Articles
New Oral Cancer Early Detection Tool
Now Offered as Delta Dental Benefit
Subscribers Give DeltaCare Dental
HMO High Ratings in Survey
PANDA Program Helps Dentists, Others Fight Child
Abuse
Claims, Customer Service Performance Remain
High in 2004
Just Two Months Until Golf Outing
Electronic, Online Claims Save Dental Offices
Time, Money
Bobbi Homeyer Named Manager, Network Development
Data Reveals Dentists' Best Tools for Kids' Oral Health
Did You Know That... Claim Forms Must Reflect Date Service Completed
HIPAA Security Rule Effective April 21
When Patients Have DeltaUSA Coverage
Thanks for Dental Offices for Dental Equipment
Participating Dentist Handbook Reminder
Hints for Faster Processing of Paper Claims
FastAttach Discount through July 31
New Oral Cancer Early Detection
Tool Now Offered as Delta Dental Benefit
Delta Dental of New Jersey is pleased to announce
coverage for a new procedure that helps detect oral
cancer at early stages.
The brush biopsy (procedure code D7288—brush
biopsy, transepithelial sample collection) makes
it possible for dentists to test patients with unexplained
red or white oral lesions right in the office. The
simple procedure can be done during the course of
a regular exam, and involves little or no patient
discomfort.
Unexplained red or white spots occur in about 10%
of patients. Usually, these spots are harmless, but
they can be warning signs of oral cancer. Only about
half of those diagnosed with advanced oral cancer
survive more than five years. Early detection, however,
significantly improves a patient’s outlook
for long-term survival.
Until recently, methods for dentists to tell if a
spot had the potential to turn into cancer were limited.
If the brush biopsy test detects atypical or pre-cancerous
cells the patient is referred for a definitive diagnosis
via a scalpel biopsy.
With the brush biopsy, the dentist uses a small brush
to collect tissue. The tissue is sent to CDx Laboratories,
Inc., for testing and diagnosis. CDx Laboratories,
based in Suffern, New York, developed the procedure.
More information about the company is available at
www.oralcdx.com.
Delta Dental of New Jersey covers the brush biopsy
procedure itself upon confirmation of the laboratory
analysis of the specimen. In most cases, the patient’s
medical plan reimburses for laboratory analysis.
The brush biopsy is now being taught as standard
practice in many dental schools in the United States.
Delta Dental is developing continuing education modules
on brush biopsy. The American Dental Association
gave brush biopsy its Seal of Acceptance.
“Oral cancer is a devastating disease,” says Dr. Scott Navarro,
dental director, Delta Dental of New Jersey. “It can destroy your ability
to communicate and obtain nourishment, as well as destroy your appearance,
and ultimately may take your life. In spite of advances in cancer treatment,
the survival rate of oral cancer has not risen significantly in the last 40
years. Early detection is the key to improving not only the survival rate but
also the quality of life for those victims of oral cancer. Delta Dental of
New Jersey is pleased to do its part in not only providing benefits for this
early detection procedure but also in educating the public and profession regarding
this valuable new tool in the fight against oral cancer.”
Delta Dental will also continue to cover traditional
scalpel biopsies for oral cancer.
Delta Dental is offering free online training on
the brush biopsy. For more information, go to www.deltadentalnj.com,
and click “oral cancer training” in the “What’s
New” box.
Oral Cancer Facts
- 8,000 people in the U.S. each year die from oral
cancer.
- 30,000 new cases of oral cancer are diagnosed
each year.
- Oral cancer kills as many Americans yearly as
melanoma, and almost twice as many Americans as
cervical cancer.
- The five-year survival rate for those with advanced
forms of oral cancer is just 57%; it has not improved
in the last 40 years.
- When detected early, oral cancer survival rates
increase dramatically (to 81% or more).
- The average cost of treating an advanced case
of oral cancer is $200,000. Treatment costs for
cancers detected earlier, especially in pre-cancerous
stages, are significantly less.
Who Is At Risk for Oral Cancer?
Oral cancer can strike anyone. At particular risk
are:
- Smokers;
- African Americans;
- Users of smokeless tobacco;
- Those who excessively consume alcohol.
However, 25% of those diagnosed have no risk factors
at all!
- The incidence of the disease is on the rise among
women under 40 and nonsmokers.
Subscribers Give DeltaCare Dental
HMO High Ratings in Survey
A recent survey of Flagship Dental Plan’s
DeltaCare subscribers found that nearly 9 out of
10 are satisfied overall with their dental benefits
program.
DeltaCare subscribers reported satisfaction in all
categories, including the information provided by
DeltaCare (94%), plan coverage (87%), access to participating
dentists (84%), quality of care (89%), and the Customer
Service Department (90%). One subscriber surveyed
said, “I have dealt with many customer service
reps over the years from many different companies
and most of the reps never followed through to fix
the problem. Your reps are great!”
