Articles
Subscriber News Re-Named Newsletters; New Online Newsletter for Subscribers Also Launched
Subscribers Get News Each Month Online
Claims Inquiry Launches
Eight Reasons to Start Making Eligibility Submissions Online
HIPAA Q&A
Order Custom Reports Online
Delta Dental Introduces New, Easy-to-Read Explanation of Benefits Statement
Register Now for Delta Dental Classic
Delta Dental Launches Web Site Improvements
Delta Dental Partners with Matheny School and Hospital and UMDNJ-School of Dentistry to Establish a Dental Clinic for People with Disabilities
Submitting Claim Forms

Subscriber News Re-Named Newsletters; New Online Newsletter for Subscribers Also Launched

Two factors contributed to the decision to re-name this publication. "The name Subscriber News never accurately fit the demographics of our audience," explains Diane Belle, assistant vice president, Corporate Communications, and Newsletters editor. "The publication had always been focused on the informational needs of benefits administrators." Then, Delta Dental started developing a monthly online publication targeted to subscribers. "At that point, we realized it made sense to call the online publication Subscriber News, and come up with a name for this publication that better represented our readers," says Belle.

Thus, Newsletters as born.

Subscribers Get News Each Month Online

The online Subscriber News, which debuted in January, is a free publication for all Delta Dental Plan of New Jersey members. Each issue contains valuable information about how subscribers can make the most of their Delta Dental benefits. Subscriber News stories cover everything from how to find a participating dentist, to where subscribers can get detailed explanations about their family's benefits, and much more.

In addition, Subscriber News features the latest news in the areas of dental health and wellness. Readers can find out what they can do between dentist visits to keep their smile healthy, learn what they should do in a dental emergency, and discover what dental science has in store for the future. Subscriber News headlines are delivered to their e-mail inbox each month. They can just click the link to read the full story.

To sign up for your free subscription, go to www.deltadentalnj.com and click on "Subscribers." Then enter your e-mail address in the "Subscriber News" box on the right side of the screen. You may unsubscribe to Subscriber News at any time. Please note: We do not sell, rent, or disclose your e-mail address to third parties. Therefore, you will not receive unsolicited e-mail ("spam") as a result of subscribing to Subscriber News.

Claims Inquiry Launches

Benefits Connection, Delta Dental's online service that gives subscribers and dentists easy online access to dental benefits information, has launched a new feature. Claims inquiry enables subscribers to check the status of their dental claims online.

The claims inquiry feature gives subscribers access to two years of detailed Delta Dental claim history, including whether a claim is pending or has been paid, the amount and date paid, and details about procedures performed. Subscribers are able to research claims by claim number, tooth number, or procedure code. Subscribers will also be able to read processing policies that were applied to any claims.

To access the claims inquiry feature, go to www.deltadentalnj.com, click on "Subscribers," and log on to Benefits Connection.

Eight Reasons to Start Making Eligibility Submissions Online

1. It's the fastest way there is to make eligibility changes. It even beats faxing and phone calls.
2. It reduces errors and confusion. Online eligibility submissions eliminate trying to decipher hard-to-read handwritten changes, which often require follow-up phone calls for clarification. The online system even prompts users if they forgot to include any necessary information.
3. It's easy to use. Try our Online Submissions Demo to see for yourself just how intuitive it is. To access the demo, go to our Web site at www.deltadentalnj.com and click on "Employers." Then click on "Online Submissions Demo." There's even an online Quick Reference Guide for additional help.
4. It's secure. Information is safeguarded against unauthorized access.
5. Eligibility changes take effect quickly. Changes go into effect in 24 hours - often sooner.
6. You can make almost every type of eligibility change online. The system enables secured users to enroll and terminate subscribers, as well as perform changes, transfers and reinstatements.
7. It simplifies record keeping. You can view subscriber profiles online and view, print and save your submissions log. You can review not only the effective date of each change, but can also determine what date the change was made and what type of change was made. (Note that due to different family enrollment plans, eligible family members may not display if a claim has not yet been processed for them.)
8. Hundreds of others have tried it and love it. More than 200 groups enrolled in the first month alone. Even more significant, benefits managers who try the service once usually keep using it. Thousands of eligibility changes are submitted online each week.

To get started using Delta Dental's Online Eligibility Submissions, call 973-285-4119 or 973-285-4065 to request your password. Then go to www.deltadentalnj.com, click "Employers," and sign in at the "Administrator's Logon" box.

