Articles
New Software Turns Paper Claims Electronic
2004 Annual Report Published
Blood Pressure Screening: Converting Policy to Practice
Delta Dental of New Jersey Donates $35,000 to Henry J. Austin Health Center
New Pages Not Necessarily Yellow: Promoting Your Practice on the Web
Dentists Now May Apply for National Provider Identifier (NPI) Number
Frequently Asked Questions About the NPI
Golf Outing Results Available Shortly
Did You Know That Misrepresenting Treatment is Fraud?
Online Brush Biopsy Training Available
Finding Claim Status Fast

New Software Turns Paper Claims Electronic 

In 2004, Delta Dental’s data entry operators keyed in more than 1 million paper claims into our system. 

The process is now much easier, thanks to new optical character recognition (OCR) software that went live last October. 

First, every paper claim is scanned. Each operator can scan more than 1,000 claims per hour. Then the OCR software, developed by Recognition Research Incorporated (RRI), automatically lifts critical information from each claim and loads it into Delta Dental’s claims database. 

In most cases, little or no operator intervention is required. “RRI essentially transforms a paper claim into an electronic claim,” says Georgann Magaw, Manager, Claims. 

About 52% of claims submitted to Delta Dental are paper claims. The other 48% are electronic claims, submitted by dentists online or via dental practice management software. 

RRI means that 100% of all claims, including paper claims, become “electronic.” Electronic claims, which cost less to process and process faster than paper claims, help contribute to both cost containment and service improvements. 

Sidebar: Helping OCR “Read” Faster

Please help us process your claims faster! Before submitting paper claims to Delta Dental, please do the following:

• If your claim form is computer printed, please check that the form is lined up properly in the printer. Misaligned claim forms can cause the printer to print text on lines. When this happens, the system can’t read it.
• If you complete claim forms by hand, please print (rather than handwrite) all information.
• If the procedure cost is in dollars only (it includes no cents), don’t include the dollar sign or decimal point. Putting a decimal point followed by two zeros can delay processing of the claim.
• Don’t print near or over pre-printed information. The system won’t be able to read what you wrote.

2004 Annual Report Published

Delta Dental's 2004 Annual Report – Celebrating 35 Years of Serving Our Community - is now available. The report highlights how Delta Dental has made oral-health history since our founding in 1969. We continued making history in 2004. Milestones featured in the 2004 Annual Report include:

• Adding coordination of benefits (COBs) to our online claims submission feature. Dentists may file claims, including claims involving COBs, and check claim status online using our online Benefits Connection.
• Receiving the first “Internal Customer Service Operation of the Year” award from the Garden State Chapter of the International Customer Service Association. In addition, subscribers rate us highly in customer satisfaction surveys year after year. 
• $2 million grant to the University of Medicine and Dentistry of New Jersey to establish the Delta Dental Educational Conference Center. In addition, our Foundation supported numerous oral health programs in schools and communities throughout New Jersey and Connecticut.

To order your copy of the 2004 Annual Report, visit our Web site at www.deltadentalnj.com, click "Our Company" on the left navigation bar, then "Annual Report." Complete the order form on the screen. The Annual Report will be mailed to you.

Blood Pressure Screening: Converting Policy to Practice

Focusing new attention on a longstanding policy of the American Dental Association (ADA), the Board of Trustees of the New Jersey Dental Association (NJDA) recently approved a resolution recommending its member dentists to follow ADA guidelines for the screening of patients’ blood pressure during visits to the dental office.

The ADA House of Delegates first adopted its policy in 1974 and subsequently developed guidelines on incorporation of hypertension detection in the dental office.

High blood pressure, frequently an asymptomatic condition, is a major cause of cardiovascular disease in the United States. According to a New Jersey Department of Health and Senior Services survey, an estimated 22% of New Jersey residents have been diagnosed with hypertension; however, this figure includes only those who have had their blood pressure checked within the last two years, and therein lies the problem. 

Previous estimates show that while one in four adults has hypertension, only half of them are aware of it. Alerting patients to this condition and making appropriate referrals to physicians may prevent heart attack, stroke, kidney disease and other consequences of undetected and uncontrolled hypertension. And, dentists are in a unique position to aid in the early detection of hypertension, since most people will visit the dentist more often than their physician (72.9% of those surveyed reported a dental visit in the last year, versus 33% reporting a physician visit).

Measuring the patient’s blood pressure is consistent with the dental profession’s priority for prevention of disease, confirms to patients the dentist’s sincere interest in their total health, and underlines the dentist’s participation in the community health team.