Subscribers are also satisfied with the size of the
DeltaCare network. Seven in 10 subscribers voiced
satisfaction with the number of dentists from which
to choose, up from 58% in 2002. The dental network
includes 338 primary care physicians and 295 dental
specialists.
Additionally, 95% of subscribers said their oral
health was the same or better than in the previous
year.
A random sample of 222 DeltaCare subscribers responded
to the survey, which was conducted in the fall 2004.
Brownstone Information Resources of Morristown, New
Jersey, conducted the survey for Flagship Dental
Plans. Flagship Dental Plans is a wholly owned subsidiary
of Delta Dental of New Jersey. Flagship underwrites
and administers the DeltaCare product, a managed
dental care program.
PANDA Program Helps Dentists,
Others Fight Child Abuse
Each year 40,000 cases of abuse and neglect are
reported to the New Jersey Division of Youth and
Family Services. Every 11 minutes a child is reported
abused or neglected in the United States. More than
three children die each day from abuse or neglect.
Would you be able to recognize an abused child?
The signs of abuse aren't always obvious. That's
why 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.
The PANDA presentation is a one- to three-hour slide
program and workshop conducted by trained professionals.
The PANDA 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.
Sidebar: Delta Dental Supports Blue Ribbon Campaign Against Child Abuse
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 250,000 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 (732) 246-8060 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 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.
Claims, Customer Service Performance
Remain High in 2004
Delta Dental continued to maintain excellent service
levels in 2004, according to the company's 2004 Operations
and Customer Service Reports. Here is a snapshot
of some of our 2004 statistics:
Total number of claims
2.89 million
Number of electronic claims
1.33 million (46.2% of all claims)
Number of claims filed over the Internet through Benefits Connection (www.deltadentalnj.com)
35,600 (average 3,000 per month)
Average claims turnaround time
7.4 business days
99.9% of claims processed within 30 days
Accuracy rates
Key accuracy measures (clerical accuracy, payment
accuracy and dollar accuracy): 99% or higher
Call Center statistics
Average speed of answer: 30 seconds
Calls answered within 20 seconds: 67%
Abandon rate: 1.3%
Correspondence
Responses sent within 15 days: 98%
Just Two Months Until Golf Outing
The 15th Annual Delta Dental Golf Classic takes
place June 22nd at the Fiddler’s Elbow Country
Club in Bedminster, New Jersey. The annual event
benefits Special Olympics New Jersey (SONJ). SONJ
is a non-profit organization that provides athletic
training and competition for children and adults
with developmental disabilities.
Registration and sponsorship materials are available.
For more information, please call Jennifer Appaluccio
at (973) 285-4059.
Electronic, Online Claims Save
Dental Offices Time, Money
Here are five reasons why your dental practice should
switch from paper claims to online or electronic
claims.
- They reduce postage and costs. It costs
dental offices absolutely nothing to file claims
using Delta Dental’s online Benefits Connection.
(Costs for filing electronic claims, through dental
practice software, will vary.) There’s no
need to buy stamps or envelopes. Estimates from
within the Delta Dental system predict that a dentist
who files 40 claims per week could reduce annual
expenses by more than $11,000, just by switching
to electronic claims submission.
- There are fewer forms and stationery to manage. There’s
no need to keep claim forms stocked, and no worry
about running out of forms.
- Online saves time. Your practice will
spend less time on paperwork, claims tracking and
telephone calls by filing online or electronically,
so you can dedicate more time to patient care.
- Online claims flag potential problems before
sending. Delta Dental’s online claims
submission system alerts you if you’ve
forgotten required information and requires you
to enter the information before a claim can be
submitted. For instance, if a procedure code
requires a tooth number, you cannot proceed without
entering the tooth number. The system lets you
correct mistakes and omissions before they delay
processing. The system will also tell you which
procedures require diagnostic material.
- Your practice receives payment faster. Electronic
and online claims can be processed in half the
time it takes to process paper claims. In fact,
most claims filed online are processed immediately!
Reduced turnaround time for payments can help a
dental office improve its cash flow.
Bobbi Homeyer Named Manager,
Network Development
Delta Dental recently named Bobbi Homeyer Manager
of Network Development.
The Network Development Department serves as liaison
between participating dentists and Delta Dental.
Homeyer supervises our three dental network coordinators,
who visit participating dentists to answer questions
about participation, claims, and processing policies;
provide plan descriptions; demonstrate how to use
online Benefits Connection and submit online claims;
describe the features of our value-added In-Net discount
program, and more.
