Articles
Online Claims Submission Launches!
How to Submit X-rays Using Online Claims
Submission
Claims That You May Submit Online
COB Reminder
Porcelain/Ceramic Bridge Systems Announcement
Congratulations, Dr. Feinberg!
Online Claims Submission Tip
Key CDT-4 Changes
Dental Seminars Set for April, October
Resources to Help Prepare for HIPAA's Privacy Rule
Dr. Zweig Earns Certification
Just 'Fore' More Months Till Golf Classic!
Dell Offers Computer Discounts to Participating Dentists
Online Claims Submission Launches!
Dental Plan of New Jersey recently rolled out its
new service that enables dentists to submit claims
directly to Delta Dental online, without going through
a clearinghouse.
Both participating and non-participating dentists
may submit claims online.
Online claims submission offers several advantages
over paper claims. A dental office that sends eight
claims a day to Delta Dental could save about $3,000
a year if it submitted them online rather than mailed
them. In addition, claims process about 50% faster
when they are submitted online. Online claims submission
is easy to use, even for first-time users.
The system accepts online claims Monday through Friday
from 7 a.m. to 10 p.m. EST. Our site uses industry
standards such as firewalls and Secure Socket Layer
(SSL) technology to safeguard the confidentiality
of personal information. The confidential information
we receive is not disclosed to other companies for
marketing purposes, and eligibility and dental benefit
information is released only to authorized individuals.
To get started, go to Delta Dental's Web site at
www.deltadentalnj.com and click on "Dentists" on
the right side of the page. This takes you to the
Dentists section of our Web site. Log onto Benefits
Connection. (If you're unfamiliar with Benefits Connection
or are not registered for Benefits Connection, follow
the online directions to register.) Select "Claims
Submissions" and follow the step-by-step instructions
on the screen.
Any practicing dentist in the United States may use
our online claims submission feature to submit claims
to Delta Dental Plan of New Jersey for patients covered
by our Delta Dental Plan. We cannot accept claims
for patients covered by other Delta Dental Plans.
The service is available to both participating and
non-participating dentists.
For more information about online claims submission,
visit our Web site at www.deltadentalnj.com, click "Dentists" and
log onto the "Benefits Connection Logon" box. A Q&A
and user guide are available online.
How to Submit X-rays Using Online
Claims Submission
Delta Dental developed an expedited process for
submitting x-rays and other attachments when you
use online claims submission. Before submitting any
x-ray or attachment, you should always verify if
they are required. Delta Dental has taken steps when
possible to reduce the number of x-rays and other
attachments required when filing claims. A complete
list of procedures requiring documentation is available
on our Web site at www.deltadentalnj.com; click "Dentists" on
the Delta Dental home page and then click "Required
Documentation Charts." If documentation is required,
note the claim document number and mail the diagnostic
material to the special post-office box (the address
is provided on the screen). If you would like to
submit documentation electronically (including x-rays,
perio charting and narratives), please contact NEA
(National Electronic Attachment) at (800) 782-5150.
Claims That You May Submit Online
Practically every type of claim that you submit
by paper can now be submitted online, including:
- Claim with dated services; no Coordination of
Benefits (COB)
- Pre-Treatment Estimate (PTE) for non-dated services
- Payment of a PTE (must have a PTE voucher number)
COB Reminder
There has been some confusion about the correct
way to coordinate benefits (when a patient is covered
by two or more dental benefits plans). Delta Dental's
Claims Department provides the following tips:
- The subscriber's dental benefits plan is always
primary for the subscriber. This means if your
patient has Delta Dental and your patient's spouse
has another dental plan, the primary plan for the
subscriber is Delta Dental. The spouse's dental
plan would be the primary plan for the spouse.
- Coordination of dental benefits for dependents
usually (but not always) follows the birthday rule.
This means that the dental plan for the parent
whose birthday (month and day) is earlier in the
calendar year provides the primary coverage. (Delta
Dental has a small number of groups that determine
the primary carrier by the gender rule.)
