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 efforts enable groups to manage their expenses wisely while providing Delta Dental's excellent dental benefits programs to their employees.

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 "Brokers" and "Cost Containment."