Articles
Delta Dental Piloting Digitized X-Ray Program
Mark That Date!
Do You Fully Participate in Delta Dental's Programs?
Online FAQs Improved
Dental Benefits Called Major Factor in Americans' Oral Health
But Those Without Coverage Suffer
Delta  Dental Supports Clinic Providing Dental Care for Working Poor
What Our Not-for-Profit Status Means
Credentialing Program Nearly Complete
What is My Responsibility in Detecting Systemic Disease?

Delta Dental Piloting Digitized X-Ray Program

Delta Dental recently began a pilot program with National Electronic Attachment, Inc. (NEA) and a few select dental offices to test the technology. Dentists participating in the pilot have been extremely enthusiastic, says Beth DeCapio, EDI Coordinator. "They all were thrilled that Delta Dental is gearing up to receive digitized x-rays and attachments. They all believe it will save them time and money."

Digitized x-rays offer several advantages to dental practices. Dental office staffs report that the system is easy to use. They also noted that it is easier, faster and more efficient than handling traditional x-rays. It eliminates lost or missing x-rays and the need to duplicate film. Perhaps best of all, digitized x-rays help speed payments!

Dental practices interested in submitting digitized x-rays require:

• A scanner, digital radiography system or analog camera with video capture to digitize attachments
• An Internet Service Provider to transmit attachments to NEA's secure website
• Practice management software

This can be used in conjunction with any practice management software and clearinghouse.

We anticipate the pilot phase to be completed before the end of the first quarter of 2001. Look for more information on this program in upcoming issues of Dental News. For more information about how to use digitized x-rays when submitting electronic claims, please contact Beth DeCapio via e-mail at bdecapio@deltadentalnj.com or at 973-285-4035.

What better time to jump on the electronic claims superhighway? Faster x-ray review and faster claims processing amount to faster claim payment!

Mark That Date!

The Eleventh Annual Delta Dental Golf Classic will take place on June 5, 2001, at Cherry Valley Country Club. The golf classic benefits Special Olympics New Jersey. More details will follow shortly.

Do You Fully Participate in Delta Dental's Programs?

Delta Dental offers three types of dental programs:

• DeltaPremier is our traditional fee-for-service dental benefits program. More than 6,400 dentists in New Jersey and Connecticut and 109,000 nationwide participate. Participating dentists and specialists pre-file their usual fee for each procedure commonly performed, and accept the least of their actual charge, their filed fee, or Delta Dental's established UCR as payment in full.
• Delta's Advantage Program, available only in New Jersey, is an enhanced preferred provider option program in which participating dentists agree that the fee for covered services will not exceed the plan's maximum allowable charges. Payments are based on the Delta's Advantage Program Table. More than 2,600 dentists in New Jersey are enrolled.
• DeltaPreferred Option Program is our basic preferred provider option in which participating dentists agree to accept the DeltaPreferred Option schedule of maximum allowable charges as payment in full. Three thousand dentists in New Jersey and Connecticut participate in the DeltaPreferred Option Program.

More than 2,600 groups in New Jersey and Connecticut participate in these plans.

For a complete description of these plans, please visit our website at www.deltadentalnj.com or call your Dental Network Coordinator toll free at 888-396-6641.

Online FAQs Improved

Do you have a question about Delta Dental's policies? Finding the answer is easier than ever when you visit Delta Dental's recently updated "FAQs" section on our website. The new FAQs (for Frequently Asked Questions") section features three easy ways to obtain the answers you need.

1. You can browse the list of the most frequently asked questions and their answers. This list includes everything from how to verify a patient's claim status, assigning benefits, obtaining a referral to a specialist, and much more.
2. You can search the solution database using simple keywords or phrases. For example, if you want to know about documentation for full-time students, just type the word student and click on "Search Right Now." A drop-down list appears of all FAQs that include the word student.
3. If you don't find the information you need using the previous methods, you may click on the "Ask Us Right Now" icon to e-mail your question directly to our Customer Service Department. A Customer Service Agent will quickly respond to your request. (You may also reach Customer Service by e-mailing service@deltadentalnj.com.)

The FAQ database will be continuously updated to include frequently asked questions submitted to Customer Service via "Ask Us Right Now."

To access FAQs, go to www.deltadentalnj.com and click on "FAQs" from the menu.

Dental Benefits Called Major Factor in Americans' Oral Health

Americans are hearing less of the dental drill as a result of spending more time visiting their dentists for routine exams, according to Delta Dental Plans Association, the national network of independently operated not-for-profit dental service corporations of which Delta Dental Plan of New Jersey, Inc., is a member.