Article printed in coordination with the New Jersey Dental Association

Delta Dental of New Jersey Donates $35,000 to Henry J. Austin Health Center

Delta Dental of New Jersey Foundation, Inc. recently donated $35,000 to the Henry J. Austin Health Center in Trenton, New Jersey. The health center has served as the largest non-hospital based primary care provider for the greater Trenton area for more than 30 years. Henry J. Austin Health Center is especially known for its outstanding dental services. Delta Dental’s grant will be used to expand services in Trenton dental care for low-income patients during 2005. Specifically, monies will be used for patient care in the areas of dental prosthetics.

“At Delta Dental, it is part of our mission to support organizations such as the Henry J. Austin Health Center that directly impact the oral health of New Jersey’s underserved residents,” said Walter VanBrunt , president and CEO of Delta Dental of New Jersey. “The health center is a wonderful resource for area residents who cannot afford dental health care.”

In 2004 Henry J. Austin Health Center served more than 3,000 patients in its dental care program. Ninety percent of the health center’s patients are at or below 200 percent of the federal poverty income level ($19,350 for a family of four). Many times dental procedures, such as dental prosthetics, cause low-income patients to have to make unaffordable monthly payments to cover their oral health care costs. 

“The support we have received from the Delta Dental of New Jersey Foundation, Inc. will help Henry J. Austin Health Center reach our goal of providing affordable quality dental care to area residents in need,” said Walter Isaacs, the CEO of Henry J. Austin Health Center.

The Henry J. Austin Health Center was established in 1969 as the City of Trenton's Neighborhood Health Center.  In 1986, it gained status as a private, non-profit 501 (c) (3) corporation to continue services to the medically underserved population of Trenton. Annually, the health center provides comprehensive medical, dental, and other services to more than 13,000 area residents. 

New Pages Not Necessarily Yellow: Promoting Your Practice on the Web

Linda Hetcher Vice President of Professional Services
Concurrent Technologies

It wasn’t that long ago that the primary way to advertise your dental practice was by placing an ad in the regional yellow pages. Today, there is another perhaps even better vehicle to generate awareness and advertise your practice. By developing a basic Web site, you can easily and quickly establish a presence on the Internet. The Web offers flexibility, can reach a broader audience and may be more cost effective than relying on an entry in the phone book. 

In just a few years, online access has gained the type of traction it took other media decades to achieve. According to Nielsen/NetRatings, Internet penetration in U.S. households has reached almost 85%, rising 9% a year. 

Once you have decided to establish an Internet presence, the next question is what do you expect to accomplish with your Web site? Sites can be developed for a number of reasons, including:

• Serving as an electronic business card or online brochure where you can describe your services, announce your location and hours.
• Collecting information about your visitors’ needs. Patient-friendly content that is easily accessible, kept current and sent to visitors who choose to receive it in e-mail is an effective way to stay connected to a growing patient base.
• Scheduling appointments and accepting patient referrals online.
• Differentiating your practice by providing value-added information such as dental news feeds from third-party sources generated from your site.

As your practice evolves along with advancements in dentistry, you will most likely outgrow the basic single Web home page and may want to consider a full-service technology partner. Technology partners can assist you in designing and developing a more robust site by taking into account your patient and practice needs, resources and business plan. In addition, they can provide cost-effective upgrades, maintenance and support packages.

Your Web site is a fluid work-in-progress. It can begin as a basic presence, but the key is to design it so it can evolve easily in order to match the ongoing demands of your practice and patients.

Concurrent Technologies designs and develops custom Web-based interactive solutions for a diverse clientele ranging from Fortune 500 companies to non-profit organizations. In 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.

Dentists Now May Apply for National Provider Identifier (NPI) Number

HIPAA has affected nearly everyone in health care since it was enacted in 1996. One of the newest changes is the introduction of a National Provider Identifier (NPI). With NPI on the horizon, you probably have questions about how it may affect your practice and your interaction with Delta Dental and other dental carriers. We’ve put together some basic information, including a list of frequently asked questions, to help you understand the regulation and its requirements. 

Beginning on May 23, 2005, health care providers, including dentists, could begin submitting applications through the Internet to receive their NPI. Paper applications were available as of July 1, 2005. If you transmit electronic claims or other electronic transactions governed by HIPAA, you are required to apply for an NPI. However, all dentists are eligible to apply for an NPI, and those who do so will benefit in the long run by helping increase efficiency and reduce costs related to transactions. In addition, the NPI will provide you with one unique provider identifier for all dental plans to utilize that will not change in the event of practice relocation or changes in specialty. It will make coordination of benefits more efficient, and help dental carriers better track transactions.

