state abbreviation on your telephone keypad.)
You will be prompted to enter your four-digit PIN.
If you have not received a PIN, please wait. Your call will be transferred to a customer service agent, who will assist you in establishing your four-digit PIN. You will also select a security question and answer, which will be used to verify your identity if you forget your PIN.

Once your PIN is established, each time you call the automated voice response system you will be asked to enter:

Your license number
State
PIN
Subscriber's Social Security number
Subscriber's six-digit birth date

Except for these changes, the system will continue operating as usual. The voice response system provides information about patient benefits, eligibility, claim status, remaining maximums and deductibles, provider listings and how to order forms.

Please note: If you use Benefits Connection on the Internet, you cannot use the password (PIN) established there for the voice response system.

HIPAA Update

Delta Dental Plan of New Jersey is required by the federal Health Insurance Portability and Accountability Act (HIPAA) to take reasonable steps to ensure the privacy of the personally identifiable health information we are entrusted with to provide service and pay claims.

The term "Protected Health Information" (PHI) includes all individually identifiable health information transmitted or maintained by us, regardless of form. PHI may be oral, written, or electronic.

The HIPAA privacy regulations, effective April 14, 2003, also require Delta Dental, as a Covered Health Plan, to personally inform all our insured subscribers about:

our allowed uses and disclosures of PHI;
the privacy rights of individuals with respect to their PHI;
an insured subscriber's duties with respect to PHI;
a covered person's right to file a complaint with us and/or the Secretary of the U.S. Department of Health and Human Services; and
the person or office to contact for further information about our privacy practices.

The requirement that a Notice be sent out by Delta Dental only applies to fully insured cases, and does not apply to self-insured, Administrative Services Contract groups.

Delta Dental's "Notice of Privacy Practices for PHI" tells our insured subscribers, as required by law, about the ways in which we may use and disclose their PHI consistent with state and federal law. It also describes the rights and certain obligations we have regarding the use and disclosure of the PHI of our subscribers. At the time of this printing, the Notice was being mailed to more than 300,000 insured subscribers.

If you would like to view our Notice for yourself, please visit our Web site at www.deltadentalnj.com, click "HIPAA," and then "Notice of Privacy and Information Practices."

Note: Dentists are not considered Business Associates and do not need to have a Business Associate Agreement with Delta Dental.

ADA HIPAA Resource

The American Dental Association provides information to help dentists comply with the Health Insurance Portability and Accountability Act (HIPAA). Go to www.ada.org, and click on "Your Practice." Then click "Find HIPAA information here!" in the Featured Content section.

Just Two Months Until Tee Time at Delta Dental Classic

There's still time to register for the Thirteenth Annual Delta Dental Classic, which takes place June 4 - if you hurry!

The Golf Classic raises funds for Special Olympics New Jersey (SONJ), a non-profit organization that provides athletic training and competition for children and adults with mental retardation. The event will be held at Fiddler's Elbow Country Club in Bedminster, New Jersey. Last year's Classic raised $55,000 for SONJ, bringing the total funds raised through this annual event to more than $350,000.

For information about SONJ, go to www.sonj.org. For registration information, call 973-285-4059 or e-mail jappaluccio@deltadentalnj.com.

In-Net Program Could Result in Substantial Savings to Your Practice

Delta Dental's value-added program for participating dentists, called In-Net, provides discounts on many items your practice may need in the coming year, including dental supplies and equipment, wireless telephone service, practice management software and hardware, and even free electronic claims submission.

The In-Net program recently added several new features for participating dentists only, including discounts on:

Office phone systems. Safari Telecom offers discounts to participating dentists in northern New Jersey. For information, call 800-696-4567, or visit www.safaritelecom.com and click on "Custom Programs." For Company ID, enter "deltanj"; for Password, enter "parsippany."
Medical emergency products. HealthFirst offers emergency kits, which are color-coded for easy identification, as well as quick symptom and antidote recognition. For more information, call 800-331-1984.
Sterilizer monitoring service. Steri Check Systems, Inc. offers a service to monitor your steam, chemical vapor, dry heat and ethylene oxide gas sterilizers on a weekly, bi-weekly or monthly basis. It includes laboratory culturing service, certificate of compliance, sterilizer monitoring log, full documentation and prepaid postage/free shipping. For more information, call 800-677-8374.
Free electronic claims submission. Delta Dental and Dental Connect have joined together to offer dentists the opportunity to submit claims to payers via the Internet. There is no cost to dentists for submitting these e-claims. For more information, call Dental Connect at 800- 624-2904 and select option 3.

Delta Dental's In-Net Program offers a number of other products and services at a discount, including:

Practice-management software, hardware, training and service;
Free Internet home page;
Price-comparison shopping service for dental supplies;
Wireless phone service with Sprint PCS.

