Articles
Benefits Managers Give Delta Dental
High Marks
COB Claims Can Now Be Submitted
Online
Key CDT-2005 Code Changes and DeltaUSA
Processing Policy Revisions
Delta Dental Receives 'AA-' Rating From Standard & Poor's
for Fifth Consecutive Year
Benefits Connection Spotlight: Keith Bohleke,
Quality Dental Care
Tech-Niques: Understanding Your Internet Connectivity
Options
Delta Dental Donates to Three Clinics
Submission of Claim Forms Checklist
ADA Helps Kids Answer Question, "What Do You Want To Be When You Grow Up?"
Wanted: Used Dental Equipment for Clinics
Captain Supertooth Begins Tour in January, February
Benefits Managers Give Delta
Dental High Marks
We are pleased to report that Delta Dental continues
to receive high overall ratings from benefits managers.
In the 2004 Benefits Managers' Satisfaction Survey,
nearly 9 in 10 benefits managers reported being "extremely
satisfied" or "very satisfied" with Delta Dental.
Ninety-five percent would recommend Delta Dental
to other administrators.
Brownstone Information Resources, Inc., an independent
market research firm in Morristown, New Jersey, conducted
telephone interviews with 250 benefits managers selected
at random in August.
How Benefits Managers Rated Our Performance
in 2004
Percentage who are "Extremely" or "Very Satisfied" with
Delta Dental - 86%
Percentage who would recommend Delta Dental to other
administrators - 95%
Percentage who said Delta Dental performs "extremely" or "very
well" at processing claims accurately - 82%
Percentage who said Delta Dental performs "extremely" or "very
well" at processing claims quickly - 81%
Percentage who said Delta Dental performs "extremely" or "very
well" at allowing employees/members to choose their
own dentist - 80%
Percentage who said Delta Dental performs "extremely" or "very
well" at having Customer Service agents who are knowledgeable
- 76%
Percentage who said Delta Dental performs "extremely" or "very
well" at having Customer Service agents who are courteous/pleasant/empathetic
- 79%
Benefits managers also believe their employees are
satisfied with Delta Dental. Three-quarters said
their employees are "extremely" or "very happy" overall.
The mission of Delta Dental Plan of New Jersey is "to
promote oral health to the greatest number of people
by providing accessible dental benefit programs of
the highest quality, service, and value." The annual
survey helps ensure that we continue to serve our
customers to the high standards set by our mission.
COB Claims Can Now Be Submitted
Online
Delta Dental expanded our online claim submission
feature. Dental offices may now submit coordination
of benefits (COB) claims online.
The following types of claims and pre-treatment estimates
can be submitted online:
- Claims with dated services no Coordination of
Benefits (COB)
- COB with carrier other than Delta Dental Plan
of New Jersey (DDPNJ)
- COB with two or more Delta Dental Plan of New
Jersey coverages
- COB with capitation
- Pre-Treatment Estimate (PTE) for non-dated services
- Payment of a PTE with no COB (must have a PTE
voucher number)
When submitting COB claims with two or more Delta
Dental coverages, simply select the type of claim
that applies. If the primary claim can process all
the way through, our system will generate the secondary
claim at the time of your submission.
If the primary claim pends, we will generate the
secondary claim when we process the primary claim.
You do not need to indicate COB in the "Comments" section.
We will know because you told us up front when you
submitted the claim type. Comments cause all claims
to pend and should only be included when the additional
information is necessary for us to process the claim
(e.g., indicating handicap status).
Online claim submission offers several advantages
for dental offices. It is done in real time, thereby
eliminating the delays the clearinghouse step usually
entails. Claims go directly from your office to ours.
There are no per-claim submission fees, whether you
submit one claim or hundreds. Payment is about 50%
faster than with paper claims.
To start submitting claims and PTEs online, go to
www.deltadentalnj.com, click on "Dentists," and log
onto Benefits Connection. First-time users must click
on "Register Now."
Key CDT-2005 Code Changes and
DeltaUSA Processing Policy Revisions
This abbreviated list includes Delta Dental Plan
of New Jersey/DeltaUSA Processing Policies as revised
to incorporate CDT-2005 as well as other policy changes.
