Dental News - Delta Dental of New Jersey

Dental News
August 2012
Community
Calendar
How Our Dental Network
Coordinators Can Help You
October 10
Foundation Seminar
Takes place at the Pines
Manor in Edison, NJ. Dr.
Arnold Rosenheck, Assistant
Dean, Hospital
Affairs/Institutional
Development, UMDNJ-New
Jersey Dental School, will
present “Oral Manifestation
of Diseases of Local &
Systemic Etiology.”
Delta Dental’s website,
www.deltadentalnj.com, features
answers to many of the possible questions that your dental office might face.
But what if you can’t find your answer?
Or you need more information than is
on the website? Or you need to talk to
someone who can take the time to walk
you through a solution? Contact your
dental network coordinator.
Dental Network Coordinators serve as
liaisons between the dental community
and Delta Dental. They can:
■ Answer participation inquiries
■ Provide you with a copy of our
Participating Dentist’s Handbook
■ Explain how to submit electronic
and online claims
(continued on page 2)
October 17
Delta Dental Days
Takes place at the Pines
Manor in Edison, NJ. The
free half-day educational
workshop covers tips on
claims submissions and
electronic claims, preventing
insurance fraud, using
Benefits Connection, and
more.
Both programs offer continuing education credits.
Registration information
for each will be available
later this summer on our
website. Go to
www.deltadentalnj.com.
Click “Dentists” on the left
navigation bar. Then click
“Schedule of Events” under
the “Educational Resources
and Schedule of Events”
heading.
printed with 100% renewable energy
Silverman Elected SVP-COO
Delta Dental of New Jersey’s Board of Trustees has elected
Bruce Silverman to Senior Vice President and Chief Operating
Officer. Bruce was recognized, among other acknowledgements, for his leadership and significant strategic contributions throughout Delta Dental.
“Over his career at Delta Dental, Bruce has been instrumental in the growth of our organization, the successful integration of new technology, and the adoption of new business
processes,” said Walter VanBrunt, president and CEO.
“Bruce’s contributions have resulted in significant operational
improvements and administrative cost reductions.”
Bruce joined Delta Dental of New Jersey as Vice President of Claims in September
1989. He was promoted to Senior Vice President of Claims, Customer Service, and
Professional Relations in 1998. He oversees all aspects of operations, including claims
processing, enrollment, customer service, client administration, systems quality assurance, telecommunications, provider relations, network management, information services, and the Project Management Office.
In his new role, Bruce plans to continue to leverage investments in people and technology in order to reduce administrative costs and improve on Delta Dental’s already
high levels of customer satisfaction. He also will continue to serve as Delta Dental’s
compliance officer and chair the company’s Level II Provider Credentialing Committee.
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Dental News
How Our Dental Network Coordinators Can Help You
(continued from page 1)
■ Show how to add a new dentist to
your practice
■ Explain how to use Fax Back and
Benefits Connection to access
your patients’ Delta Dental benefits
information, claim status and claim
history
■ Explain the features of Delta Dental’s
In-Net Program, a value-added program for participating dentists that
provides discounts on many items
your practice may use or need,
including dental supplies and equipment, practice-management software
and hardware, and sterilizing monitoring service
■ Help with training new staff regard-
ing Delta Dental claims submission
policies and procedures
■ Assist you in enrolling in Electronic
Funds Transfer to have claims payments deposited directly into your
bank account
To schedule a visit with the Dental
Network Coordinator in your area, call
(888) 396-6641 (in New Jersey) or (860)
635-3152 (in Connecticut). Our Delta
Dental Dental Dental Network
Coordinators are:
■ Kim Alberico (CT)
kalberico@deltadentalnj.com
■ Susan Chase (NJ)
schase@deltadentalnj.com
■ Beth DeCapio (NJ)
bdecapio@deltadentalnj.com
To find out about participation in our
DeltaCare® program, a dental health
maintenance-type organization
administered by our subsidiary,
Flagship Dental Plans, please contact
Joanne Nudo, our Flagship Dental
Network Coordinator, at (973) 285-4113,
or jnudo@deltadentalnj.com. Please
note that DeltaCare is available only in
New Jersey.
Dental News
A publication of
Delta Dental of New Jersey, Inc.