- In cases of divorce, if the responsibility is
not detailed in the divorce decree, the parent
with custody is usually primary, the stepparent
is usually secondary and the non-custodial parent
is usually tertiary (third). If the parents have
joint custody, then the parent with the birthday
earlier in the calendar year usually has primary
coverage.
Porcelain/Ceramic Bridge Systems
Announcement
Delta Dental Plan of New Jersey (DDPNJ) recently
reviewed materials related to porcelain/ceramic bridge
systems (D6740, D6245). Based on the relatively short
duration of the clinical trials Delta Dental will
provide, subject to dental consultant review, an
alternative benefit of a conventional fixed porcelain/metal
bridge (D6750, D6250).
The difference between the approved amount for the
conventional appliance and the approved amount for
the porcelain/ceramic appliance is billable to the
patient by a Delta Dental participating dentist.
Dentists are reminded that the vast majority of DDPNJ
groups have five-year contractual limits for fixed
bridges and, therefore, the strength and weaknesses
of restorative materials and the added patient financial
liability should be discussed with the patient before
proceeding with treatment.
Congratulations, Dr. Feinberg!
Delta Dental Plan of New Jersey wishes to congratulate
Dr. Maxine Feinberg, a participating periodontist
from Cranford, New Jersey, who was recently elected
president of the New Jersey Dental Association. Dr.
Feinberg is the first woman president of the organization.
Congratulations!
Online Claims Submission Tip
How to tell if your submission went through or not
When you reach the Claim Status screen, your claim
has been submitted to Delta Dental. You can check
the Delta Payment and Patient Payment sections to
determine dollar amounts. If dollar amounts are indicated,
this means your claim has adjudicated and your check
and EOB (Explanation of Benefits) will be issued
in our next check run. This schedule is posted on
our Web site. If those fields say Pending Review,
this means your claim needs manual intervention when
it arrives at Delta Dental.
Some of the reasons claims pend are for review of
diagnostics, comments in the Comments field, research
at Delta Dental is required (for instance, how to
process the claim in a divorce situation), plan limitations
and exclusions, and dollar amount paid by another
carrier. At this point, there is nothing you can
do online to that claim. It has already entered our
system and is being processed.
If you must make a change to that claim, keep track
of the claim number, which appears on the Claim Status
screen (and in your log) and call our Customer Service
Department at (800) 452-9310 to explain what you
need to change.
For most users, we have disabled the browser back
button when you reach the Claim Status screen. (The
browser back button is at the top left of your screen.)
Hitting it gets you no further. If you are able to
go back (usually because you are using a browser
other than Internet Explorer), you are not fixing
the claim you submitted. All you are doing is creating
a duplicate claim, which will deny because of duplicate
services. Please refrain from doing this.
Once you have reached the Claim Status screen, you
can either Log Off if you are done with your claims
submission session, view your submissions log (and
print it if you'd like) on the left navigation bar,
or hit the Submit Another Claim button, which allows
you to continue submitting new claims.
Please avoid using your browser back button. On the
screens where going back will not negatively impact
your claim submission, you will see a back button
at the bottom right of your screen. If there is no
back button, please choose one of the options listed
above.
Sending duplicate claims to Delta Dental adds to
your workload and ours. We create additional claims
and their corresponding EOBs. Your cooperation will
improve the efficiency of claims processing.
If you have any questions about online claims submission,
please contact your Dental Network Coordinator at
(888) 396-6641.
Key CDT-4 Changes
This abbreviated list includes Delta Dental Plan
of New Jersey/DeltaUSA Processing Policies for several
key CDT-4 code changes. When submitting CDT-4 codes,
DDPNJ participating dentists agree to abide by these
policies. A complete handbook update will be mailed
to DDPNJ participating dentists this spring. For
a CDT-4 manual you may contact the ADA catalog sales
at (800) 947-4746 or www.adacatalog.org.
