D E N T A L news etwork - Premera Blue Cross · - Dental Correspondence Project Underway - Filing...

ContentsCompany Updates page 1- New and Renewing Groups- Premera Holiday Closure Notification:

Sept 4-7

Claims Update page 2-3- Illegible and Highlighted Claims

Cause Delays- Change in the Return of Dental X-rays

Effective June 1, 2009- Treating Self and Family Members- Billing Anesthesia on a Medical

Claim Form- ADA Dental Claim Form Submitting Tips

Consultant’s Corner page 3- Preventing Horizontal Impaction –

Permanent Cuspids

Administrative Resources page 4-5- Revisions Made to the Appeal

Submission Form- Secure Email Capability- Lean Helps Dental Providers Save Time

With Benefit Quotes- Dental Correspondence Project Underway- Filing Electronically and Using

COB Feature

Community Connections page 6-7- Supporting the Dental School- Building a Network, Building

Your Business- Alaska Dental Conference: Supporting

Those Who Support You!

Summer Fun page 7- August Word Teaser

Company Updates

August 2009

newsnetworkD E N T A L

w Sourdough Express Inc. - Greatland

Leasing Co. Inc.

w Bethel Native Corporation - GCBC

w Providence Anchorage Anesthesia

Medical Group PC

w Alaska Roteq Corporation

w Altman Rogers & Company

w Valley Medical Care PC

w Barrow Arctic Science Consortium

w Kids’ Corps Inc.

w Cross Road Medical Center

w Petroleum Equipment & Services

w Alaska Sleep Clinic Inc.

w Phillips Field Equipment & Repair LLC

w WPX Courier LLC

w Music, Inc. and Vend Alaska - Fairbanks

w McDowell Group Inc.

w Harbor Crown Seafoods Inc.

w Timberwolf Ventures Inc.

w Measure & Improve Inc.

w Swanson General Contractors Inc.

w Three Mile Creek Services Inc.

New and Renewing Groups

Following is a small sampling of some of the new and renewing groups with a Premera Blue Cross Blue Shield of Alaska dental plan:

August 2009 Alaska Dental Network News 1An Independent Licensee of the Blue Cross Blue Shield Association

News from Premera Blue Cross Blue Shield of Alaska

Premera Holiday Closure Notification: Sept. 4-7

Premera will be closed Friday, Sept. 4 through Monday, Sept. 7, 2009, for an extended Labor Day holiday. This long weekend will be treated the same as any other holiday closure. We selected this particular Friday before Labor Day weekend because of the historically lower call volumes. This closure is one of several measures Premera is taking to reduce operating costs. Providers can access eligibility and claims status information on our provider portal via premera.com/provider.

2 August 2009 Alaksa Dental Network News

Claims Update

Illegible and Highlighted Claim Forms Cause Delays

Illegible claim or Explanation of Benefits (EOB) forms create more work for your billing office, and can

delay payment by an additional 10 to 15 days compared with standard claims processing time.

Every day, Premera receives a number of illegible claims and EOBs. Using a highlighter pen on these documents is one of the most common causes of illegibility. When the highlighted document is scanned to create an electronic image, that portion of the content shows up as blacked out.

The document then requires manual review, and in some cases, it must be returned to the provider’s office for resubmission. When the claim is resubmitted, it is processed within standard turnaround times.

Assist us in speedy processing of your claims by submitting clear and legible documents. If you are attempting to submit a corrected claim, we suggest you complete and include our Corrected Claims Cover Sheet. This document can be found at premera.com/provider, in the Forms section.

Treating Self and Family Members

Premera follows many Medicare guidelines. Similar to Medicare, we do not reimburse for professional services or supplies that are usually provided free because of the relationship to the patient.

As a reminder, we do not reimburse physicians, dentists, providers, or suppliers who are Premera members for professional services when the services are:

w performed on themselves;

w rendered to family members residing in the home; or

w provided to individuals related to them by blood, marriage, or adoption.

If you have questions, please call Physician and Provider Relations at 1-800-722-4714, option 4.

Billing Anesthesia on a Medical Claim Form

Follow CPT guidelines when billing general anesthesia on a medical claim form (the most common code is 00170). Anesthesia for medical should be reported on one line item with total minutes in the units field. If more than one anesthesia line is billed for the same date of service, only the first anesthesia services is allowed, and all others will be denied.

