Articles
Delta Dental Plan of New Jersey Now Accepts Digitized Attachments!
Conference Update
AIDS Medications and Liability Risk
Credentialing Reminder
A Letter From Our Chairman of the Board
PANDA Helps Dentists ID Child Abuse
April is Child-Abuse Prevention Month: What You Can Do
Mark That Date!
HIPAA: How Will the Mandatory Reforms Affect You?
HIPAA Mandated Transactions
Free Assistance with Electronic Claim Submission

Delta Dental Plan of New Jersey Now Accepts Digitized Attachments! Free Registration through April 30, 2001

Delta Dental is now accepting digitized x-rays and attachments from National Electronic Attachment (NEA). Digitized x-rays and attachments offer many advantages to a dental practice. They are easy to use and offer much faster handling of a dental claim when diagnostics are required. Attachments are available to Delta Dental at the NEA-secure website at the same time the electronic claim arrives at Delta Dental, so they can be reviewed simultaneously. This means NO MORE MAILING X-RAYS, NO  MORE REQUESTS FOR HARD COPY X-RAYS OR PERIO CHARTING FOR USERS OF DIGITAL ATTACHMENTS. This should cut down on the amount of paper that goes back and forth between your office and Delta Dental. This can translate into faster claims processing and, therefore quicker turnaround times on your claim payments! It should also eliminate the possibility of any lost or missing x-rays and the need to duplicate films.

Dental offices interested in submitting digitized attachments 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
• The ability to send claims electronically

If you would like to get started right away and be eligible to have Delta Dental waive the NEA $200 registration fee, please contact NEA at 800-782-5151 extension 2. You can also contact Delta Dental's EDI coordinator, Beth DeCapio at 973-285-4035 or e-mail her at bdecapio@deltadentalnj.com. This limited free offer expires April 30, 2001.

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

Conference Update

Delta Dental will be participating in several upcoming dental conferences. Please stop by our booths at the following meetings:

• Charter Oak Dental Meeting (annual meeting of the Connecticut State Dental Association), May 8-10, 2001, at Foxwoods Resort and Casino in Ledyard, Connecticut.
• Mid-Atlantic Dental Expo (annual meeting of the New Jersey Dental Association), June 1-3, 2001, at the Atlantic City Convention Center, Atlantic City, New Jersey.

AIDS Medications and Liability Risk

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

Nearly every dentist practicing in a metropolitan area today has patients with AIDS or HIV infection in his or her practice. The prescription medications that AIDS patients are taking have resulted in less illness and longer lives for these individuals. At the same time, the pharmaceuticals themselves pose a potential problem for the dentist. Serious interactions can result in medical emergencies and malpractice claims. Therefore, a careful medical history and consultation with the patient's physician are essential. Because medications are changing so rapidly, the dentist cannot possibly be aware of all the potential problems and complications that may occur.

Two large classes of widely used drugs are of importance to the dentist. Often taken in combination, these are the nucleoside analogue reverse transcriptase inhibitors, such as AZT, and the protease inhibitors, such as ritonavir.  Some of the transcriptase inhibitors may affect the absorption of antibiotics, especially tetracyclines used in the treatment of periodontal disease. With the protease inhibitors, there may be limits to the use of lidocaine. Since these drugs can potentially increase the serum levels of lidocaine to cardiotoxic levels, the use of alternative local anesthetics should be considered. Some AIDS medications can also cause peripheral neuropathy and paresthesias in the perioral area. Such reactions may be confusing to the dentist if they are present after oral surgery or routine dental treatment. In addition, the patient's complex pill-taking regimen may call for extra consideration in scheduling appointments.

It is important to provide the consulting physician with a clear picture of the patient's dental condition because of their lower resistance to bacterial and fungal infections. Discuss the treatment plan, including the types and dosages of drugs to be employed. Confirm clearly with the physician that he or she knows this particular patient and has records available indicating viral load and other parameters. Record the physician's advice in the chart. It may also be prudent to fax the physician a copy of the chart note as a confirmation of the information received.

Hopefully, we have passed the period when fear caused dentists to turn away patients with these chronic conditions, resulting in legal actions against dentists. In this new era, it is important to turn our attention to providing coordinated, high-quality treatment to such patients.

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.

Credentialing Reminder

Are you one of the few participating dentists who has not completed Delta Dental's credentialing process? If so, please make this a priority! All dentists in a practice must submit a credentialing questionnaire or they will lose their participating status with Delta Dental.

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.

A Letter from Our Chairman of the Board

To All Dentists Who Participate with Delta Dental:

I recently attended the meeting of the Union County Dental Society Executive Committee. At that meeting there was a discussion concerning the bill, which would require that dental service corporations and health service corporations honor assignments of benefits to non-participating dentists. I was asked to explain the bill and after doing so was informed that it would be helpful if I could explain Delta Dental's position in writing so that other members could fully understand it and consider whether they wished to express support of the assignment of benefits bill. A copy of my letter to that component is reproduced below.

