Articles
Benefits Connection Milestone: 100,000th
Online Claim Submitted
Subscribers Give Delta Dental High
Ratings in Survey
CDT 2005 Reminder: When To Use D8060 vs. D8070
Save $150 or More on Electronic Attachments
Registration through May 19
Understanding the HIPAA National Provider
Identifier
Claims, Customer Service Performance Quality
Remain High in 2005
Sixteenth Annual Delta Dental Classic Almost
Here!
P.A.N.D.A. Program Helps Dentists, Others
Fight Child Abuse
Submitting Claims for "Free"
Services Unacceptable
Ask Your Dental Network Coordinator about
Joining Delta Dental Patient Direct
Delta Dental to Attend Dental Conferences
How to Verify Eligibility for GM Employees
Where to Mail Claims for Other Delta Dental Member Companies
Benefits Connection Milestone:
100,000th Online Claim Submitted
Sussex Dental Center in Sussex, NJ, has submitted
hundreds of claims online to Delta Dental of New
Jersey. One of those recently became the 100,000th
to be processed by Delta Dental’s online claims
submission system.
“We started using Benefits Connection in April
2004,” says Nancy Orr of Sussex Dental Center. “Online
claim submission is much easier than sending paper
claims. It cuts down on a lot of paperwork, and the
payment turnaround is much faster. Now we submit
all our claims to Delta Dental online.”
The Sussex Dental Center team includes James
E. Anderson, D.M.D., FAGD; Thomas E. Lapinski,
D.M.D.; John E. Nicholson, D.M.D.; Donna Demmert;
Nancy Orr and Diane Nicholson.
Thanks to Sussex Dental Center and all the
dental practices in New Jersey and Connecticut
that helped us reach this milestone!
Subscribers Give Delta Dental
High Ratings in Survey
More than 9 in 10 Delta Dental subscribers are satisfied
overall with their dental benefits program, according
to a recent survey.
Subscribers reported satisfaction1 in
the following key areas:
Overall satisfaction with Delta Dental - 94%
Quality of care - 98%
Access to dental care - 91%
Customer Service - 92%
Claims processing - 93%
Subscribers also rated their dentists and dental
offices highly. Ninety-five percent said they would
return to their Delta Dental dentist, and 91% would
recommend their Delta Dental dentist to a friend
or family member.
1Brownstone Information Resources, an
independent research firm based in Morristown, NJ,
conducted the survey in the fall 2005. Percentages
include "very satisfied," "satisfied" and
"neutral" responses.
CDT 2005 Reminder: When To Use
D8060 vs. D8070
Our Claims Department has noticed inconsistency
in the submission of claims for CDT 2005 codes D8060
and D8070.
Use D8060 for interceptive orthodontic treatment
of the transitional dentition. D8060 should
only be used for the treatment of the transitional
dentition. Per CDT 2005, the transitional dentition
is defined as the final phase of the transition
from primary to adult teeth, in which the deciduous
molars and canines are in the process of shedding
and the permanent successors are emerging. The
CDT 2005 descriptor states, “Treatment using
codes for interceptive orthodontic treatment are
for procedures to lessen the severity or future
effects of a malformation and to eliminate its
cause.” The CDT 2005 descriptor also states, “Early
phases of comprehensive therapy may utilize some
procedures that might also be used interceptively,
but such procedures are not considered interceptive
in those applications.”
Use D8070 for comprehensive orthodontic treatment
of the transitional dentition. D8070 should
be used when there are multiple phases of treatment.
The CDT 2005 descriptor states, “This code
should be used when there are multiple phases of
treatment provided at different stages of dentofacial
development. For example, the use of an activator
is generally stage one of a two-stage treatment.
In this situation, placement of fixed appliances
will generally be stage two of a two-stage treatment.
Both phases should be listed as comprehensive treatment
modified by the appropriate stage of dental development.”
As a rule of thumb, if the treatment is part of a
multiple phase treatment plan, the appropriate comprehensive
orthodontic procedure code should be submitted. Proper
use of the CDT 2005 codes will expedite the processing
of your claims and prevent unnecessary delays.
Save $150 or More on Electronic
Attachments Registration through May 19
Delta Dental of New Jersey encourages dental offices
to submit electronically transmitted attachments
whenever electronic or online claims require supporting
documentation.
Many dental offices still duplicate and mail attachments
such as x-rays and periodontal charts. Submitting
electronic attachments is usually much faster and
easier. Attachment software enables dental offices
to transmit x-rays, periodontal charts, proof of
primary payments, narratives and other attachments
for payers to view in support of electronic or online
claims.
As a special promotion to help your office get started,
Delta Dental has negotiated a special offer from
National Electronic Attachment (NEA) for participating
dentists only.