For more details about each of these In-Net offerings, visit our Web site at www.deltadentalnj.com, click "Dentists" and "In-Net Program," or contact your Dental Network Coordinator at 888-396-6641.

When you contact these vendors, please identify yourself as a Delta Dental Plan of New Jersey participating dentist. They will lead you through the enrollment process. Please note that these vendors will deal directly with you. Delta Dental will do its best to maintain these vendors and add new vendors to provide even more value to you. However, Delta Dental does not guarantee the performance or continued participation of these vendors. This program has been designed to provide savings opportunities to our participating dentists. Delta Dental Plan of New Jersey does not receive any compensation from any vendor under this program.

CT Delta Dental Day Seminar April 23

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 is April 23 from 9 a.m. to 1 p.m. at the Inn at Ethan Allen in Danbury, CT.

The seminar covers:

The different types of programs Delta Dental offers
Electronic claims-how to get started and helpful tips
Delta Dental's HIPAA compliance efforts
Delta Dental's use of processing policies in claims processing
Preventing fraud and abuse
Using our new Benefits Connection, including its online claims submission feature, on the Internet

To attend, please complete the registration form and send it to Delta Dental by April 18. The registration form is available from our Web site at www.deltadentalnj.com. Click "Dentists," then "Schedule of Events." On the April 23 item, click "Registration Form." Or, you may call Professional Relations at 888-396-6641 to request a registration form.

Delta Dental Joins Fight Against Breast Cancer

Delta Dental Plan of New Jersey, Inc. (DDPNJ) is known for fighting against oral disease, but now it's joining the fight against another kind of disease: breast cancer.

During the 2003 Delta Dental Plans Association (DDPA) annual meeting, Gay VanBrunt, whose husband is the president of DDPNJ, will join in a fundraising walk against breast cancer. She also chairs the event, which takes place on Saturday, June 21. Proceeds from the walk will be donated to the National Breast Cancer Coalition Fund, a grassroots advocacy group interested in raising funds for research and improving access to care, including breast cancer clinical trials.

"DDPA's annual meetings are filled with goodwill and camaraderie, and Gay is helping to turn that spirit into a public good by participating in this walk and collecting donations for this cause," said Diane Belle, vice president, Corporate Communications, DDPNJ.

Many families and friends of the Delta Dental system have suffered with breast cancer, and the event's organizers said they had been looking for something the organization could do to help fight the disease that has touched so many.

This is the first time Delta Dental has participated in this particular charitable event.
"We always promote the idea that oral care and general bodily wellness are linked, and this is a great way to personify the message," Belle said.

If you would like to support this cause, please complete the pledge form below.

Delta Dental/National Breast Cancer Coalition Fund Pledge Form

All proceeds from the walk at donated to NBCCF and are tax-deductible as permitted by federal law. Please print all information for acknowledgement and tax purposes. Thank you.

Sponsor's Name:

Sponsor's Address:

City/State/Zip:

Sponsor's Phone Number (required for credit card donations):

Payment Type: Check _____ Credit Card _____ Cash _____

Please make checks payable to: National Breast Cancer Coalition Fund (NBCCF)

VISA _____ MC _____ AX _____

Card Number:

Signature:

Expiration Date:

Please return sponsorships to:

Delta Dental Plan of New Jersey, Inc.
Attention: Breast Cancer Walk
P.O. Box 222
Parsippany, New Jersey 07054-0222

What You Need to Know About Recent Changes in New Jersey Coordination of Benefits Regulation

When They Became Effective
The rules became effective January 1, 2003.

Plans That Must Comply With the New Rules
The rules apply to plans written in New Jersey on an "insured" or "risk" basis -- they do not apply to "self-funded" or "administrative service" contracts unless the self-funded plans agree to use the new rules. We are encouraging self-funded plans to adopt the new rules. Over time we hope that the majority of self-funded plans will do so as increased use of the new rules will increase efficiency and consistency in coordinating benefits.

Major Changes Made by the New Rules

1. The total fee that the provider is allowed to collect under the primary plan is the total fee that the provider can collect.

Example:
The dentist's usual fee for a crown is $1,200. The dentist participates with the ABC Insurer and agrees to accept $800 as the fee for a crown. The dentist also participates with the XYZ Insurer and agrees to accept $1,000 as the fee for a crown. Both carriers have 80% coverage.

(a) Where the ABC Insurer is the primary plan, the dentist cannot charge or collect more than $800 for the crown.
(b) Where the XYZ Insurer is the primary plan, the dentist cannot charge or collect more than $1,000 for the crown.
(c) Whether (a) or (b), the dentist can never collect from the patient an amount which exceeds the copay the patient would owe if the patient only had the secondary plan's coverage.