HIPAA Q&A

The Health Insurance Portability and Accountability Act (HIPAA) requires health care plans (including Delta Dental and self-funded plans), health care clearinghouses and certain health care providers (including dentists) to establish standards that protect the privacy of individually identifiable health information (IIHI). The Privacy Rule requires compliance by April 14, 2003 (or April 14, 2004 for small health plans).

Delta Dental developed the following Q&A to explain HIPAA, and how the legislation will affect the relationship your company and your employees have with Delta Dental. Note: At press time, Health and Human Services announced it would be issuing additional clarifications shortly.

What is the Privacy Rule and who must comply with it?
The Privacy Rule applies to three types of "covered entities": a health plan (including dental plans such as Delta Dental's); health care clearinghouses; and health care providers (including dentists) who transmit certain health information electronically.

The Privacy Rule protects independently identifiable health information (IIHI) that is transmitted or maintained in "any form or medium" (known as "protected health information" or "PHI"). This appears to include virtually all communications - whether paper, electronic or oral. IIHI includes health information (including demographic information) that:

• is created or received by Delta Dental;
• relates to the past, present or future physical or mental health condition of an individual, as well as the provision of health care to an individual or the past, present or future payment for the provision of health care to an individual; and
• identifies the individual or there otherwise exists a reasonable basis to believe that the information can be used to identify the individual.

What types of transactions are covered under the Privacy Rule?
Transactions covered under the Privacy Rule include the following types of information:

• Health care claims or equivalent encounter information
• Health care payment and remittance advice
• Coordination of benefits
• Health care claims status
• Enrollment and dis-enrollment in a health plan
• Eligibility for a health plan
• Health plan premium payments
• Referral certification and authorization
• First report of injury
• Health claims attachments

What Delta Dental programs must comply with HIPAA's Privacy Rule?
When conducting risk business, Delta Dental Plan of New Jersey, Inc., is considered a health plan (i.e., covered entity) under the Privacy Rule and, as such, must comply with the Privacy Rule. When conducting ASO business, Delta Dental may be a business associate of the group health plan (i.e., ERISA plan) and, as such, must comply with the Privacy Rule. The Privacy Rule applies to all programs of Delta Dental, including DeltaPremier, Delta's Advantage Program, DeltaPreferred Option and DeltaCare (as well as the national account applications of these programs).

What types of restrictions does the Privacy Rule place on the use of protected health information?
With the exception of health plans' use or disclosure of PHI for its treatment, payment or health care operations, covered entities may not use PHI internally or disclose PHI externally without an individual's consent or authorization. (Other exceptions may apply, such as in the case of public health emergencies.)

"Consent" and "authorization" apply in different contexts under HIPAA. "Consent" is given for the use or disclosure of PHI for the purposes of "treatment," "payment" or "health care operations" (as these terms are defined under the Rule). "Authorization" is given for any use or disclosure of PHI for purposes other than treatment, payment or health care operations.

The basic rules of consent and authorization are as follows:

• Dentists who are covered under HIPAA must obtain consent from a patient in order to use PHI for treatment, payment or the dentist's health care operations. For example, a dentist must obtain a written consent from the patient in order to treat a patient or submit claims to Delta Dental.
• Health plans (including Delta Dental) generally do not need to obtain consent in order to use PHI for treatment, payment or Delta Dental's health care operations purposes.
• An authorization is generally needed by all covered entities (including Delta Dental) for the use or disclosure of PHI for purposes other than treatment, payment or health care operations.

How will Delta Dental proceed?
The details are currently being developed. Delta Dental will be providing subscribers with a notice that describes, among other items, the types of uses and disclosures that Delta Dental is permitted to make for treatment, payment and health care operations, as well as a description of each of the other purposes for which Delta Dental may proceed to make disclosures without the patient's written consent or authorization.

Delta Dental will make reasonable efforts to limit use or disclosure of PHI to the minimum necessary to accomplish the intended purpose. This "minimum necessary use" rule, however, does not apply if the use or disclosure is for treatment purposes, the request comes from the patient or Health and Human Services (for compliance reviews), or is required by law.

What types of rights does HIPAA grant to patients?
The Privacy Rule provides patients with various rights, including the right to receive an accounting of certain uses and disclosures, request restrictions on certain uses and disclosures, receive confidential communications in certain circumstances, inspect and copy their records, and amend PHI in their records. (However, a covered entity may refuse to amend the information if it is accurate or was not created by the covered entity.) Any request for access must generally be granted within 30 days.