Homeyer also is responsible for managing Delta Dental’s
dentist credentialing program.
She joined Delta Dental 10 years ago, and most recently
served as Supervisor, Correspondence Team in Customer
Service. The Correspondence Team handles all letters
and e-mails to and from Customer Service, as well
as processes and tracks all claims appeals. In that
position, Homeyer worked hard to forge good relationships
between Delta Dental and our customers.
Before coming to Delta Dental, Homeyer managed dental
offices in Denville and Rockaway, New Jersey. “I
know the issues dental offices face, and look forward
to working with dentists in my new role,” she
says.
She will be attending the Connecticut and New Jersey
State Dental Association Conventions. (Connecticut’s
convention is May 12-14; New Jersey’s is June
8-10.) If you will be attending, be sure to stop
by the Delta Dental of New Jersey booth to meet her.
Data Reveals Dentists' Best Tools
for Kids' Oral Health
A new analysis of dental claims data shows that
sealants and professional fluoride treatments are
playing a huge role in helping kids fight tooth decay.
The data from this recent analysis support what most
dentists recommend: Regular visits to the dentist
for cleanings and preventive care.
Analysts from the Data and Analysis Center (DAC)
tracked dental benefits claims from nearly 500,000
enrollees within the Delta Dental system from 1998
to 2003. The claims covered children and adolescents
6 to 15 years old who, after receiving sealants,
were 78% less likely to need fillings.
Children who also received up to five professional
fluoride treatments during the five-year period were
87% less likely to develop cavities. When kids with
sealants received more than five fluoride treatments
in the five-year period, they were protected from
new cavities in 93% of the cases.
"We've known for a long time that sealants are effective, but a boost of almost
16% from fluoride treatment is noteworthy," said Dr. Scott Navarro, dental
director, Delta Dental of New Jersey.
Dr. Navarro added that sealants were the ninth most
common dental procedure among children in 2003. That
figure comes from a separate review of claims for
patients in the 2- to 18-year age range. It showed
that 240,847 patients submitted claims for sealants
in 2003 and 1.3 million patients in the age range
submitted claims for fluoride treatment. The review
also indicates that some 2.2 million kids received
treatments such as fillings, extractions, crowns
and pulpotomies in 2003. Pulpotomy is a treatment
for deep decay that goes through the outer layers
into the heart of a tooth.
“The goal of preventive care is to try to avoid dental problems altogether," said
Dr. Navarro. "The encouraging news is that the recommended course of action
is simple - brush at least twice daily, floss once each day and visit your
dentist regularly."
The Data and Analysis Center is an investor-owned,
for-profit company of dental science experts and
business analysts who manage the country's most extensive
claims-based dental health data warehouse. The DAC
evaluates treatment outcomes based on evidence from
millions of dental insurance claims submitted from
every state in the nation.
Did You Know That... Claim Forms
Must Reflect Date Service Completed
A dental provider must correctly report to Delta
Dental of New Jersey the date that accurately reflects
when the service or procedure rendered was completed.
Correctly submitting the date of service for a dental
procedure on a claim form may seem fundamental, but
it is not always done. Inaccurate dates may be the
result of office policy. For example, an office may
always submit the start dates for root canal therapy
instead of the finish dates, or the preparation dates
for crowns instead of the cementation dates. Conversely,
the submission of inaccurate dates may be intentional,
such as when the date of a standard recall visit
is changed in order to maximize benefits.
The submission of inaccurate or misrepresented dates
is one of the unacceptable billing practices reviewed
during the claim verification process. The incorrect
submission of the date of a service can result in
overpayments that are recoverable. If claim forms
are intentionally submitted in this fashion, 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 4, Form
Completion and Chapter 11, Claim Verifications
HIPAA Security Rule Effective
April 21
The Security Rule of the Health Insurance Portability
and Accountability Act (HIPAA) becomes effective
for most covered entities--including dental offices--on
April 21, 2005.
The Security Rule is designed to protect the confidentiality,
integrity, and availability of protected health information
(PHI) that is stored on computer systems or removable
media, or transmitted across computer networks. To
comply, dental offices must develop physical, technical
and administrative safeguards to ensure the security
of electronic PHI.
The Security Rule focuses on external threats (such
as viruses, e-mail attacks and hackers attempting
to steal proprietary information) and internal threats
(such as a patient's PHI inadvertently being exposed
to public view, or malicious insiders who misuse
PHI).
As covered entities, dental offices must establish
reasonable and appropriate safeguards to protect
the confidentiality, integrity, and availability
of their electronic PHI. The American Dental Association
(ADA) recommends:
- Appointing a security officer, who may also be
the privacy officer and contact person (and may
be the dentist).