Effective January 1, 2005, Delta Dental Plan of New
Jersey participating dentists agree to abide by these
policies. To obtain a CDT-2005 manual, you must contact
the American Dental Association catalog sales at
(800) 947-4746 or www.adacatalog.org.
CDT-2005 Procedure Code Nomenclature and Current or
Proposed DeltaUSA Processing Policy
D0277 Vertical Bitewings
(1) Vertical bitewings are considered bitewings for
benefit purposes and go against the time limit
frequencies for bitewing films in the contract.
If the fee for the vertical bitewings is equal
to or exceeds the fee for full mouth series, it
would be considered a full mouth series for payment
benefit purposes and time limitations. The fee
in excess of the fee for full mouth series of radiography
is DISALLOWED.*
(2) If the fee for the bitewing and occlusal radiographs
is equal to or exceeds the fee for a full mouth series,
it would be considered a full mouth series for payment
benefit purposes and time limitations. The fee in
excess of the fee for the full mouth series is DISALLOWED.
(3) The fee for any type of bitewings submitted with
a full mouth series are considered part of the full
mouth series for payment and benefit purposes. Any
fee in excess of a full mouth series is DISALLOWED.
(4) In the absence of contract language for bitewing
frequency limitation, bitewings of any type are DISALLOWED
within 12 months of a full mouth series.
D2910 - Recement inlay, onlay, or partial coverage
restorations
D2915 - Recement cast or prefabricated post and core
D2920 - Recement crown
D6930 - Recement fixed partial denture
(1) Delta Dental Plans consider the cementation date
to be that date upon which the completed cast post,
prefabricated post and core, inlay, onlay, or fixed
partial denture is first delivered to the mouth.
The type of cement used is not a determining factor
(whether permanent or temporary).
(2) Fees for recementation of cast or prefabricated
post and cores, inlays, onlays, crowns, and fixed
partial dentures are DISALLOWED if done within six
(6) months of the initial seating date by the same
dentist or dental office.
(3) Benefits will not be considered for payment of
a recementation until at least six (6) months have
elapsed since initial placement. At that time one
recementation may be paid. Subsequent requests for
recementation by the same provider are DENIED and
the approved amount is collectable from the patient.
Benefits may be paid when billed by a provider other
than the one who seated the bridge or performed the
previous recementation.
D2934 - Prefabricated esthetic coated stainless
steel crown--primary tooth
(1) A prefabricated esthetic coated stainless steel
crown is a benefit only on anterior primary teeth.
If submitted for a posterior primary tooth or for
a permanent tooth, an alternate benefit allowance
for D2930 or D2931 is made. The difference between
the allowance for the D2930 or D2931 and the approved
amount for the D2934 is DENIED and collectable from
the patient.
(2) A fee for replacement of a stainless steel crown
on a primary or permanent tooth by the same dentist/dental
office within 24 months is included in the initial
crown placement and is DISALLOWED. The fee for replacement
within 24 months of initial placement by a different
dentist/dental office is DENIED and the approved
amount is collectable from the patient.
(3) Benefits may be allowed with the same processing
policies and edits as a D2933 if performed on permanent
teeth and subject to individual consideration.
D2975 - Coping
(1) Copings are considered an integral part of the
final restoration. Additional fees are DISALLOWED.
D4265 - Biologic materials to aid in soft and osseous tissue regeneration
(1) D4265 (Emdogain only) may be eligible for stand-alone
benefits when reported with periodontal flap surgery
and only when billed for natural teeth and performed
for periodontal purposes. Benefits for these procedures
when billed in conjunction with implants, ridge augmentation,
extraction sites, periradicular surgery, etc., are
DENIED as a specialized or elective technique.
(2) When submitted with a D4263, D4264, D4266, D4267,
D4270, D4273, D4275 or D4276 in the same surgical
site, the fee for the D4265 is DENIED. When a D4265
is submitted with an extraction or periradicular
surgery, the D4265 is DENIED and the approved amount
is collectable from the patient. If a D4265 is reported
with D7950 or D7955, refer to medical.
D4266 - Guided tissue regeneration - resorbable
barrier, per site
D4267 - Guided tissue regeneration - nonresorbable
barrier, per site (includes membrane removal)
Benefits for guided tissue regeneration are DENIED
in conjunction with soft tissue grafts in the same
surgical area.