CDT Code with Delta Dental's Processing Policy
D0180 - comprehensive periodontal evaluation - new
or established patient.
This evaluation code will be used primarily by a
periodontist for a referred patient from a general
dentist and should not be reported in addition to
a comprehensive oral evaluation (D0150) by the same
dentist in the same treatment series. This procedure
is not intended for use as a separate code for periodontal
charting. Procedure code D0180 will be processed
similarly to code D0150.
D0277 - vertical bitewings - 7 to 8 films - This
does not constitute a full mouth intraoral radiographic
series.
For plan benefit and payment purposes, if the billed
fee is equal to or exceeds the maximum plan allowance
of a full mouth series of radiographs, the payment
will be equal to that of a full mouth series (D0210)
and subject to the frequency limitation of a full
mouth series.
D2140 / D2150 / D2160 / D2161 - amalgam restorations,
primary or permanent teeth.
The primary amalgam procedure codes have been deleted.
When submitting this code for a primary tooth, report
the lesser of your actual fee or your usual fee for
this procedure when performed on a primary tooth
for a patient without insurance.
D2390 / D2391 / D2392 / D2393 / D2394 - resin-based
composite restorations, posterior primary or permanent
teeth.
The primary posterior resin based composite procedure
codes have been deleted. When submitting this code
for a primary tooth, report the lesser of your actual
fee or your usual fee for this procedure when performed
on a primary tooth for a patient without insurance.
D2950 - core buildup, including any pins.
A core buildup, including any pins, may be reported
when there is insufficient tooth strength and retention
for the crown procedure. A core buildup should not
be reported when the procedure only involves a filler
to eliminate any undercut, box form or concave irregularity
in the preparation.
D4210 - gingivectomy or gingivoplasty- four or more
contiguous teeth or bounded teeth spaces per quadrant.
Four or more diseased teeth distal to the midline
are considered a quadrant. Bounded tooth spaces are
not counted in making this determination. When this
periodontal procedure does not meet all of these
criteria, use procedure code D4211.
D4211 - gingivectomy or gingivoplasty - one to three
teeth, per quadrant.
See D4210.
D4240 - gingival flap procedure, including root planing
- four or more contiguous teeth or bounded teeth
spaces, per quadrant.
Four or more diseased teeth or bounded teeth spaces
distal to the midline are considered a quadrant.
A bounded tooth space counts as one space irrespective
of the number of teeth that would normally exist
in the space. When this periodontal procedure does
not meet all of these criteria, use procedure code
D4241.
D4241 - gingival flap procedure, including root planing
- one to three teeth, per quadrant.
See D4240.
D4260 - osseous surgery (including flap entry and
closure) - four or more contiguous teeth or bounded
teeth spaces, per quadrant.
Four or more diseased teeth or bounded teeth spaces
distal to the midline are considered a quadrant.
A bounded tooth space counts as one space irrespective
of the number of teeth that would normally exist
in the space. When this periodontal procedure does
not meet all of these criteria, use procedure code
D4261.
D4261 - osseous surgery (including flap entry and
closure) - one to three teeth per quadrant.
See D4260.
D4341 - periodontal scaling and root planing - four
or more contiguous teeth or bounded teeth spaces
per quadrant.
Four or more diseased teeth distal to the midline
are considered a quadrant. Bounded tooth spaces are
not counted in making this determination. When this
periodontal surgical procedure does not meet all
of these criteria, use procedure code D4342.
D4342 - periodontal scaling and root planing - one
to three teeth, per quadrant.
See D4341.
D7287 - cytology sample collection - For collection
of oral cytology sample via mild scraping of the
oral mucosa.
This code may be used for the brush biopsy procedure
for the collection of the sample only, not for the
oral pathology procedures. This procedure is by report
and subject to coverage under the subscriber's medical
plan. It must be submitted first to the medical carrier
and then to Delta Dental with a narrative and the
benefit determination of the medical carrier. This
procedure is appropriate as a diagnostic service
for patients with unresolving oral lesions or a patient
with an oral lesion who has significant risk factors.