- Establishing administrative safeguards. These
are documented procedures for limiting PHI access
to appropriate parties and guarding information
from all others.
- Establishing physical safeguards. These detail
how to protect computer systems and related buildings
and equipment from hazards and intrusion. Steps
may be as simple as locking doors when no one is
in the office.
- Establishing technical safeguards. These are
processes to protect and monitor information access,
both internally and while transmitting data over
networks. These may include password protections
and back-ups of patient records.
A copy of the full Security Rule is available at
http://www.cms.hhs.gov/hipaa/hipaa2/regulations/security/03-3877.pdf.
When Patients Have DeltaUSA
Coverage
What if your patient insists he or she has Delta
Dental coverage, but there’s no record when
you check eligibility using Delta Dental of New Jersey’s
online Benefits Connection?
Your patient may have DeltaUSA coverage. Delta Dental
Plans offer dental programs to national account groups
under the DeltaUSA banner.
If your patient works for a company headquartered
outside of New Jersey or Connecticut, he or she is
probably covered by another Delta Dental Plan rather
than Delta Dental of New Jersey.
You can verify coverage of DeltaUSA patients by visiting
the Delta Dental Plans Association portal at www.deltadental.com;
click “Dentists,” then “Dentist
Connection” and follow the prompts.
DeltaUSA claims are submitted to the patient’s
Delta Dental Plan, no matter where the patient is
treated. When you treat DeltaUSA patients, you
will be reimbursed at Delta Dental of New Jersey
rates. If your patient is covered by Delta Dental
of California, for example, claims should be sent
to Delta Dental of California. Address information
for all Delta Dental Plans is available at www.deltadental.com;
click “Dentists,” “Contact Us,” and “Plan
Locator.”
Questions can be e-mailed to us at service@deltadentalnj.com,
or by calling Customer Service at (800) 452-9310.
Thanks to Dental Offices for
Dental Equipment
The Delta Dental of New Jersey Foundation thanks
the many dental offices that responded to our request
for used dental equipment. The equipment will be
used by several nonprofit clinics that cannot afford
to purchase equipment.
Participating Dentist Handbook
Reminder
Delta Dental mailed the new Participating Dentist
Handbook on CD to all participating dentists in New
Jersey and Connecticut late last year. The new handbook
includes everything offices need to know about participating
with Delta Dental of New Jersey. If you did not receive
the Participating Dentist Handbook CD, please call
your dental network coordinator at (888) 396-6641.
Hints for Faster Processing
of Paper Claims
Delta Dental of New Jersey recently began using
a new system for scanning claim images. It includes
Optical Character Recognition (OCR), a technology
that is able to read and interpret typed or handwritten
information on each claim form. The system then creates
a data file, which is loaded into Delta Dental’s
claims processing system.
This system has proven to be a very accurate, efficient
and reliable data capture system. Many claims process
automatically, resulting in fast and accurate claims
payments.
To help ensure that your paper claims are processed
accurately and quickly, please:
- Use only an ADA approved form containing all
necessary claims processing information. Do
not use pre-printed or computer-generated speed
forms. Delta Dental’s policy is to not
accept “super bills.”
- Submit original claims, not photocopies. If
a photocopy must be submitted, be sure that it
is clear and has not been copied more than once.
- Be sure your printer provides clear, dark
prints. All information should print completely
in the appropriate fields on the claim form.
Make sure the forms are aligned in your printer
accordingly.
- Send claims in the mail rather than by fax. Faxing
decreases the print quality of the claim. If a
claim must be faxed, be sure to fax clear, original
claim forms.
- Include Delta Dental’s letter or EOB
if resubmitting a claim in response to a request
for additional information. This will ensure
that the returned claim is not mistaken for a
new, duplicate claim.
- Follow the appeal instructions on the back
of the EOB if requesting an appeal. This
will ensure the appeal is not mistaken for a
new or duplicate claim.
FastAttach Discount through
July 31
FastAttach™ enables dental offices
to transmit x-rays, perio charts, photographs, proof
of primary payments, narratives, and other attachments
for payors to view in support of electronic claims.
Submitting electronic attachments is surprisingly
easy and affordable. It does not matter what dental
software you use, as long as you have Microsoft Windows
98 or higher.
As a special promotion for Delta Dental of New Jersey
participating dentists, National Electronic Attachment,
Inc. (NEA) has agreed to discount the normal $200
registration fee by 75% ($150 savings) until July
31, 2005. This means you can get the FastAttach
software, installation, and training for only $50.
For more information, please visit
www.nea-fast.com and enter “DDNJ” in
the light blue promotion code box, or call NEA at
(800) 782-5150, ext. 2. Be sure to mention the Delta
Dental of New Jersey special promotion.
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