Until May 19, 2006, participating dentists can save
$150 off the normal $200 registration fee for NEA’s
FastAttach™ system. Registration includes software,
installation and training.
Plus, Delta Dental will pay the additional $50 for
the first 50 offices that register.
Additionally with NEA’s FastAttach you can
transmit attachments to more than 140 other payers.
It works with all Windows-operated dental software
systems.
For more information and to register, please visit
www.nea-fast.com and enter “DDNJ” in
the promotion code box. Click “Find My Promotion”;
from there you will be able to view the FAQs and
scanner recommendations, as well as register directly
online. If you have any questions, please call (800)
782-5150, ext. 2 and mention the promotion code “DDNJ.”
For more information on submitting claims electronically
to Delta Dental, visit our Web site at www.deltadentalnj.com;
click “Dentists” and then “Electronic
Claims Submission.” Or, call your dental network
coordinator at (888) 396-6641.
When you contact NEA, please identify yourself as
a Delta Dental of New Jersey participating dentist.
They will lead you through the enrollment process.
Please note that NEA will deal directly with you.
Delta Dental does not guarantee the performance or
continued participation of this vendor. This program
has been designed to provide savings opportunities
to our participating dentists. Delta Dental of New
Jersey does not receive any compensation from any
vendor under this program.
Understanding the HIPAA National
Provider Identifier
HIPAA has affected nearly everyone in health care
since its 1996 inception. One of the latest requirements
is the introduction of a National Provider Identifier
(NPI).
Delta Dental is committed to helping you understand
the NPI process and benefit from this new identifier.
Here’s some basic information to help you understand
the regulation and its requirements.
Who Needs an NPI?
If you answer “yes” to any one of the
following questions, you are considered a “covered
entity” under the NPI standard and are required
by federal law to obtain an NPI.
- Have you submitted claims electronically?
- Have you submitted claims attachments electronically?
- Have you used the Internet to verify eligibility
or check on the status of a claim?
If you answered “no” to all of the above,
you should still consider obtaining an NPI. Why?
- One simple identifier eliminates the need to
maintain and match identification numbers to specific
payers for transactions.
- The NPI allows professionals to relocate practices
or change specialties without requiring new identifiers
from multiple payers.
- Standardized identifiers will help reduce costs
and simplify health care transactions throughout
the system.
- The NPI will contribute to more efficient coordination
of benefits.
- Some, although not all, health plans may choose
to require NPIs on all transactions.
To learn more about the NPI, please visit our Web
site at www.deltadentalnj.com; click “Dentists,” and
then “The National Provider Identifier: What
Dentists Need to Know.” Delta Dental has developed
a free downloadable guide called “The National
Provider Identifier (NPI): What Dentists Need to
Know.” It explains:
- Why the NPI was developed.
- Who is required to obtain and use NPIs.
- How to apply for and receive an NPI.
- What to do with your NPI once you receive it.
Claims, Customer Service Performance
Quality Remain High in 2005
Delta Dental continued to maintain excellent service
levels in 2005, according to the company's 2005 Operations
and Customer Service Reports. Here is a snapshot
of some of our 2005 statistics.
Total number of claims received
2.82 million
Number of electronic claims received
1.4 million (49% of all claims)
Average claims turnaround time
8.3 business days
99.64% processed within 30 business days
Accuracy rates
Key accuracy measures (clerical accuracy, payment
accuracy and dollar accuracy): 99% or higher
Sixteenth Annual Delta Dental
Classic Almost Here!
Spring is here, which means it’s only a short
time until tee time at the Sixteenth Annual Delta
Dental Classic. The golf event benefits Special Olympics
New Jersey.
It takes place on June 21, 2006 at Fiddler's Elbow
Country Club in Bedminster, New Jersey—one
of the finest golf courses in New Jersey. It also
allows you to network with other important players
in the dental service industry and most notably,
to help a truly worthy cause. For information, contact
Jennifer Appaluccio at jappaluccio@deltadentalnj.com.
Be sure to mark the date!
P.A.N.D.A. Program Helps Dentists,
Others Fight Child Abuse
"There is no disease, natural disaster or trauma
that is killing more children under four than child
abuse and neglect," according to the United
States Department of Health and Human Services. Every
11 minutes a child is reported abused or neglected
in the United States.
The signs of abuse aren't always obvious. That's
why the Delta Dental Foundation offers its P.A.N.D.A.
(Prevent Abuse and Neglect through Dental Awareness)
educational program to those who are in regular contact
with children.
