Articles
Here's What the Experts Say About Delta Dental's Online Eligibility Submissions!
Delta Dental Once Again Receives AA- Rating from S&P
Year-To-Date Claims Production Performance
Accurate Claims Benefit Employers, Subscribers, and Dentists
Delta Dental Classic Raises $55,000 for Special Olympics
2001 Annual Report Now Available

Here's What the Experts Say About Delta Dental's Online Eligibility Submissions!

We were convinced that once people tried it, though, they would welcome its ease, convenience and timesaving features. To check our assumptions, Newsletters recently asked several benefits administrators about their experiences with Delta Dental's online eligibility submissions feature.

Here's what they said.

"In the past several years my district has experienced numerous turnover in staff members. As you can imagine, there is a lot of paperwork involved. However, enrolling and terminating members via the Delta Dental Web site has made this task extremely easy. Within minutes I am able to enroll new members and can print the list of new members I have enrolled for accuracy. Viewing whether a particular dentist is participating is also helpful."
-Sandy Zarate, Wharton Board of Education

"I like using the eligibility part of the Delta Dental Web site. I'm glad that your enhancements this year allow me to use the Internet for changes as well as additions and terminations. The recap is very useful, and the site is easy to navigate. Thank you!"
-Jay Weissglass, Magruder Color Company, Inc.

"Having Delta Dental online has made the task of updating eligibility information a breeze. I feel confident in the changes I make online, and find the Web site very useful in providing me up-to-date information about our employees. Delta Dental online has improved my job efficiency tremendously."
-Geri Alestra, Quick Chek Food Stores

"I used to submit eligibility changes by fax, but decided to try Delta Dental's online eligibility system because it sounded like less paperwork. I discovered that online submissions are easier and more convenient. I input the changes and know that they will get processed. I don't have to wait by the fax anymore to make sure the fax went through."
-Michelle Breiten, Burrelle's Information Services

"I'd only been with the company and in my position a month when I decided to give Delta Dental's online eligibility submissions a shot. It was a good idea. There's less paperwork and mailing. Everything's done right online. It's all very simple. I especially like the accessibility of online."
-Maryann Hauck, Redi-Mail Direct Marketing/StayinFront

Delta Dental's online eligibility submissions feature is easy to use, convenient and free. Use it to:

• Enroll and terminate subscribers
• Make changes, transfers and reinstatements
• View subscriber profiles online

To get started, call 973-285-4119 or 973-285-4065 to obtain your password. Then go to www.deltadentalnj.com, click on "Employers" and log on!

The system guides you step-by-step through the process. For extra help, there's also an Online Submission Demo with a quick reference guide, and a technical support hotline at 888-783-5750.

Delta Dental Once Again Receives AA- Rating from S&P

Delta Dental Plan of New Jersey recently completed Standard & Poor's most comprehensive analysis and received an AA- counterparty credit and financial strength rating for the third straight year. The strong rating confirms that Delta Dental is an attractive alternative for businesses looking to improve benefits packages through the implementation of a dental plan.

Based upon the analysis, Standard & Poor's predicts a stable outlook for Delta Dental, citing its extremely strong capitalization, excellent earnings, and good business position as major rating factors. Delta Dental has also been designated a Security Circle insurer, which means that it voluntarily underwent Standard & Poor's comprehensive analysis and was assigned a rating in one of the top four categories for financial security.

In the analysis, Standard & Poor's noted that Delta Dental is extremely well capitalized, giving the company a capital adequacy ratio of 474% as of year-end 2001. This indicates that the not-for-profit dental benefits carrier clearly has the financial capacity to meet policyholder obligations. It was also noted that Delta Dental is well positioned for continued growth, anticipating a 10% increase in membership in 2002.

"Affirmation of our financial stability, from a premier independent organization such as Standard & Poor's, is especially significant in today's economy," said Delta Dental President and CEO Walter VanBrunt. "This validation reflects our commitment to a sound business philosophy based on the principles of value and quality. The fact that we've received the same high rating for three years in a row is meaningful to our employees, current and prospective clients, and the network of dentists we do business with."

The rating is another reason for companies to contract with Delta Dental for employee dental benefits. In addition to enjoying the security of partnering with a financially stable company, companies that contract with Delta Dental may improve employee retention and workplace efficacy by offering employees access to the nation's largest dental network.

Delta Dental Plan of New Jersey, Inc. is New Jersey and Connecticut's leading dental benefits carrier, providing coverage to more than one million people through contracts with employers in New Jersey and Connecticut. The Delta Dental Plan system is a national network of independently operated, not-for-profit dental service corporations specializing in providing dental benefits programs for employee groups throughout the country.

Year-To-Date Claims Production Performance

The average claims turnaround time - the length of time from when Delta Dental receives a completed claim until payment information is sent to our vendor for Explanation of Benefit/check processing - for Delta Dental Plan of New Jersey was 8.77 business days for the first six months of 2002. Mailing usually occurs within two business days.

Delta Dental processed 99.93% of claims within 30 days.