To Union County Dental Society - This explanation follows our discussion at the November 28, 2000 meeting. I hope this helps our component members understand Delta Dental's opposition to the assignment of benefits bill.

Delta Dental Plan of New Jersey has experienced a very successful growth since its beginnings in 1969. it currently has approximately seventy-five percent (75%) of the active practicing dentists in the State of New Jersey. It has achieved that level of participation because it has combined fair payment with fair processing. It has been able to substantially increase its number of covered persons by providing good dental coverage with a strong network of participating dentists.

Approximately six years ago, the NJDA began to push for enactment of a bill which would require dental service corporations to honor assignments of the patient's benefit to dentists who did not participate in the network. For the last few years the bill would apply only to dental service corporations (Delta Dental is the only major dental service corporation in New Jersey) and health service corporations (Horizon Blue Cross is the only major health service corporation in New Jersey). The NJDA bill would not apply to other dental insurers or to other third party payers such as self-funded ERISA plans.

Delta Dental believes that the assignment of benefits bill is undesirable and would not serve the public interest nor the interest of Delta Dental's panel of participating dentists. Let me explain. First of all, Delta Dental would experience increased administrative costs in the event that it was required to honor certain requests for assignment of benefits to non-network dentists. That would make valuable premium dollars unavailable for the payment for dentistry. That serves no one. Second, it would give a benefit to those dentists who have chosen not to participate in Delta Dental's network or who have lost the right to do so because of overbilling; they would receive a major benefit of participation (direct payment) without being required to honor the cost containment protections and other patient protections which participating dentists must honor. That is not fair to participating dentists. Third, we are concerned that some dentists who currently participate with Delta Dental would leave the network because they could still receive direct payments that could mean that the patient would have an increased copay. We are proud to have the strong participation which we currently have, we are proud to be regarded as the best dental plan available, but any loss of our dental network will make us less competitive and will therefore make it more difficult for us to sell Delta Dental coverage. That is not to the benefit of dentists who, like us, believe that Delta Dental coverage is the best available. We believe in having the strongest network in New Jersey on fair terms to the dental community with cost containment advantages for the patient and the group. We believe that to the extent that Delta Dental is adversely impacted by the assignment of benefits bill, that all of our participating dentists will be adversely impacted as well. The benefits to being a participating dentist are directly related to Delta Dental's ability to sell  its coverage. Therefore, any exodus from our network would hurt not only Delta Dental, but all participating dentists who remain in the network. And, it will not stop there. It will also hurt non-participating dentists to the extent that more claims are being processed and paid by carriers or other intermediaries who are not as prompt or not accurate or whose payment levels are not as favorable as Delta Dental's coverage.

The Delta Dental system, which is dependent upon a strong network and strong costs containment advantages for its groups, has worked well for 30 years. The assignment of benefits bill would disturb the balance which has been achieved between cost containment and the benefits of participation. It would allow dentists who decline to follow the participating dentists rules to receive a major benefit to the detriment to those dentists who participate with Delta and follow the rules. This would not be fair. And, this would not serve the public, our groups, our covered persons, or our participating dentists.

Very truly yours,

Gerald A. Sydell, D.D.S.
Chairman of the Board

PANDA Helps Dentists ID Child Abuse

Tens of thousands of children in New Jersey and Connecticut are victims of child abuse each year. Delta Dental's PANDA (Prevent Abuse and Neglect through Dental Awareness) program is working hard to save them from further injury.

PANDA, funded by Delta Dental's philanthropic arm, the Delta Dental Plan of New Jersey Foundation, educates dental office personnel about how to recognize and report suspected cases of child abuse and neglect.

Dentists have a unique opportunity to detect child-abuse injuries. Nationally, about 65% of child-abuse injuries involve the head, neck or mouth areas. However, a disproportionately lower percentage of the 50,000 cases of child abuse reported each year in New Jersey come from dentists. The reason for this low reporting rate by dentists may be related to lack of training and concerns about the ramifications of becoming legally involved in such cases.

Studies indicate that dentists educated in this area are nearly five times as likely to report suspected abuse.

Many people, including dentists, are reluctant to report suspected child abuse because they are uncertain whether an injury resulted from abuse or something else. PANDA shows dentists how to identify the difference between accidental injuries and those inflicted by a guardian or caretaker.

Thousands of dentists have attended PANDA programs throughout New Jersey and the country. Programs are offered several times a month, not only to dentists, but also to school nurses, teachers and other health-care providers.

The PANDA program qualifies for continuing education credits. The PANDA Coalition has members who are willing to present the program free of charge to dental or other interested groups with 10 or more members. For more information or to schedule a presentation:

• In New Jersey: Call Delta Dental at 973-285-4058, or send an email to dbelle@deltadentalnj.com
• In Connecticut: Call the Connecticut State Dental Association at 203-278-5550

April is Child-Abuse Prevention Month: What You Can Do

• Wear a blue ribbon. Prevent Child Abuse-New Jersey runs its Blue Ribbon campaign in April, which Delta Dental supports. Through volunteers, community agencies and businesses, the organization plans to distribute more than 375,000 ribbons this year, which people wear throughout the month to raise awareness of the problem. Each ribbon comes with information on how to prevent child abuse. For more information, call 800-CHILDREN.
  