D6190 - Radiographic/surgical implant index,
by report
Benefits are DENIED unless implant services are covered,
per contract. Under contracts with implant coverage,
diagnostic and treatment facilitating aids are considered
a part of definitive treatment and separate benefits
for an index to the same dentist/dental office are
DISALLOWED.
D6205 - Pontic -indirect resin based composite
Benefits will be considered for a conventional fixed
prosthesis. The difference between the allowance
for the conventional prosthesis, and the approved
amount for the D6205 is DENIED and collectable from
the patient.
D6710- Crown - indirect resin based composite
Benefits will be considered for a conventional fixed
prosthesis. The difference between the allowance
for the conventional prosthesis and the approved
amount for the D6710 is DENIED and collectable
from the patient.
D7311 - Alveoloplasty in conjunction with
extractions- one to three teeth or tooth spaces,
per quadrant
The fee for D7311 performed by the same dentist/dental
office in the same surgical area on the same date
of service as surgical extractions (D7210-D7230)
is DISALLOWED.
Count bounded tooth spaces for D7311 partial quadrant
code.
A bounded tooth space counts as one space irrespective
of the number of teeth that would normally exist
in the space.
D7321 - Alveoloplasty not in conjunction
with extractions - one to three teeth or tooth spaces
per quadrant
Count bounded tooth spaces for D7321 partial quadrant
code.
A bounded tooth space counts as one space irrespective
of the number of teeth that would normally exist
in the space.
D7511 - Incision and drainage of abscess
intraoral soft tissue- complicated (includes drainage
of multiple fascial spaces)
General Policy - This procedure is by report and
is subject to coverage under medical.
The fee for surgical incision is DISALLOWED when
done on the same date (in the same operative area)
and by the same dentist/dental office as endodontics,
extractions, palliative treatment or other definitive
service.
D7953 - Bone replacement graft for ridge
preservation-per site
General Policy - This procedure is by report and
is subject to coverage under medical.
Benefits for osseous autografts and/or osseous allografts
are available only when billed for natural teeth
for periodontal purposes using periodontal procedure
codes (D4263-D4264). Benefits for these procedures
when billed in conjunction with implants, ridge augmentation,
extraction sites, periradicular surgery, etc., are
DENIED as a specialized or elective technique. If
the contract covers dental implants, this procedure
may be a benefit at the time of extraction.
D7963 - Frenuloplasty
A separate fee for frenuloplasty is DISALLOWED when
billed in conjunction with any other surgical procedure(s)
in the same surgical site.
D9450 -- Case Presentation, Detailed and Extensive Treatment Planning
(1) The fee for extensive treatment planning is DENIED
and the approved amount is collectable from the patient.
(2) The fees for routine treatment planning and case
presentation are considered inclusive in an evaluation
and are DISALLOWED.
(3) The fee for extensive treatment planning may
be benefited for complex treatment planning cases
involving multiple treatment disciplines and multiple
providers of care.
(4) When covered, the D9450 is subject to the same
frequency limitations and processing policies as
a comprehensive evaluation (D0150).
D9942 - Repair and/or reline of an occlusal
guard
(1) An occlusal guard and related repair and/or reline
are not a covered benefit unless it is contract specific.
The fee is DENIED.
(2) If covered contractually, the fee for the occlusal
guard includes any adjustment or repair required
with six (6) months of delivery. Fees for the adjustment
or repair of the occlusal guard are DISALLOWED if
performed by the same dentist/dental office within
six (6) months of initial placement.
(3) General Policy- If covered contractually, the
fee for repair of an occlusal guard cannot exceed
one-half of the fees for a new appliance, and any
excess fee is DISALLOWED.
Local Variation: Delta Dental Plan of New Jersey may utilize the DeltaUSA
National Account Processing Policies as previously set forth or the following
variations on said processing policies where Delta Dental Plan of New Jersey
is the Delta Dental Plan that has contracted to provide dental coverage.
Restoration with subsequent crown
DeltaUSA:
General Policy - If a cast restoration is performed
by the same dentist within 24 months of the placement
of an amalgam or composite restoration, the Delta
Dental payment and patient co-payment allowance for
the amalgam or composite restorations will be deducted
from the cast restoration benefit.