How will Delta Dental ensure compliance with the Privacy Rule?
Delta Dental will implement a comprehensive program to ensure its compliance with the Privacy Rule. The basic elements of a privacy compliance program under the Privacy Rule are:

• Appointing a privacy official;
• Implementing appropriate administrative, technical, and physical safeguards to protect the privacy of PHI;
• Developing detailed privacy policies and procedures;
• Training all workforce members on privacy policies and procedures;
• Establishing a system to report privacy complaints;
• Responding quickly to investigate potential privacy breaches;
• Disciplining individuals and business associates who are found to have breached the privacy policies; and
• Ongoing auditing and monitoring of the privacy initiative workforce training program.

How will HIPAA affect my company's relationship with Delta Dental?
Despite some of the challenges imposed by HIPAA, Delta Dental Plan of New Jersey, Inc. believes the Act will bring about positive changes by helping control certain administration costs while increasing satisfaction among our subscribers. These benefits will be achieved through:

• Improved claims processing - Required standardization of claim and eligibility data should result in claims being processed with more speed and accuracy.
• Improved privacy and security - Patients will know that people handling their health information are held to strict rules and guidelines.
• Improved patient care - Standards for data collection and storage will create opportunities for precise tracking of the outcomes of various dental procedures, ultimately helping bring more effective techniques and cost management to patients.
• Improved administration for employers and groups - Those offering dental benefits can use the standard enrollment transactions offered through HIPAA to send a single enrollment record to all of their health plans.

Where can I get additional information about HIPAA?
A copy of the final rule is published in the Federal Register. In addition, the preamble and rule along with "Frequently Asked Questions" can be read at http://aspe.hhs.gov/admnsimp.

This information is for instructional and educational purposes only. It does not constitute legal advice. Recipients are urged to contact their legal counsel for advice with respect to the interpretation of the HIPAA Privacy Rule and its applicability to the recipient and the facts and circumstance of the situation at hand. It is also strongly recommended that individual Plan attorneys review all such communications before they are disseminated.

Order Custom Reports Online

Delta Dental helps your company save money on its dental program. To find out how well your program is working, order your free, customized Cost Containment report and Network Utilization report.

Among the report features:

• Benefit Cost Containment
• Payment to Dentist by Classification
• Payment to Dentist by Participating Status
• Summary with Incidence by Procedure
• Payment to Group by Dentist License Number

Reports can be ordered online, at www.deltadentalnj.com. Click "Employers" and then select "Reports." You will be contacted by your account executive, who will deliver the reports and review them with you.

Delta Dental Introduces New, Easy-to-Read Explanation of Benefits Statement

Delta Dental's notification of benefits statement recently received a new name - Explanation of Benefits - and a new look. The redesigned statement includes even more information than before, but presented in a much more readable, user-friendly format.

The statement now includes:

• Up to three processing policies listed per procedure (instead of one), so patients and dentists clearly understand how the benefits payment was determined.
• The name of the patient's plan.
• The participating status of the dentist.
• A notice indicating whether the patient or the dentist received the check.
• Plan allowance information, which shows not only the annual allowance, but also what the patient has used to date.
• Detailed definitions about what different Explanation of Benefits terms mean.

The new Explanation of Benefits statement is mailed to the patient and the patient's dentist (whether a participating or non-participating provider).

To see what the new Explanation of Benefits statement offers, visit our Web site at www.deltadentalnj.com and go to the "What's New" section at the center of the screen.

Register Now for Delta Dental Classic

The Twelfth Annual Delta Dental Classic will be here before you know it. The annual golf event and dinner, which benefit Special Olympics New Jersey, will take place Tuesday, June 4, at the Cherry Valley Country Club in Skillman, New Jersey.

Brochures and registration information were mailed in January to past participants. If you did not receive a brochure, please contact Jennifer Appaluccio at 973-285-4059 or jappaluccio@deltadentalnj.com to request a copy. It can also be downloaded from our Web site at www.deltadentalnj.com; click "Employers" and "Schedule of Events."

Registration is accommodated on a first come, first-served basis. Last year's event drew 126 golfers and raised $50,000 for Special Olympics New Jersey, raising the event's lifetime total to more than $300,000. We hope you'll join us for a great day to benefit a worthy cause!