TRUSTEES
Ronald Deblinger, D.M.D.,
Chairman of the Board
Gerald A. Sydell, D.D.S.,
Vice Chairman of the Board
William F. Faherty, Jr.,
Corresponding Trustee
Robert H. Barney, Esq.
Carl Chaityn, D.D.S.
William Faulkner
Jerome Feldman, D.D.S.
John P. Hall, Jr.
Henry F. Henderson, Jr.
W. Thomas Margetts, Esq.
George McLaughlin, D.M.D.
Gene F. Napoliello, D.D.S.
Morton Reinhart
Debra Salman, D.D.S.
Howard A. Schwartz, D.D.S.
EXECUTIVE OFFICER
Walter VanBrunt
President and CEO
EDITOR
Diane Belle
Comments and suggestions are
welcomed and should be directed
to:
Network Coordinators Help You Get Started
with Benefits Connection, Too
Have you been thinking about trying our online Benefits Connection but would
like a little extra help to get started?
If your practice is in New Jersey or Connecticut, you can sign up for a free in-office
overview. Please contact your dental network coordinator to schedule your free
consultation today! Call (888) 396-6641 (in New Jersey) or (860) 635-3152 (in
Connecticut).
An in-office visit isn’t required, however, to see how Benefits Connection can help
your practice. Benefits Connection lets you quickly access patient eligibility and
benefits information, submit claims and pretreatment estimates, and much more.
You can take an online tour by visiting our website at www.deltadentalnj.com.
Click “Login|Register” at the top of the screen and then the online “demo” link.
To register for Benefits Connection, go to www.deltadentalnj.com. Click
“Login|Register” at the top of the screen. Then click the “Register” button on the
login screen and follow the online instructions.
Corporate Communications Dept.
Delta Dental of New Jersey, Inc.
P.O. Box 222
Parsippany, NJ 07054-0222
www.deltadentalnj.com
In Connecticut, Delta Dental
Insurance Company writes dental
coverage on an insured basis and Delta
Dental of New Jersey administers selffunded dental benefit programs.
Connect with Us
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Dental News
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3
Orthodontic Q&A
phase is submitted as comprehensive treatment
using the code that reflects the patient’s stage of
dentition for that phase (transitional, adolescent or
adult). Refer to the American Dental Association
CDT guide or your Delta Dental Participating
Dentist Handbook for more information on stages
of dentition and how to code orthodontic treatment.
We often get questions about orthodontics from dental offices.
We’ve compiled these answers to our most frequently asked
questions.
1.
Do I need to bill separately for an orthodontic
workup? Is this a separate fee or part of the
orthodontic treatment?
Whether or not a separate fee is charged for an
orthodontic workup or included as part of the orthodontic treatment is a business decision to be made
by the dentist.
2.
If a patient comes in for a visit and a panoramic
film, and it is determined that the patient is too
young to begin orthodontic treatment, can I charge
for the visit and the panoramic film?
These procedures may be submitted using the
appropriate procedure codes of D8660 for the preorthodontic treatment visit and D0330 for the
panoramic film. They will be processed according to
the patient’s orthodontic benefit.
4.
How will an orthodontic workup be benefited if I
am a general dentist rather than an orthodontist?
An orthodontic workup is processed according to
the patient’s orthodontic benefit whether performed
by a general dentist or an orthodontist.
5.
When should I bill for an orthodontic workup?
If billed separately, the fee for an orthodontic
workup should be billed when performed.
6.
Is a second orthodontic workup covered once
Phase I is completed?
Orthodontic workups are processed according to the
patient’s orthodontic benefit. Most plans allow one
orthodontic workup for a provider for a full comprehensive orthodontic treatment plan.
7.
What procedure codes should be used when there
are multiple phases of treatment?
Comprehensive orthodontic procedure codes should
be used for multiple phase treatment plans. Each
If treatment is extensive, what procedures should
I follow so that Delta Dental might consider the
extenuating circumstances as part of its
reimbursement review?
When submitting claims, any case with extenuating
circumstances should be submitted with documentation for individual consideration.
Does the benefit paid for an orthodontic workup
always come out of the orthodontic maximum?
The benefit payable for an orthodontic workup
comes out of the orthodontic maximum under most
patients’ contracts.
3.
8.
9.