Routine oral cancer screening procedures for non
high-risk patients are considered part of the comprehensive
evaluation procedure. A separate fee is not benefited
by Delta Dental and not collectable from the patient.
D9450 - case presentation, detailed and extensive
treatment planning.
Use this code only to report complex treatment planning
cases involving multiple treatment disciplines and
multiple providers of care. Routine case presentation
is considered a part of the evaluation procedure.
A separate fee is not benefited by Delta Dental and
not collectable from the patient.
BENEFIT COVERAGE FOR THESE PROCEDURES MAY VARY BY
CONTRACT.
Dental Seminars Set for April,
October
Delta Dental's next seminar for dentists features
Dr. Stanley F. Malamed on "Drugs, Death and Dentistry." The
seminar, scheduled April 30, 2003, takes place at
the Birchwood Manor in Whippany, New Jersey.
On October 22, David R. Federick, DMD, MScD, FACD,
FICD, will present "Foundation and Aesthetic Restorations
for Decimated Teeth." This seminar will be held at
Doral Forrestal in Princeton, New Jersey.
All participating dentists will receive invitations
to these seminars with details, or check our Web
site at www.deltadentalnj.com; click "Dentists" and "Schedule
of Events."
Resources to Help Prepare for
HIPAA's Privacy Rule
The Health Insurance Portability and Accountability
Act of 1996 (HIPAA) Privacy Rule takes effect on
April 14, 2003. Is your practice ready? The Privacy
Rule will affect all health plans, health care clearinghouses,
and health care providers - including dentists. All
must be ready to comply with new regulations for
protecting patient information.
The United States Department of Health and Human
Services' Office for Civil Rights answers many frequently
asked questions about the HIPAA Privacy Rule on its
Web site, at www.hhs.gov/ocr/faqs1001.doc.
Some of the issues addressed by the Web site include:
Can a dentist's office fax patient information to another dentist's or physician's
office?
Yes, so long as the covered entity has reasonable
and appropriate administrative, technical, and physical
safeguards to protect the privacy of protected health
information. For example, the sender should confirm
before sending information that the fax number is
correct, and that the recipient's fax machine is
in a secure location to prevent unauthorized access
to the information.
Can dental offices use patient sign-in sheets or call out the names of patients
in their waiting rooms?
Yes, so long as the information disclosed is appropriately
limited and does not display information that is
not necessary for the purpose of signing in, such
as the nature of any dental problem.
How will the Privacy Rule affect professional liability insurers?
The Privacy Rule permits covered health care providers
to disclose information for "health care operations," including
for professional liability coverage. A covered health
care provider may disclose individually identifiable
health information to a professional liability insurer
to the same extent that a provider is able to disclose
such information for other health care operations
purposes.
Does the Privacy Rule permit covered entities or their collection agencies
to obtain payment from parties other than the patient, such as from spouses
or guardians?
Yes; however, a covered entity, or its business associate, must reasonably
limit the amount of information disclosed for such purposes. Covered entities
also must abide by any reasonable requests for confidential communications
and any agreed-to restrictions on use or disclosure of protected health information.
Are dentists required to have business associate contracts with technicians
such as plumbers, electricians or photocopy machine repair people who provide
repair services in the office? What about janitorial services? Delivery services?
Not usually. "Business associates" are contractors or other non-workforce
members hired to do the work of, or for, a covered entity that involves the
use or disclosure of protected health information. Those workers listed above
do not require access to protected health information to perform their services,
so they do not meet the definition of a business associate. Any disclosure
of protected health information that occurs in the performance of duties (such
as a janitor emptying trash cans) is limited in nature, occurs as a byproduct
of their duties, and could not be reasonably prevented. Such disclosures are
incidental and permitted by the Privacy Rule. Similarly, organizations such
as the U.S. Postal Service, certain private couriers and their electronic equivalents
act merely as conduits for transporting protected health information; since
no disclosure is intended, a conduit is not a business associate of the covered
entity.