Delta Dental Plan of New Jersey:
General Policy - If a cast restoration is performed
by the same dentist within 12 months of the placement
of an amalgam or composite restoration, the Delta
Dental payment and patient co-payment allowance for
the amalgam or composite restorations will be deducted
from the cast restoration benefit.
* As a reminder, the term "DISALLOWED" indicates
that there is no Delta Dental or patient payment
for this service.
Benefit coverage for these procedures may vary by contract.
Delta Dental Receives 'AA-' Rating
From Standard & Poor's for Fifth Consecutive
Year
Standard & Poor's (S&P) recently affirmed
Delta Dental Plan of New Jersey's "AA-" counterparty
credit and financial strength ratings for the fifth
consecutive year. The company's capital position,
earnings and business position were cited as the
major rating factors.
Delta Dental's continued high ratings are especially
meaningful in the context of a challenging economy.
The company has maintained a superior level of capital
adequacy, which provides both flexibility and growth
opportunities. Earnings, which increased 50 percent
from the previous year, came from a balance of underwriting
gains and investment income.
"The brokers and consultants we work with feel confident when offering Delta
Dental to their clients because of our financial strength and stability," said
president and CEO Walter VanBrunt. "We have been operating in New Jersey for
35 years, and some of our sister Delta Dental Plans have been around for 50
years. We are proud of the fact that Delta Dental Plan of New Jersey remains
one of the most highly rated dental plans in the country."
In addition to the economic assessment, Delta Dental
was also evaluated on its business position. It received
a ranking of "good" based on a variety of factors
including size, market share and competition. The
company is the largest provider of group dental benefits
in New Jersey and has the largest network in the
state. Furthermore, through its access to the Delta
Dental Plans Association's national network, Delta
Dental also offers access to the largest dental network
in the country.
"As a single-line carrier, our expertise remains focused on offering the best
quality dental benefits to our clients," said VanBrunt.
Studies show that dental coverage continues to be
a popular benefit among employees, ranking second
only to medical benefits. A properly designed benefits
plan has the potential to positively impact the retention
of valued staff. Delta Dental is able to offer a
variety of programs that make it easy, affordable
and convenient for employers to provide comprehensive
dental benefits through a strong commitment to innovation
and cost-sharing arrangements, and business partnerships
with sister Delta Dental Plans.
"Delta Dental's mission is to promote oral health to the greatest number of
people by providing accessible dental benefit programs of the highest quality,
service and value," said VanBrunt. "Continued strong S&P ratings affirm
that we are a sound company to do business with."
Benefits Connection Spotlight:
Keith Bohleke, Quality Dental Care
Quality Dental Care in Vineland, New Jersey, is
one of the top 10 dental offices using Delta Dental's
Benefits Connection. Benefits Connection allows dental
offices to verify patient eligibility and benefits
online.
We recently asked Keith Bohleke, the office's insurance
coordinator, why Quality Dental Care uses Benefits
Connection.
"It's by far the quickest method for verification of patient eligibility and
benefits," he says. "We can immediately obtain 90% of the information we require
going online."
Bohleke started using Benefits Connection while working
at another dental office. He's used it steadily since
joining Quality Dental Care in February 2003.
"It's especially useful when patients present at our office in an emergency
situation," Bohleke adds. "Their situation deserves immediate attention. It's
much easier and faster to go online to get the information we need. It allows
our office to operate more efficiently, and patients appreciate the immediate
response we can provide should they have concerns about coverage."
Benefits Connection 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.
Tech-Niques: Understanding Your
Internet Connectivity Options
By Linda Hetcher, Vice President Professional
Services, Concurrent Technologies
Once you decide that the Internet will benefit your
practice, the next question is, what type of connection
should you use?
Most dental offices will have three options to consider:
- Dial-up access, which uses a modem to send and
receive digital data over a telephone line.
- Digital Subscriber Line (DSL), which offers a
higher speed connection than dial-up access and
uses existing telephone wiring.
- Cable, which provides high-speed connections
using the cable network originally developed for
transmitting television channels.
The chart at the end of this article compares the
three options.
For more information about Internet options, visit
the following Web sites:
- http://www.broadbandreports.com/, which provides
information on price, availability, quality and
reliability of various broadband (high speed) options.