For information on obtaining your NPI, you can go to the following government Web site: http://nppes.cms.hhs.gov/NPPES/Welcome.do. There is also an on-line tutorial, called a “Viewlet,” available at http://www.cms.hhs.gov/hipaa/hipaa2/.

Once you receive your NPI, please send it to Delta Dental of New Jersey at 1639 Route 10, Parsippany, NJ 07054, Attn: Professional Relations - NPI so that we can input it into our system. Please provide us with a copy of your NPI registration from the government Web site mentioned above or, if you applied using a written application, a copy of the response received by mail. However, please don’t begin using it on claims and other transactions until you receive notification from Delta Dental of New Jersey that we are accepting the NPI. We are working to make this transition as smooth as possible, and receiving your NPI in advance of your first NPI transaction will help us to do this. You will need to report your NPI only to Delta Dental of New Jersey. Other Delta Dental Plans will be able to access your NPI if you submit claims for patients covered by a different Delta Dental Plan.

Health care providers who are required under HIPAA to have an NPI must have the new identifier and be ready to use it by May 23, 2007. While two years might seem like plenty of time to apply for the NPI, Delta Dental urges you to apply for and submit your number to us as soon as possible. It’s easy, quick and will be one less thing to worry about once you have it. 

We will continue updating you with important dates and requirements as they become known and as they affect your transactions and communication with Delta Dental. If you have questions, please visit the official HIPAA site mentioned previously, the ADA’s HIPAA site at www.ada.org/prof/resources/topics/hipaa/index.asp, or contact us at (973)285-4163.

Frequently Asked Questions About the NPI

What is the NPI? 
Part of the Health Insurance Portability and Accountability Act (HIPAA), the National Provider Identifier (NPI) regulation establishes one unique identifier for each health care provider. Issued on January 23, 2004, the NPI regulation seeks to eliminate multiple identifiers currently in use. 

What are the advantages of using the NPI?
Using the NPI should result in several advantages, including: 

• one unique provider identifier for all health plans to utilize
• a permanent provider identifier that will not change in the event of practice relocation or changes in specialty
• a more efficient coordination of benefits
• an easier process for health plans to track transactions and avoid duplication

Who is required to apply for an NPI? 
All health care providers, defined under the regulation to include dentists, are eligible to receive an NPI. However, only “Covered Entities” are required to obtain an NPI. A dental provider is a “Covered Entity” if he or she transmits electronic transactions governed by HIPAA, primarily electronic claim transactions. Dental providers who access claims information or benefits via the Internet are also covered entities. Clearinghouses are also required to be able to accept and transmit the NPI by the federal compliance deadline.

In addition to dentists who are considered “Covered Entities,” the broad definition of health care “provider” given in the regulation encompasses all who provide health care services: individuals (including dental hygienists, physicians and all other practitioners) as well as organizations (such as hospitals, pharmacies, clinics and medical supply companies). 

What if I only submit paper claims?
If you do not submit electronic transactions governed by HIPAA, which includes claims or benefits inquiries via the Internet, you are not required to obtain an NPI. However, Delta Dental strongly encourages you to obtain and use an NPI to submit all of your claims once we are prepared to accept it. This will enable you to maintain only one unique identifier for use with all payers.

How do I apply?
According to the Centers for Medicare & Medicaid Services (CMS), you be able to apply for your NPI in one of the following ways: 

• You may apply through an easy Web-based application process. The Web address is http://nppes.cms.hhs.gov.
• You may prepare a paper application and send it to the entity that will be assigning the NPI (the Enumerator) on behalf of the Secretary. A copy of the application, including the Enumerator’s mailing address, is available on http://nppes.cms.hhs.gov. You may also call the Enumerator for a copy. The phone number is (800) 465-3203 or TTY (800) 692-2326.

It is estimated that applicants will receive their NPI within 10 days after a properly completed application is received. Once you have been assigned an NPI, you must furnish updates to its data within 30 days of any changes. 

You may receive notices about the NPI from other dental plans with which you do business, but remember, you need apply only once for an NPI. The same NPI is used for every dental plan.

What is a “Provider Taxonomy Code”?
When you apply for your NPI either through the Web-based application or on a paper application, you will be asked to provide “your 10-digit taxonomy code.” These codes are not “assigned” to health care providers; rather, health care providers select the taxonomy code(s) that most closely represents their education, license, or certification. For dental providers, it is essentially an identifier that corresponds most closely to area of specialty. In lieu of a taxonomy code, you may provide a written description of your specialty in the space provided on the electronic or paper application, and you will be assigned the closest appropriate code. To facilitate your registration, the taxonomy codes applicable to dentists are listed below.