Since the early 1970s, dental care has witnessed a dramatic shift from treatment to prevention. The results of a Delta Dental Plan of Michigan study evaluating the claims data of insured dental patients confirm that this shift has led to exciting improvements in oral health. Research indicates improvements in the increased use of dental benefits, quality dental service, education and widespread use of fluoride are factors contributing to the trend.

In 1970, only 7% of all Americans had private dental coverage. Today, nearly half of the U.S. population is covered by employer-sponsored dental plans. Increased access to dental benefits encourages patients to seek regular checkups. The Michigan study revealed that scheduled oral exams have increased from one annual visit to 1.5 since 1980.

While routine dental checkups have increased, treatments for common dental ailments have decreased. From 1978 to 19990, tooth extractions declined 41 percent, and fillings were reduced by 52 percent. In 1960, the average American over age 65 had just seven of his or her original teeth. With today's level of dental care, baby boomers can expect to have at least 24 teeth left at that same age.

Delta Dental Plan of Michigan examined 15 years of claims data from approximately 750,000 individuals with Delta Dental benefits. The following statistics were drawn from the survey:

• Scheduled oral exams have increased from one annual visit to 1.5 since 1980.
• Fillings have decreased 45 percent in adults aged 64 and younger since 1970.
• The need for full dentures for beneficiaries under the age of 35 literally ended by 1990, and is rapidly declining among all older age groups.
• Simple extractions for patients 45-54 have decreased by nearly 45 percent.

"Results from this study clearly indicate that people attach a higher priority to maintaining their teeth and a health mouth," said Roger C. Smith, DDS, chairperson of the Delta Dental Plans Association's Dental Policy committee. "It's clear that regular, preventive care translates to longer-lasting teeth and better overall oral health."

But Those Without Coverage Suffer

Nearly half of all Americans lack dental benefits, one of several factors that prompted the non-profit advocacy group Oral Health America to give the nation a C-minus on its first Oral Health Report Card. "We have found that there are serious problems in terms of access to oral health care," said Surgeon General David Satcher. (Satcher was not involved in the preparation of this report card, but was instrumental in developing the Surgeon General's report on "Oral Health in America.") Roughly 108 million Americans are without dental coverage, many of them children and the elderly. Only one in five children on Medicaid sees a dentist in any given year.

Fluoridation was another factor affecting the nation's oral-health grade. There are 100 million people who live in areas without access to fluoridated water. New Jersey was one of 11 states that received an F in this area, for failing to bring fluoridation to even 10% of residents. Connecticut received a B for fluoridation.

Delta Dental Supports Clinic Providing Dental Care for Working Poor

The consequences can be tragic.

"One woman who came to us from a shelter was eager to go to work - but she had no teeth," says Kay Zufall, administrator of Dover Free Clinic in Dover, New Jersey. No one would hire her until her teeth were fixed, but she couldn't afford to do so until she found a job.

Clinic Reaches Underserved
Fortunately, organizations such as the Dover Free Clinic are dedicated to bringing dental care to the underserved, with the help of the Delta Dental Foundation of New Jersey. "One mission of the Delta Dental Foundation is to financially support organizations such as the Dover Free Clinic, which provides dental services to the indigent," says Michael Colatarci, Senior Vice President and CFO of Delta Dental Plan of New Jersey. "A lot of people fall through the cracks who can't afford dental care. Over the past few years, the Dover Free Clinic has expanded its program to serve a growing number of people in its community."

The clinic last year provided low-cost dental care to 1,800 patients.

"It's not free," emphasizes Zufall. "It's not charity care."

Patients Save for Care
Patients pay $35 when they schedule their appointment. That covers everything that can be done during a single appointment, except lab fees. Patients are expected to show up on time. If they need to change their appointment, they must call 24 hours in advance. Failure to do so means they don't get treatment. Very few miss their appointments. Most are extremely grateful for the care. "They will save up until they can afford a visit," says Zufall. "One mother saved for all her kids. It took her all year. Then she came in for herself."

The clinic has one dentist and a bilingual dental assistant on staff. It occasionally refers patients to specialists, and has developed relationships with several area dentists who accept reduced payments for their services.

"We try to be cautious about not expecting a dentist to do something for nothing," says Zufall. In cases where dentists have refused payment, Zufall encourages patients to write thank-you notes or bring something they made at home as tokens of their appreciation.

Clinic Expands as Need Grows
With Delta Dental's assistance, the clinic recently acquired a second dental chair and x-ray equipment from St. Clare's Hospital when the hospital closed its Dover facility. The clinic is being renovated to accommodate the additional equipment and the extra people that it must now treat since St. Clare's closing.

"We would not have been able to undertake this expansion without the support of the Delta Dental Foundation," says Zufall. "You have our sincere thanks and gratitude."

For information on how you can support the Dover Free Clinic, contact Zufall at 973-328-3344.