Delta Dental paid 99.5% of claims accurately. Our clerical accuracy is 99.7% and financial accuracy is 99.6%.

Accurate Claims Benefit Employers, Subscribers, and Dentists

Most Delta Dental subscribers probably leave it to their dentists to submit their Delta Dental claims. Please remind employees that it's very important to make sure that those claims accurately identify the services provided and fees charged.

Under New Jersey and federal law, misrepresentations on claim forms are considered fraud if they are intentional and material to the claim. That includes failure to disclose waiver of all or part of the co-payment responsibility.

The amount of the co-payment and terms of each subscriber's benefits are determined by the contract between Delta Dental and your organization. Co-payments serve to make patients aware of the costs of healthcare. They also prompt patients to use their benefits wisely and seek out dentists who participate with Delta Dental Plan of New Jersey, in order to maximize their benefits.

If a dentist waives the co-payment, without disclosing his or her intention on the claim submitted to Delta Dental, then the actual fee charged is lower than the fee submitted. For example, if a claim is submitted for $100, and Delta Dental Plan of New Jersey pays the claim at 80% or $80, but the doctor "forgives" the co-pay, then the actual fee charged is $80 and Delta Dental should only pay $64.

The undisclosed waiving of co-payments could be used by dentists to create unfair competition or as an inducement to attract new patients. Delta Dental Plan of New Jersey does not prohibit dentists from offering discounts; however the discounted fee must be indicated on the claim form.

Submitting a fee higher than the fee the dentist actually intends to collect constitutes "overbilling." This applies to the undisclosed waiver of co-payment as well as undisclosed discounts. Dentists must disclose all waivers of co-payment and/or discounts on the claim form. This policy is in accordance with the N.J. State Board regulations, N.J.A.C. 13:30-8.10(c), which reads in part:

"A licensee who renders dental services or procedures to a patient enrolled in any dental plan with co-payment features and who intends to waive any part of the co-payment or all of the co-payment by the patient shall, when submitting any claim or bill to the third-party payor, conspicuously disclose on the face of the claim or bill in a legible manner, or in the electronic claim submission, that the co-payment, or a portion of co-payment, shall not be billed to, or collected from, the patient."

Knowingly making a false statement on an insurance claim is fraud. The New Jersey Insurance Fraud Prevention Act (IFPA) N.J.S.A. 17:33A-1 and the New Jersey Administrative Code (N.J.A.C. 11:16-6) require insurance carriers to detect, investigate and report fraud.

Every subscriber and dentist should strive to assure the accuracy of the services and fees submitted. Although subscribers might not see their claim forms before their dentists submit them, Delta Dental always mails subscribers an Explanation of Benefits statement, which details what services were performed and how much was paid to their dentists. Subscribers should always review their EOB statements for accuracy.

As a dental benefits provider, Delta Dental is responsible for reviewing and paying subscriber claims. It is also our responsibility to provide assurances to our groups that we deliver benefits in the most efficient and cost-effective manner. Toward that goal, we verify the accuracy of claims on an ongoing basis to keep group premiums affordable. Fighting fraud enables Delta Dental to help companies manage their benefit costs while providing excellent dental benefits to subscribers.

Delta Dental Classic Raises $55,000 for Special Olympics

The Twelfth Annual Delta Dental Classic, which drew 128 golfers to the Cherry Valley Country Club on June 4, raised $55,000 for Special Olympics programs. Since the Delta Dental Classic began in 1991, the event has raised more than $355,000 for Special Olympics New Jersey.

Contest winners include:

1st Place Low Gross (Women): Dr. Leslie Skurla (89)
1st Place Low Gross (Men): James Armstrong (76)
1st Place Gross Team: Dick Schlott, Maury DiDomenico, Jack Welch, Mike Gatto

Special thanks to all of our participants and sponsors.

The Thirteenth Annual Delta Dental Classic will take place on Wednesday, June 4, 2003, at Fiddler's Elbow Country Club in Bedminster, New Jersey. Watch for more details shortly.

2001 Annual Report Now Available

This year's Annual Report highlights how Delta Dental is using Internet technology to make it easier for benefits managers, subscribers, dentists and brokers to do business with us. In 2001, Delta Dental launched our online eligibility submissions feature, which enables benefits administrators to more easily manage eligibility changes. In addition, we introduced "Benefits Connection," the online service that makes it possible for subscribers and their dentists to easily receive instant, detailed information about their Delta Dental benefits.

Other highlights of our 2001 Annual Report include:

• Achieving an impressive "AA-" Standard & Poor's rating of our financial strength for the second consecutive year.
• Adding close to 85,000 new subscribers, bring our subscriber base to an all-time high.
• Details on our Foundation's extensive community outreach programs, which help deliver care to underserved populations, support dental education and research, raise public awareness, and assist worthwhile organizations.

To request a copy of our 2001 Annual Report, visit our Web site at www.deltadentalnj.com and click on "Our Company" on the navigation bar on the left side of the home page.