• General Practice - 1223G0001X
• Dental Public Health - 1223D0001X 
• Endodontics - 1223E0200X
• Oral and Maxillofacial Pathology - 1223P0106X 
• Oral and Maxillofacial Radiology - 1223X0008X
• Oral and Maxillofacial Surgery - 1223S0112X
• Orthodontics and Dentofacial Orthopedics - 1223X0400X 
• Pediatric Dentistry  - 1223P0221X 
• Periodontics - 1223P0300X 
• Prosthodontics - 1223P0700X 

When is the deadline for application? 
All HIPAA “Covered Entities” must use NPIs on all HIPAA-governed transactions by the compliance date of May 23, 2007. To assure a smooth transition, all providers are urged to apply for their NPI well in advance of the compliance date. 

How will the NPI affect other numbers I’ve used in the past? 
The NPI will replace other identifying numbers currently used in electronic transactions, such as the Medicaid, Blue Cross and Blue Shield, UPIN, CHAMPUS, and certain other “legacy” numbers. The NPI will not replace the Social Security number, DEA number, Taxpayer ID number, taxonomy number, or state license number, since these are used for purposes other than general identification. Taxpayer ID numbers or Social Security numbers must still be provided for 1099 purposes, but the NPI will replace all other identifiers on the claim.

How is my NPI determined? 
The NPI is a 10-digit number (nine digits plus a check digit to detect keying errors). It is simply a random number that never expires. It contains no inherent information about the provider, such as state of residence or license number. NPIs are issued by the National Plan and Provider Enumeration System (NPPES). The federal government is also responsible for assisting providers in completing the application and resolving problems associated with an NPI.

What do I do with my number once I have it? 
Once you receive your NPI, please send it to Delta Dental of New Jersey at 1639 Route 10, Parsippany, NJ 07054, Attn: Professional Relations - NPI so that we can input it into our system. Please provide us with a copy of your NPI registration from the government Web site mentioned above or, if you applied using a written application, a copy of the response received by mail. However, please don’t begin using it on claims and other transactions until you receive notification from Delta Dental of New Jersey that we are accepting the NPI. Please contact clearinghouses and other plans with which you do business for instructions about their transition plans for use of the NPI.

Where can I go for additional help and information? 
To access current information, please visit the federal government’s Web site, which includes links to a question and answer database, at http://www.cms.hhs.gov/hipaa/hipaa2/. The American Dental Association’s HIPAA Web page is located at www.ada.org/prof/resources/topics/hipaa/index.asp.

Golf Outing Results Available Shortly

Results of the Fifteenth Annual Delta Dental Classic, which took place June 22, will be available shortly. The annual event raises funds for Special Olympics New Jersey (SONJ). 

Thanks to the many dentists who support our outing year after year. The Delta Dental Classic, which began in 1991, has raised more than $472,000 for SONJ.

Did You Know That Misrepresenting Treatment is Fraud?

When submitting a claim for payment, a dental provider must accurately report to any third-party payer each dental service or procedure that was actually rendered. 

Correctly describing a dental procedure on a claim form may seem fundamental, but it is not always done. Sometimes, porcelain veneers are submitted as full crowns, standard three-month recall visits are submitted as single quadrants of root planing and scaling, and sealants are submitted as single-surface composite restorations. 

Inaccurate submissions may be the result of office error, or confusion over the correct dental procedure code to use. Or, they may be intentional and done for the purposes of obtaining additional benefits. 

The submission of inaccurate or misrepresented dental treatment is one of the unacceptable billing practices reviewed during the claim verification process. The incorrect submission of the dental services or procedures rendered can result in overpayments that are recoverable and lead to other action. 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 

Online Brush Biopsy Training Available

We are pleased to announce that Delta Dental of New Jersey offers brush biopsy as a benefit. The brush biopsy is a new procedure to help identify precancerous and cancerous cells in red or white oral lesions. An “atypical” or “positive” brush biopsy result requires scalpel biopsy for definitive diagnosis. 

We also offer free online training for participating dentists on the brush biopsy. Dentists can earn CE credit by completing the online training modules. For more information, go to www.deltadentalnj.com, and click “oral cancer training” in the “What’s New” box. 

Finding Claim Status Fast

If you have a question about a claim that may be in process, the easiest way to check claim status is by going online to www.deltadentalnj.com and logging into Benefits Connection. As soon as claims enter our systems, their status is available in our Claims Inquiry section of Benefits Connection.