- http://reviews-zdnet.com.com/, which provides
technology reviews and other information.
Most Internet Service Providers (ISPs) have Web
sites, which include specific information about their
services. Popular ISPs include:
The good news is that connection speeds are faster
and ISP prices are lower than ever. Competition is
fierce, and ISPs offer frequent promotions to lure
new customers. Be sure to ask about any discounts,
trials and a detailed explanation of the total package
offered.
Be aware that both DSL and cable connectivity have
their own supporters based on their particular needs,
preferences and past experiences. However, the business
of providing and supporting connectivity services
is moving toward standardization.
As always, weigh the options available with respect
to time vs. expense and also ask the necessary security
questions, especially where the exchange of patient
data is involved.
Remember that no connection is 100% guaranteed secure.
Password protection, firewalls and data encryption
are critical when handling sensitive information.
| Features |
Dial-up Access |
Digital Subscriber
Line (DSL) |
Cable Modem |
Configuration
|
Uses a standard
phone line.
|
Uses existing
telephone copper wire, twisted pair.
|
Uses existing
cable coaxial or fiber from the cable company. |
How it connects
to Internet
|
Works like a
phone except it's a computer-to-computer
instead of person-to-person connection. You
dial up an Internet Service Provider access
telephone number to connect your computer
to Internet.
|
Enables the
user to take advantage of extra telephone
line capacity (which regular telephone service
cannot do) so you can use the Internet while
also talking on the phone using the same
line. The connection is "always on." |
Enables the
user to take advantage of extra bandwidth
available on TV cable to connect to the Internet.
The connection is
"always on."
|
Cost*
|
Cost of your
monthly phone bill. Toll charges may apply
if your Internet Service Provider is out
of your immediate area.
|
Installation
ranges from $100 to $300, plus monthly fees
from $80 to $300 for business.
|
Installation
ranges from $75 to $200, plus monthly fees
from $80 to $300 for business.
|
Speed*
|
Slow; maximum
speeds 56 Kbps (56,000 bits of data per second).
|
Very high speed
compared to dial-up; generally 128 Kbps to
1.5 Mbps (1.5 million bits of data per second)
for downloading. DSL comes in various
"flavors," some of which make a
difference in uploading vs. downloading speed.
|
Very high speed.
The average is 500 to 700 Kbps for downloading.
Cable companies can throttle or limit your
speed.
|
Equipment required
|
Modem, computer,
phone connection.
|
DSL modem (usually
included as part of the installation), computer,
DSL line. |
Cable modem,
cable connection.
|
Availability
|
Wherever there
is a telephone line. It is also possible
to connect via a wireless cell phone connection. |
Although prevalent
in some areas, DSL is not available everywhere.
|
Although prevalent
in some areas, cable is not available everywhere.
|
Causes of performance
degradation
|
Connection speed
depends on the line quality. The modem tests
the line and falls back to lower speeds if
the line can't handle a faster connection.
|
DSL is distance-sensitive.
The computer must be located no more than
18,000 feet (3.4 miles) from the provider's
central office. Connection speed degrades
with distance. Those located a mile from
the central office will usually have a better
quality connection than those 3 miles away. |
Up to 1,000
users can connect to the Internet through
a single channel. Connection degradation
occurs as the number of people sharing a
channel increases.
|
*Cost and speed of each option are only estimates.
The actual cost and speed depend on many factors,
including your practice's ISP. You should ask prospective
ISPs about expected costs and speeds for their plan.
Please note that Delta Dental is not guaranteeing
or endorsing any of the ISPs mentioned. The article
is for information purposes only.
Concurrent Technologies designs and develops custom
Web-based interactive solutions for a diverse clientele
ranging from Fortune 500 companies to non-profit
organizations. In the business for over 18 years,
Concurrent Technologies is a total solution provider
(TSP) offering a range of services from e-business
strategy to complete technology outsourcing. For
more information, visit them at www.concurrenttechnologies.com or
call 800-345-3895.
Delta Dental Donates to Three
Clinics
In an ongoing effort to positively impact the state's
oral health, Delta Dental Plan of New Jersey Foundation,
Inc. recently made donations to the Ocean Health
Initiatives clinic in Lakewood, NJ, the Dover Community
Clinic in Dover, NJ, and the Northwest New Jersey
Dental Coalition's UMDNJ (University of Medicine
and Dentistry of New Jersey) Dental Center in Newton,
NJ.