Other HIPAA resources include:
- Delta Dental's Web site, at www.deltadentalnj.com.
Click "HIPAA" on the home page for information
about Delta Dental's compliance efforts, as well
as a list of HIPAA-related Web sites.
- American Dental Association's HIPAA Web site,
at www.ada.org/goto/hipaa. This site provides news
and resources to help dentists comply with HIPAA.
Its section on "HIPAA Privacy Guidance for Dentists" features
compliance guidelines prepared by the ADA.
This information is for informational and educational
purposes only. It does not constitute legal advice.
We urge you to contact your legal counsel for advice
with respect to the interpretation of HIPAA and its
applicability to you.
Dr. Zweig Earns Certification
Dr. Marc Zweig, manager of Delta Dental's Professional
Review Department, recently received certification
from the American Association of Dental Consultants
(AADC).
To date, only 155 members of the AADC have been examined
and earned the title Certified Dental Consultant.
The certification process requires candidates to
meet eight eligibility requirements, including being
sponsored by an active certified member, having a
minimum of ten years' experience in the clinical
practice of dentistry, being retained by an insurance
carrier or similar entity for a minimum of five years,
and fulfilling continuing education requirements.
Eligible applicants must then pass a comprehensive
three-hour written dental consulting examination,
which includes such diverse topics as claims review,
data analysis and interpretation, critical review
of the scientific literature and clinical trials,
quality assurance, utilization review, contract interpretation,
credentialing, legislation and litigation. In preparation
for the examination, candidates are required to study
a reference list of more than 100 articles, studies,
and books.
Founded in 1979, the AADC is dedicated to serving
patients, the public, purchasers of health benefits,
and the profession of dentistry. It is the only organization
of its type and has grown to more than 400 members
in dental consulting, administration and education.
Dr. Zweig received his Doctor of Dental Medicine
(DMD) from the University of Louisville and his periodontal
specialty certificate from the University of Maryland.
Just 'Fore' More Months Till
Golf Classic!
Mark your calendars! The thirteenth annual Delta
Dental Golf Classic, which raises funds for Special
Olympics New Jersey (SONJ), will take place June
4 at Fiddler's Elbow Country Club in Bedminster,
New Jersey. Last year's event raised $55,000 for
SONJ.
Delta Dental Plan of New Jersey is a proud sponsor
of Special Olympics New Jersey, a non-profit organization
that provides athletic training and competition for
children and adults with mental retardation.
For information about SONJ, go to www.sonj.org. To
request information about the Delta Dental Classic,
call (973) 285-4059 or e-mail jappaluccio@deltadentalnj.com.
Dell Offers Computer
Discounts to Participating Dentists
Delta Dental has added another valuable service
to our In-Net Program. Participating dentists are
now eligible to receive discounts on Dell home computers
through Dell's Employee Purchase Plan (EPP) program.
Dell offers a 5% to 10% discount on all consumer
machines (Dimension desktops and Inspiron notebooks).
The 5% discount is on all consumer machines with
a one- or two-year warranty. The 10% discount is
on all consumer machines with a three- or four-year
on-site warranty.
In order to receive your discount, please have your
Member ID available. The Delta Dental Plan of New
Jersey Member ID number is HS7135070.
You may either call or go online to order. The EPP
phone number is (800) 695-8133. You can reach sales,
technical support and customer service through this
phone number.
You may also call a sales representative for pre-sales
questions and quotes. You can reach a sales representative
Monday through Friday, from 7a.m. to 9 p.m. CST.
In order to view the systems, please go to www.dell.com/eppbuy.
The first page will ask you for your Member ID number
(which is HS7135070).
You can place orders through the EPP online store
24 hours a day, seven days a week.
Please visit our Web site at www.deltadentalnj.com
to review other valuable services made available
to participating dentists through Delta Dental's
In-Net Program. Click "Dentists" and "In-Net Program."
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