What Our Not-for-Profit Status Means

Delta Dental is an influential partner in maintaining oral health. But we're not an insurance company. Delta Dental Plan of New Jersey is a not-for-profit dental service corporation, which means we contract with organizations to administer their dental-care plans on a prepaid basis.

As a not-for-profit dental service corporation, Delta Dental operates a bit differently than an insurance company.

First and foremost, we are able to focus on our primary mission - improving the oral health of those we serve. Secondly, Delta Dental does not have stockholders, nor is it a publicly traded company. This means that the dollars collected for the administration of dental benefits plans go toward your patients' benefit programs - not for stock dividends.

Our not-for-profit status also contributes to keeping premiums in check and our administration costs low, which further adds to the value of a Delta Dental program. In fact, the vas majority of each premium dollar pays directly for dental care. The balance pays for the careful review of claims, dental audits and customer service - hallmarks of the Delta Dental program.

The balance also pays for research, product development and oral health campaigns in the communities we serve. As a not-for-profit entity, we are committed to giving back to our community through our philanthropic arm, the Delta Dental Foundation of New Jersey. Among the many programs supported include PANDA (Prevent Abuse and Neglect through Dental Awareness) Program, which educates dentists and others on the warning signs of child abuse; Captain Supertooth, the superhero of dental hygiene, who visits New Jersey schools to spread the word to students about the importance of good oral hygiene; the Bloomfield Health Careers Foundation, which trains dental assistants and dental hygienists; the Paterson Dental Clinic, to provide supplies used to treat children of the Paterson School District; and the Dover Free Clinic and Kimball Dental Clinic to provide dental care to those in need.

Credentialing Program Nearly Complete

Every participating dentist in Connecticut and most participating dentists in New Jersey have now completed Delta Dental's credentialing process. As of November 21, 2000, 70% of DeltaPremier's dentists, 60% of Delta's Advantage Program's dentists, 65% of DeltaPreferred Option's dentists, and 100% of DeltaCare's dentists have been credentialed in New Jersey.

Every dentist in a practice must submit a credentialing questionnaire in order to participate.

If you haven't yet received your credentialing packet, please contact our Credentialing Department at 888-203-6993. Completed credentialing questionnaires should be sent to:

Delta Dental Plan of New Jersey, Inc.
Attention: Credentialing Department
P.O. Box 222
Parsippany, New Jersey 07054

Please be sure that the questionnaire is complete and all required supporting documents are enclosed before submitting. Incomplete applications may delay the credentialing process.

What is My Responsibility in Detecting Systemic Disease?

This article originally appeared in the January/February 2000 issue of the SAFECO Dental News. Permission to reprint this article was granted by SAFECO.

At one time, the relief of pain and treatment of gross infections were the primary focus of dentistry. Then, techniques and knowledge grew, and dental caries and restorative dentistry became the key to successful practice. More recently came an awareness and understanding of periodontal disease. Terms like cytokines and metalloproteinase inhibitors are discussed as part of the medical management of periodontitis.

Today, there is increasing recognition that oral health both affects and is affected by systemic disease. We know, for example, that one of the first clinical signs of AIDS can be hairy leukoplakia on the tongue. A panoramic radiograph revealing generalized bone loss may be a diagnostic indicator of osteoporosis. Recent epidemiological studies suggest that poor periodontal health can be associated with increased risk of cardiovascular diseases and poor pregnancy outcomes.

The standards and responsibilities of dental professionals for the diagnosis and detection of systemic diseases are changing. The prudent practitioner will ask about when the patient last sought medical care. Health status update information should be recorded clearly in the chart so that any changes are easily spotted without having to wade through pages of notes. Every patient should be queried at each new episode of care about any changes in general health, new or discontinued prescription drugs, and any health concerns that they might have. Dentists and dental hygienists are now expected to routinely screen every patient for oral cancer and made appropriate referrals.

In the absence of an obvious cause, xerostomia is another condition which should prompt a referral. Some patients seem to heal poorly following minor surgery and endodontic therapy. Others may have periodontal infections which seem difficult to get under control. Such patients should be encouraged to seek an evaluation to rule out diabetes or other conditions that impact oral health. Dental professionals are routinely named in malpractice claims regarding missed diagnoses of these conditions. Today's practitioner is expected to be observant of any suspicious clinical signs and symptoms, make careful chart notes, and initiate referrals when appropriate.

SAFECO offers participating dentists who have completed Delta Dental Plan of New Jersey's credentialing requirements a special 10% premium discount (over and above other available discounts) for qualified dentists insured under the SAFECO Insurance Company Preferred Dental Professional Liability Program. For a no-obligation estimate, call 800-JAMISON (526-4766), ext. 352, or e-mail lbarbaro@jamisongroup.com.