Ocean Health Initiatives
Delta Dental's grants have supported the clinic since
2001. In addition to offering dental care, Ocean
Health Initiatives provides adult internal medicine,
pediatric and OB-GYN services to thousands of people,
ranging from newborns to seniors, who are otherwise
unable to afford a visit to the doctor or dentist.
The clinic also recently expanded its services
to include behavioral health and podiatry care.
"Ocean Health Initiatives is such a valuable resource
for this community. It is exactly the type of organization
that our Foundation looks to support because they
make a difference in so many lives each and every
day," said Diane Belle, vice president, Delta Dental
Plan of New Jersey Foundation, Inc.
Several Ocean Health Initiatives staff members are
bilingual, which is helpful for the significant number
of Hispanic patients who rely on the clinic. Its
downtown location also makes the clinic accessible
for patients without a car or the means to afford
public transportation.
Ocean Health Initiatives was originally part of
the Kimball Medical Center, an acute care hospital
serving Ocean County, until cuts in Medicaid and
Medicare prompted directors to research alternatives. "We
decided that we could expand our services and reach
even more individuals by becoming a federally funded
independent clinic," said Dr. Theresa Berger, executive
director. In December 2003, the clinic began to operate
independently, and in March 2004 it received federally
qualified health center status.
"Government funding, as well as the corporate support
we receive from companies such as Delta Dental, has
allowed us to increase our hours, offer new services
and receive enhanced reimbursements to help more
patients get the medical attention they need," Dr.
Berger said.
Dover Community Clinic
The clinic provides low cost, high quality, culturally
and linguistically appropriate medical and dental
care to low-income families in Morris County and
surrounding areas. Delta Dental's grant will be
used specifically to support the clinic's dental
initiatives.
The Dover Community Clinic was founded in April
1990 by Dr. Bob and Kay Zufall to provide primary
care services. Today the staff is comprised of retired
specialists in a variety of fields including urology,
cardiology, ophthalmology and oral surgery. The staff
dentist, who saw close to 1,250 patients last year,
is on site about three days a week. Several staff
members are bilingual, which is helpful for the largely
Hispanic patient population.
"Delta Dental strives to increase access to care
and improve oral health throughout the state," said
Walter VanBrunt, vice president, Delta Dental Plan
of New Jersey Foundation, Inc. "We support the Dover
Clinic's outreach to this community and continue
to provide financial assistance to ensure the continuation
of the valuable services they deliver."
The biggest challenge the clinic faced early on
was cancellations and "no-shows," until it began
attaching a modest fee to their services. Patients
are asked to make a contribution, based on a sliding
scale according to ability, at the time they make
their appointment. This helps the clinic to meet
its goal of providing care and access to those who
need it.
According to Kay Zufall, who serves as clinic administrator, "We
offer traditional preventive dental services, but
many low-income families don't seek dental care unless
something actually hurts. We can do dentures, root
canals, crowns, and oral surgery by referral. But
part of our mission is to educate patients about
the importance regular dental care plays in their
overall health."
The clinic currently sees low-income patients from
Dover, Morristown, Parsippany, Randolph and Rockaway.
The clinic sometimes receives inquiries from patients
outside the county. When that happens, staff members
usually assist that individual in finding a clinic
that's closer to home. The goal is not to take private
patients away from practicing dentists, but rather
to offer services to those who would otherwise go
without care because they cannot afford it.
Zufall says that the clinic recently began working
with the Wharton school system to focus efforts on
treating children. The school nurse will do preliminary
screenings and make referrals to the clinic based
on individual need. The clinic hopes to expand this
service to other local areas.
Newton Dental Clinic
The grant will be used to support the continuation
of preventive and restorative dental care for those
in Sussex and Warren counties who are uninsured
or rely on Medicaid for health care. Delta Dental's
funds will be used to defray operating costs of
the program and to provide services directly to
patients.