Do I need to send a second claim to receive
additional payments? Is this the same with all
Delta Dental plans?
A second claim is necessary only if the patient’s
orthodontic benefit is subject to a benefit year maximum. This is not the majority of cases. Most
patients’ orthodontic benefits are paid according to
an automatic payment schedule that does not require
a second claim. The Explanation of Benefits for the
initial claim will indicate if remaining benefits will
be automatically generated according to a schedule.
This applies to claims processed by Delta Dental of
New Jersey. Other Delta Dental member companies
may process orthodontic claims differently.
10. What happens if a patient’s coverage is terminated
during treatment?
When coverage terminates during an active orthodontic treatment plan, Delta Dental prorates its payment. This is usually done by first determining the
number of months the patient was not eligible for
coverage. These months are then deducted from the
total months of treatment, and payment is based on
only the eligible months of treatment. The payment
is calculated by dividing Delta Dental’s maximum
liability for the entire treatment by the total months
of treatment, and multiplying that amount by the
months of treatment during which the patient was
eligible. The result determines Delta Dental’s orthodontic payment for eligible months of treatment.
This amount will be paid according to the orthodontic payment schedule of the patient’s plan.
(continued on page 4)
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Dental News
Orthodontic Q&A
(continued from page 3)
11.
What information should be listed on the claim
form for initial submission of an orthodontic
treatment plan? Where should I list that?
The following information should be provided in the
appropriate fields of the claim form or in the
Remarks field if no designated field is provided for
the information:
■
description of condition/class of malocclusion
■
type of appliance
■
reason for appliance
■
estimated total months of treatment
■
date treatment began (if applicable)
■
total case fee
■
indication of Phase I or Phase II treatment
(if multiple phases)
■
previous carrier payment information
(if applicable)
■
If clear aligners are being used, indicate this
with the amount of additional fee, if applicable,
for aligners over and above your usual fee for
conventional treatment.
■
If Delta Dental is the secondary carrier, provide
an explanation of benefits or statement from
the primary carrier indicating the total amount
to be paid for the treatment plan being submitted to Delta Dental.
12. If using clear aligners, what is needed for treatment to be considered for payment? How should it
be coded? What additional information is needed?
Treatment plans using clear aligners are processed
according to the patient’s contract. They may be
denied, or an optional benefit may be provided for
conventional therapy, subject to all contract limitations and maximums for the conventional therapy.
There is no unique procedure code for clear align-
ers; use the same procedure codes as for conventional treatment. Claims need to indicate that clear
aligners are being used and must provide the same
information as required for conventional treatment
plans. Also, indicate any additional charges over and
above your usual fee for conventional treatment, if
applicable. The additional charges for these procedures are the responsibility of the patient under
most patients’ plans.
13. If the patient is covered by Delta Dental, but the
patient has no orthodontic coverage, do I need to
submit a claim form?
Delta Dental participating dentists should submit a
claim for all treatment performed on a Delta Dental
patient, whether or not the particular service is covered so that an Explanation of Benefits can be provided indicating the patient’s responsibility for the
treatment. The patient may need this for circumstances such as Coordination of Benefits or Flexible
Spending Account reimbursement.
14. What happens if a patient has excessive breakage
or needs to continually come into the office? Can I
charge an additional fee? Will an additional benefit
be payable?
When submitting claims, any case with extenuating
circumstances should be submitted with documentation for individual consideration. This documentation will be reviewed to determine if an additional
benefit is payable according to the patient’s orthodontic benefit or if the patient should be responsible
for additional charges.
15. How do you handle orthodontic pretreatments?
Pre-treatment estimates are recommended for all
orthodontic treatment. To request a pre-treatment
estimate, simply complete and submit an Attending
Dentist’s Statement, making sure to provide all of
the information needed for processing an orthodontic treatment plan. Refer to #11, above.
Dental News
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5
Golf Classic Raises $48,000 for
Special Olympics New Jersey
Special thanks to everyone who participated in our 22nd Annual Golf Classic
Free FastAttach
Registration
Through
December
benefitting Special Olympics New Jersey! To date, Delta Dental has raised $882,000
for SONJ, a not-for-profit organization that provides sports training and athletic
competition to children and adults with intellectual disabilities.