  
• Report suspected cases of abuse. In New Jersey, contact your local DYFS District Office between 9 a.m. and 5 p.m. There is at least one District Office in every county. After hours, the Office of Child Abuse Control operates a toll-free hotline round the clock, at 800-792-8610. In Connecticut, call the CARELINE at 800-842-2288. Anyone who reports abuse or neglect, or testifies in a child-abuse hearing resulting from such a report, is immune from any criminal or civil liability as a result.

Mark That Date!

It's almost tee-time! The Eleventh Annual Delta Dental Golf Classic takes place on June 5, 2001 at Cherry Valley Country Club in Skillman, New Jersey. The golf classic benefits Special Olympics New Jersey, a non-profit organization that provides athletic training and competition for children and adults with mental retardation. For registration information, please call 973-285-4059.

HIPAA: How Will the Mandatory Reforms Affect You?

HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. It's a federal law intended to provide better access to health insurance, limit fraud and abuse, and limit administration costs.

Administrative Simplification
A major provision of HIPAA is called Administrative Simplification. It's the part of the law released in 1996 that addresses the maintenance and transmission of electronic health information. Administrative Simplification mandates the standardization of electronic transmissions for many administrative burdens in the healthcare system.

The United States Department of Health and Human Services (DHHS) is required to develop standards and requirements for all health information while ensuring that the data can be securely and confidentially shared. To do this, the department is in the process of composing a set of rules that define and support the national standards in areas such as the privacy of individually identifiable health information, electronic transactions and code sets, security and electronic signatures, and provider and employer identifiers.

What is the Goal of Administrative Simplification?
The goal is to implement national standards that will encourage electronic commerce in the healthcare industry and ultimately simplify the processes involved. Currently, there is no common standard for the transfer of healthcare information. For example, at this time, about 400 formats exist for healthcare claims. Conformity to national standards will make electronic data interchange (EDI) a viable and preferable alternative to paper processing.

Who is Affected?
All health plans (including ERISA plans), healthcare clearinghouses and healthcare providers transmitting data in electronic form must comply or be subject to substantial fines. For example, any claim submitted electronically must comply with HIPAA requirements. This means dental offices submitting electronically have two options: ensure the format they use is HIPAA compliant, or rely on an electronic clearinghouse to convert the claims data into a HIPAA format.

Delta Dental Plan of New Jersey cannot advise you of your responsibilities resulting from this legislation. We recommend that dental offices seek counsel for advice on the applicability of and steps required for compliance with the legislation and the rules and regulations adopted to implement the statute. For our part, we a Delta Dental are continuing to monitor HIPAA legislation and, as each rule is finalized, are positioned to bring our systems into compliance. Additionally, we'll continue to provide you with updates and educational materials about this important legislation.

Is There a Deadline for Adopting the HIPAA Standards?
Regulations are still evolving and the rules are in various stages of development. Once a rule has been finalized, organizations have between 24 and 36 months to comply. For example, the deadline for compliance with the Electronic Transaction Standards is October 2002.

For more information about this federal mandate and its impact to your practice, you can visit http://aspe.hhs.gov/admnsimp/.

HIPAA Mandated Transactions

HIPAA mandated transactions - those subject to HIPAA legislation - include:

• Health claims or equivalent encounter information - Health Care Claim (837)
• Health claim attachments (pending) - Patient Information (275 + HL7)
• Enrollment and disenrollment in a health plan - Benefit Enrollment and Maintenance (834)
• Eligibility for a health plan - Health Care Eligibility/Benefit Inquiry (270); Health Care Eligibility/Benefit Information (271)
• Health care payment and remittance advice - Health Care Claim Payment/Advice (835)
• Health Plan premium payments - Payment Order/Remittance Advice (820)
• Health claim status - Health Care Claim Status request (276); Health Care Claim Status Notification (277)
• Referral certification and authorization - Health Care Service Review Information (278)

Free Assistance with Electronic Claim Submission

If you are considering changing from paper claims submission to electronic claims submission, give our EDI coordination a call! She will schedule an appointment to meet with you and/or your staff at your office to take some of the guesswork out of what to look for when shopping for dental practice management software, offer questions to ask the software vendors, and provide information on our Delta MVPs. Delta MVPs are practice management software vendors who will give discounts to Delta Dental participating dentists who become new customers.

If you already use a computer with dental practice management software, you will receive tips on how to submit all your claims electronically. These tips include how to submit student information, coordination of benefits, pre-treatment estimates, x-rays, and more. The visit and the handouts are free. Help reduce your outstanding receivables and improve your cash flow. Receive priority processing with electronic claim submission. To request an office visit, call Beth DeCapio at 973-285-4035, fax your request to 973-285-4141, or email to bdecapio@deltadentalnj.com.