Currently, there appears to be only one dentist
in Sussex County and very few in Warren County who
will accept Medicaid patients. According to NORWESCAP
Perspectives of Low Income People in Northwest New
Jersey, there are approximately 5,900 Sussex County
residents and 6,700 Warren County residents who are
below 100 percent of the poverty guideline ($17,650
for a family of four). Approximately 27% of Sussex
County low-income residents and 38% of Warren County
low-income residents cited dental care as an unmet
need.
"It is part of our mission to support organizations
that directly impact the oral health of underserved
populations in New Jersey," said VanBrunt. "The Newton
Clinic is a wonderful resource for families who are
otherwise unable to afford adequate dental care."
Patients are referred to the UMDNJ Dental Center
in Newton by a number of sources, including the Bureau
of Social Services; NORWESCAP; school nurses; Domestic
Abuse Services, Inc.; the Division of Aging and more.
"There is a dire need in this community for the
dental services our clinic provides," explained Deb
Fisher, president of the Board of Directors for the
Northwest New Jersey Dental Coalition. "We are fortunate
to have a wonderful, state-of-the-art facility, but
we rely on the support of organizations like Delta
Dental to keep our doors open and provide access
to dentists for those in need."
Submission of Claim Forms Checklist
Have you...?
Correct Date
- Correctly and accurately reported every date
that a dental service was performed on, or a dental
procedure performed on more than one date was completed
on?
Correct Treatment
- Correctly and accurately reported each dental
service or procedure that was rendered?
Coordination of Benefits
- Correctly and accurately reported all other insurance
carrier coverage and payments that cover these
dental services, as well as your maximum allowable
charges (MAC) under that plan?
Disclosure of Waiver
- Legibly and conspicuously disclosed on the face
of the claim form any intention to waive all or
part of a patient's copayment responsibility?
Disclosure of Discounts
- Correctly and accurately reflected any discounts
extended to the patient for these services?
Disclosure of Coupon Use
- Correctly and accurately reflected any reduced
fees that resulted from the use of coupons?
Disclosure of "Free" Services
- Correctly and accurately reflected only services
actually being charged to the patient's ledger?
Services Not Performed
- Performed every service or procedure that is
being submitted for payment?
Identification of Appropriate Dentist
- Correctly indicated both the billing dentist
and the treating dentist's name and license number?
Barter
- Correctly and accurately reported only the actual
dollars being collected for the services on the
claim form and not the value of any "barter" exchanged?
ADA Helps Kids Answer Question,
"What Do You Want To Be When You Grow Up?"
The American Dental Association (ADA) has devoted
part of its Web site to educating students about
various dental careers. The site includes information
about becoming a dentist, dental hygienist, dental
assistant and dental lab technician.
The site includes details about each profession,
the training required, career options, future opportunities
and expected salaries.
For more information, go to www.ada.org/public/education/careers/index.asp.
Wanted: Used Dental Equipment
for Clinics
Do you have used dental equipment that you no longer
need? If it is still in working order, please let
us know. The Delta Dental Plan of New Jersey Foundation
funds several clinics that cannot afford to purchase
equipment, and they would welcome the opportunity
to upgrade their equipment at no cost. Please e-mail
Diane Belle at dbelle@deltadentalnj.com.
Captain Supertooth Begins Tour
in January, February
Delta Dental's Captain Supertooth rides again! To
celebrate National Children's Dental Health Month,
the caped superhero of dental hygiene will visit
school children in January and February to promote
the importance of early preventive dental care and
teach them proper oral care. In addition, Captain
Supertooth made 14 appearances in October 2004.
The Captain Supertooth program is part of Delta
Dental's ongoing initiative to spread the word that
oral health is vital for good overall health.
Captain Supertooth visits schools armed with a larger-than-life-sized
toothbrush and other fun props. During the 20-minute
program, the Captain shares helpful "teeth" tips,
such as using toothpaste in a pea-sized amount on
a soft-bristled toothbrush, remembering "don't rush
when you brush" by brushing for at least one minute,
eating a balanced diet, and visiting their dentist
for regular check-ups. The program is geared for
children in kindergarten through second grade, and
is provided by Delta Dental as a free public service.
Since the program began in 1990, Captain Supertooth
has instructed nearly 41,000 schoolchildren about
proper dental care. Captain Supertooth programs will
take place at eight Connecticut schools in late January
and 30 New Jersey schools throughout February.
Phone: (800) 735-3379
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