This new rule establishes the total fee the dentist is allowed to collect based on the primary plan's arrangement with the dentist. If the dentist has no contract with the primary plan, the maximum total fee is the fee actually charged and intended to be collected from the patient.

This will result in some carriers paying more than in the past. This also results in some dentists collecting less than in the past. Patients will not pay more than in the past and they may be obligated to pay less.

2. Where a fee-for-service plan and a capitation plan (in which the dentist participates) cover a patient and the fee-for-service plan is primary, the dentist will receive payment from the primary (indemnity) carrier and cannot collect any additional copayment from the patient (whether or not the copayment would have been allowed under the capitation plan).

Example:
The dentist's usual fee for a crown is $1,200. The dentist participates with ABC Insurer and agrees to accept $800 as the fee for a crown. The dentist also participates with QRS capitation plan and is allowed to collect a $200 copayment for a claim. The ABC Insurer has 80% coverage.

Where the ABC Insurer is the primary plan, it pays $640 (80% of $800) and the dentist must accept the $640 as payment in full.

This new rule will result in dentists sometimes securing a higher fee than in the past and sometimes a lower fee. The patient will not pay more than in the past and may be obligated to pay less.

3. When a fee-for-service plan and a capitation plan (in which the dentist participates) cover the patient and the capitation plan is primary, the dentist will collect only the copayment.

Where the QRS capitation plan is primary, the dentist collects the $200 copayment for the crown from the ABC Insurer and/or patient and accepts that $200 as payment in full.
The ABC Insurer will not make any other payment for the crown.

This new rule will result in dentists sometimes securing a higher fee than in the past and sometimes a lower fee. The patient will not pay more than in the past and may be obligated to pay less.

Where to Find the New Rule
The new COB rule appears at N.J.A.C. 11: 4-28.1 et seq.

What Has Not Changed
Carriers' payment obligations (whether their coverage is primary or secondary) will never exceed the amount the carrier would have been obligated to pay if it were the only carrier covering the procedure.

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 expert with a dental practice in Roselle Park 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.

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.

April Is National Child Abuse Prevention Month

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.

Important Policy Revisions

Professional Consultation (D9310) Policy

Effective January 1, 2003, Delta Dental revised its processing policies regarding professional consultation (D9310). The revision allows benefits for a consultation for a referred patient whether or not the dentist initiates diagnostic and/or therapeutic services, consistent with the definition provided by the American Dental Association in the CDT-4 codes. The revised policy for professional consultation is as follows:

Professional consultation (D9310) may be benefitted when the service is provided by a dentist or dental specialist whose opinion or advice regarding an evaluation and/or management of a specific problem may be requested by another dentist, physician or appropriate service. The dentist performing the consultation may initiate diagnostic or therapeutic services.

When covered, the consultation is subject to the same frequency limitations and processing policies as a comprehensive evaluation (D0150).

The fee for the consultation is disallowed when billed in conjunction with an evaluation by the same participating dentist.

The fee for the consultation in connection with non-covered services is denied, and the approved amount is collectable from the patient.

Limited Oral Evaluation-Problem Focused (D0140) Policy

Effective January 1, 2003, Delta Dental revised its processing policies regarding limited oral evaluation-problem focused (D0140). The revision allows benefits for a limited oral evaluation-problem focused (D0140) whether or not the dentist initiates therapeutic services on the same day. The revised policy for limited oral evaluation-problem focused is as follows:

Limited oral evaluation-problem focused (D0140) may be benefitted whether or not the dentist initiates therapeutic services on the same day.

When covered, limited oral evaluations-problem focused (D0140) are counted against the frequency limitations and processing policies applicable to periodic oral evaluations (D0120).

CT Dentist Submits 1 Millionth Electronic Claim to Delta Dental

Dr. James Tagliarini, a participating dentist from Danbury, Connecticut, was presented with a laptop computer on January 15 for submitting the 1 millionth electronic claim of 2002 to Delta Dental.

Dr. Tagliarini's office submitted more than 80% of its claims electronically to Delta Dental in 2002.

"We started submitting electronic claims at the end of 2000," says Leona Tomascak, Dr. Tagliarini's office manager. "Before that, we had to type each claim form individually. We used to have two people working in the front office, and now it's just me. I now have much more time to do other things."

Another benefit of electronic claims is faster payment, says Tomascak. "I find the turnaround in payment is quick, much faster than using paper claims. I also don't have to make as many phone calls and don't have to follow up on a lot of claims."

Tomascak adds, "I would definitely recommend electronic claims to other dental offices."

For more information about how to submit electronic claims, contact your Dental Network Coordinator at 888-396-6641. (Also, see "In-Net Program Could Result in Substantial Savings to Your Practice" in this issue for how your practice can submit free electronic claims.)