The foursome from the New Jersey Dental
Association includes (from left): Jim Schulz,
Dr. Barbara Rich, Dr. Robert Giantomas, and
Dr. Charles Perle.
Golfers included (from left): Delta Dental of
New Jersey President and CEO Walter
VanBrunt, Special Olympics athlete Paul
Butera, Special Olympics coach Pete Samaha,
Special Olympics athlete Darrell Phinney, and
Special Olympics coach Bob Benjamin.
One in Five Suffer from Untreated Dental Caries
That is among the findings from the recently published National Health
and Nutrition Examination Survey. Researchers examined selected oral
health indicators in the United States from 2005 to 2008. The study noted
that treated and untreated dental caries, as well as tooth loss, are key
indicators of oral health status in the United States and internationally.
Although the prevalence of dental caries is declining, the study found
disparities across different population groups. To view the full survey
findings, go to www.cdc.gov/nchs/data/databriefs/db96.htm.
For more startling statistics about the impact of poverty, culture, geography,
and lack of education on oral health, view our Dental Connections video featuring Dr. Gene Napoliello. Visit our website at www.deltadentalnj.com. Click
the “Dental Videos” graphic, then the “Oral Health Statistics” link.
National Electronic
Attachment, Inc.’s (NEA)
FastAttach™ makes it surprisingly simple to submit
x-rays and other attachments in support of
claims. And now through
December 31st, participating dentists can register
free—a $200 savings.
FastAttach enables dental
offices to electronically
transmit x-rays, EOBs,
narratives, and other
attachments to insurers.
NEA interfaces with most
major software systems,
making FastAttach very
easy to use. Claims data
is populated into
FastAttach, eliminating
duplicate data entry.
The free registration offer
includes the software,
installation, and training.
The $25 monthly
FastAttach fee includes
unlimited transmissions,
training, customer service,
and support.
To take advantage of this
offer, go to NEA’s website,
www.nea-fast.com, click
the “FastAttach
Registration” link and
enter “DDNJZ” in the
promotion code field.
Or, call 1-800-782-5150,
option #2.
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Dental News
Educate Your Patients about Benefits,
Risks of Dental X-rays
Virtually everyone who visits the dentist
will have x-rays (radiographs) taken at
some point. And, it’s natural for
patients to be concerned about potential
risks from too much radiation exposure.
Dental radiographs have been in the
news recently because of a new study in
the American Cancer Society’s journal
Cancer that suggests people who had
more frequent and certain types of dental radiographs in the past may be at an
increased risk for developing a meningioma, one of the most common types
of diagnosed benign brain tumors.
Delta Dental has developed a free educational handout to help patients better
understand the study and why x-rays are
often a necessary and an important part
of the dental health examination
process. To download, go to
www.deltadentalnj.com. Click “Dentists”
on the left navigational bar, then the
“Download this educational handout”
link under “Promote Oral Health…and
Your Practice.”
Online Magazine Gives Your
Patients More Reasons to GRIN!
Delta Dental has launched a new online
magazine, GRIN! The magazine features oral
health news, information, notes, entertainment—
even recipes—to help keep smiles healthy and
happy. Check out the latest issue, full of fresh,
fun, and flavorful tips for summer. Go to
www.deltadentalnj.com. Under “Welcome,” click
the link under “Take a look at GRIN! Our New
Online Magazine.”
Participating
Dentists Can
Save 70% on the
Drug Information
Handbook for
Dentistry
The Drug Information
Handbook for Dentistry
is designed for all dental
professionals seeking
information on commonly
prescribed medications,
OTCs and herbal products.
Written by dentists for
dentists, this best-selling
resource includes dentalspecific content on thousands of drugs, natural
products and dietary
supplements. To order a
copy, visit our website at
www.deltadentalnj.com.
Click “Dentists” on the left
navigation bar, then the link
under “Exclusive Offer for
Delta Dental Participating
Dentists—Save 70% on the
Drug Information Handbook
for Dentistry!” Quantities
are limited and available
on a first come, first served
basis.
PRESORTED
STANDARD
U.S. POSTAGE PAID
W. CALDWELL, NJ
PERMIT NO. 111
Delta Dental Plaza
1639 Route 10
Parsippany, NJ 07054
ADDRESS SERVICE REQUESTED