Delta Dental Launches Web Site Improvements

Delta Dental's Web site, at www.deltadentalnj.com, unveiled a new look in January. The redesigned site makes it easier than ever to find the information you need. The navigation bar on the left side of the home page prominently highlights important features such as:

• "Find a Dentist," which enables subscribers to find a participating dentist in their area, check to see if their dentist is a participating dentist, and find directions to their dental office.
• "Products," which describes the various Delta Dental programs in detail.
• "Forms," where you can download claim forms and other documents.

The Web site also includes several special-interest areas, including sections for subscribers, dentists, brokers and employers. To find information specific for benefits administrators, click on "Employers" on the right side of the Delta Dental home page. This will take you to a home page designed for you.

Some of the information you can access includes:

• "Administrator's Logon," where you sign in to make eligibility submission changes online. Only you can access your plan's records.
• Online Submissions Demo, where you can try out the features of our online eligibility submissions feature.
• Cost Containment report for a broad look at Delta Dental's claims savings capabilities.
• Information on how to order customized reports for your group on cost containment and network utilization.
• Listings of key contacts in areas such as Premium Billing and Customer Service.

If you have trouble locating the information you need, click on "Site Map" at the top of the Delta Dental home page to see the contents of the entire site at a glance. Or, go to the "Search" box next to the "Site Map" and type in what you're looking for.

Delta Dental Partners with Matheny School and Hospital and UMDNJ-School of Dentistry to Establish a Dental Clinic for People with Disabilities

Delta Dental's Foundation recently made a donation to the Matheny School and Hospital that will be used to staff and equip three dental offices in Matheny's new, state-of-the-art medical and dental facility. The donation was made to Matheny, a teaching facility for people of all ages with developmental disabilities, as part of Delta Dental's initiative to provide funds to organizations that assist those without access to traditional dental care.

Matheny, located in Peapack, New Jersey, specializes in the care of individuals with physical disabilities such as cerebral palsy, muscular dystrophy, spina bifida, and Lesch-Nyhan disease. Five years ago, Matheny received an exploratory grant from Delta Dental to evaluate and provide a means of dealing with the orthodontic needs of its residents. In reviewing the situation, Matheny's directors realized that there was a greater need for general dentistry services, including cleanings and fillings. They also determined that there's an overall shortage of dentists trained and skilled in working with physically handicapped patients.

To address these issues, Delta Dental and UMDNJ-New Jersey Dental School joined forces with Matheny to create a facility that will care for this special population and also serve as an on-site teaching clinic. Delta Dental's donation will provide the three new dental offices with instruments to accommodate residents' physical handicaps, such as tilting devices for wheelchairs. The facility, which will be staffed by UMDNJ-New Jersey Dental School faculty, will also be a learning center for dental students currently in the residency phase of schooling.

"Through our partnership with Matheny, physically-handicapped patients will now be able to receive much needed care from specially-trained dentists," said Dr. Gerald Sydell, Chairman, Delta Dental Plan of New Jersey and Vice President, Delta Dental Foundation, Inc. "Since the Foundation also endeavors to assist in educational pursuits of those interested in dentistry, it is especially meaningful to us that the clinic will also be a training facility for students to learn valuable, specialized skills that are so desperately needed in our field."

In December, Matheny began renovation of a wing in the hospital that will house the new medical and dental facility. The wing will ultimately include a waiting area, medical records area, and examination/treatment rooms. It is scheduled to open this year.

Matheny is a nonprofit organization that receives state, federal, and local funding as well as grants and private donations. It currently provides residential, inpatient and outpatient service to over 650 clients and their families. Services are available on a residential or an outpatient basis. Its mission is to provide people with habilitative services and to assist them in the attainment of their optimal level of functioning. In addition, the organization engages in professional activities including, but not limited to, research, development, and the dissemination of information.

Delta Dental established the Delta Dental Plan of New Jersey Foundation in 1986. Its mission includes promoting and assisting educational projects devoted to the enhancement of dental health, research programs designed to increase public awareness of the general benefits of good health, and to improve dental health through the science of dentistry. Each year, the Delta Dental Foundation provides financial support to various organizations throughout the state.

Submitting Claim Forms

When submitting a claim, please don't use highlighters to draw attention to an area on the claim form. Delta Dental scans all claim forms into a computer database. Any highlighted area displays as black when the claim is imaged and cannot be read.

Also, all areas on the claim form must be completed, including updated address information. Missing or inaccurate data will cause a delay in claims processing. The most frequent errors occur on patient name (use of nicknames or shortened names), date of birth and ID (Social Security) number.