“P.A.N.D.A. provides dentists with detailed training on the physical
and behavioral indicators of child abuse and neglect,” says Lawrence
A. Dobrin, D.M.D., a dentist with forensic training and experience who practices
in Roselle Park, New Jersey. Dr. Dobrin is a spokesperson for the P.A.N.D.A.
Coalition. “P.A.N.D.A. also provides resources to guide them through
procedures for reporting suspected abuse, and offers referral resources for
families to help prevent abuse and neglect.”
P.A.N.D.A. 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 P.A.N.D.A. 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.
P.A.N.D.A. 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.
Each P.A.N.D.A. presentation is a one- to three-hour
slide program and workshop conducted by trained professionals.
The presentation is approved for up to three continuing
dental education hours, depending on the length of
the session. The P.A.N.D.A. Coalition has members
who are willing to present the program free of charge
to dental or other interested groups with 10 or more
members. For more information or to schedule a presentation
in New Jersey, please call Delta Dental at (973)
944-4555. In Connecticut call the Connecticut State
Dental Association at (860) 278-5550.
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 http://nccanch.acf.hhs.gov/.
Sidebar: What Should You Do if You Suspect Abuse?
Dentists and other health care providers who suspect
a child is being abused by law must report it. In
New Jersey, you are immune from any criminal or civil
liability as a result of filing the report if you
have reason to believe that a child has been abused
and immediately report it. Anyone who knowingly fails
to report suspected abuse or neglect is subject to
a fine up to $1,000 and/or six months in jail.
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 Child Abuse and Neglect Hotline,
which operates 24 hours a day, 7 days a week, at
(800) 842-2288.
Submitting Claims for "Free"
Services Unacceptable
Dentists must only submit claims to a third-party
payer for services or procedures that have actually
been billed to the patient. Items that have been “courtesied” or
not charged to the patient cannot be billed to a
third-party payer simply because there may be coverage
for those items.
Delta Dental requires that the dentist’s submitted
fee be the lower of the usual fee or the fee actually
charged to, and intended to be collected from the
patient. A “free” service or procedure
is not charged to the patient; therefore the dentist
does not intend to collect any fee from the patient
for that service or procedure.
Billing for “free” items is one of the
unacceptable billing practices reviewed during the
claim verification process. Submitting “no
charged” items for payment on a claim can result
in overpayments that are recoverable. If courtesied
or no charged items are intentionally submitted with
fees that have not been charged to the patient, it
can be considered a fraudulent attempt to gain benefits.
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 2, Rules
and Regulations and Chapter 11, Claim Verifications
Ask Your Dental Network Coordinator
about Joining Delta Dental Patient Direct
Do you have patients without dental insurance? They
may benefit from joining Delta Dental Patient Direct,
a new dental membership program for New Jersey residents
who don’t have dental insurance. It offers
members access to a network of licensed New Jersey
dentists who agree to provide dental care at fees
no higher than the Delta Dental Patient Direct fee
schedule.
To find out how you can become part of the Delta
Dental Patient Direct network, contact your dental
network coordinator at (888) 396-6641. Your dental
network coordinator can schedule an office visit
or send you an information packet. The Delta Dental
Patient Direct network is open to participating dentists
in New Jersey.
If you have patients without dental insurance, please
let them know about Delta Dental Patient Direct.
They can call (877) TOOTH-07, or visit the Delta
Dental Patient Direct Web site at www.patientdirectnj.com
for more information.
Delta Dental to Attend Dental
Conferences
Delta Dental will participate in two major conferences
for dentists this spring:
- The 2006 Charter Oak Dental Meeting of the Connecticut
State Dental Association at Mohegan Sun in Uncasville,
Connecticut, on May 11-13; and
- The 2006 New Jersey Dental Association Annual
Convention at the Taj Mahal in Atlantic City, New
Jersey, on June 7 and 8.
Please drop by to see us as the Delta Dental booth!
How to Verify Eligibility for
GM Employees
To quickly and easily verify eligibility and benefits
for General Motors salaried employees, retirees,
and surviving spouses after January 1, 2006, please
call Delta Dental of Michigan’s Customer Service
department/DASI at (800) 524-0149, or go through
its online Dental Office Toolkit at https://dentalofficetoolkit.com.
Where to Mail Claims for Other
Delta Dental Member Companies
Most Delta Dental patients that you see are covered
by Delta Dental of New Jersey. However, some may
be covered by other Delta Dental member companies.
This usually occurs because subscribers work for
companies that are headquartered outside of New Jersey
or Connecticut.
If a patient is covered by another Delta Dental
member company, claims should be sent to that plan,
not Delta Dental of New Jersey. The addresses and
Customer Service numbers for every Delta Dental member
company are available by going to www.deltadentalnj.com;
click “Dentists” and “Where to
Mail Claims.”
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