Change in the Return of Dental X-rays Effective June 1, 2009

In an effort to streamline our business processes, we have made these changes to our policy on return of dental x-rays, effective June 1, 2009:w X-ray films or photos will not be returned to the dental office unless specifically

requested at the time of submission.w If requesting their return, we ask that you indicate the patient’s name, account

number or other identifier on the envelope or mounting.w We will not be responsible for lost x-ray films or photos. The dental office should

maintain the original copy of the x-ray films or photos in the patient record.

For more information on submitting x-rays or photos electronically please visit the FastAttachTM web site at fast-attach.com.

Thank you for joining our efforts to streamline doing business together.

August 2009 Alaksa Dental Network News 3

Consultant’s Corner

Preventing Horizontal Impaction – Permanent Cuspids

by Dr. Ronald Cantu

Intraoral occlusal x-rays are necessary to determine proper eruption of potentially impacted cuspids. When the permanent cuspids have not erupted, this film can aid in determining the location of the permanent cuspids in relation to

the primary cuspids. The goal is to aid in preventing the horizontal impaction of the permanent cuspids. Sometimes this is, unfortunately, only discovered when the patient is a teenager and the primary cuspids are still present. There is really no other film that better displays this area of concern.

In my practice, I occasionally see individuals that have impacted maxillary cuspids. Achieving proper eruption with orthodontics can be clinically difficult. Prevention of this unfortunate outcome would be greatly beneficial to the patient. This is why I continue to work with Premera to help them determine the most appropriate benefits and policies that protect our insured members but make sense to the dental community.

Premera’s general payment guidelines for intraoral occlusal x-rays are being updated as follows:w Age limit: 4 - 19w Frequency: Once per arch per yearw Primary and permanent teethw Documentation required: Narrative (The primary reason would be to track the

correct eruption pattern of permanent cuspids)w Additional x-ray films on same day of service allowed

The goal is to

aid in preventing

the horizontal

impaction of the

permanent cuspids.

Dr. Ronald Cantu

Claims Update

Here are some tips about submitting dental claims to Premera using the current version of the ADA Dental Claim Form:w In an effort to protect the personal and

private information of your patient and our member, do not submit a Social Security number in box 15, Policyholder/Subscriber ID (SSN# or ID#). Use the ID number found on the member’s ID card.

w In the Patient Information field, complete boxes 20, 21, and 22 (and 19 and 23 if applicable) even when the relationship to the policyholder/subscriber is self.

w In box 29, Procedure Code, submit only procedure codes contained in the CDT 2009/2010 reference manual published by the American Dental Association.

w In box 35, Remarks:- Information should be concise and

legible.- Do not highlight.- It is acceptable to indicate how

much the primary insurance plan paid; however we require a copy of the primary explanation of benefits to coordinate benefits as secondary insurance plan when submitting paper claims.

w In the Ancillary Claim/Treatment Information section, complete all applicable boxes (38-47) on every claim, even if you have submitted this information on previous claims for the same patient.

w In the Billing Dentist or Dental Entity section, box 51, SSN or TIN, always indicate the SSN or TIN as reported to the IRS even when submitting your National Provider Identifier.

w In the Treating Dentist and Treatment Location Information, box 53, the dentist signature should be legible.

Following these simple tips will help us process your dental claims and prevent unnecessary delay.

ADA Dental Claim Form Submitting Tips


Secure Email Capability

Premera now has secure email. Using secure email enables you to communicate with us without the

threat of interception by an outside party. ”Regular” email is not considered secure. Called Proofpoint Secure Messaging™, the new secure email is encrypted, meaning that the message contents are scrambled and can be read only by the intended receiver. No special software is needed. Here’s how to send a secure message:

To send a message to us:

w In your Internet web browser, go to https://voltage-pp-0000.premera.com/login/.

w Sign in by entering your email address, and then click Next.

w At this point, you will be asked to authenticate yourself by answering some questions.

w After you complete the authentication process, a Compose page will be displayed.

w In the To field, enter the recipient’s email address. (To send a message to multiple recipients, enter their email addresses separated by commas, semicolons, or blank spaces.)

w In the Subject field, type the subject of your message.

w Type your message in the large text box.w To attach a file, click Browse, locate

and select the file to attach, and then click the Attach button.

w Click Send Secure.

To respond to a message from us:

w You will receive a message from Premera with an attachment.

w Open the attachment and click Read Message which, for first-time use only, will launch the SecureMail ID creation.

w You will be asked to create your SecureMail ID and password.

w Then click Continue and you will be taken to your Premera secure email.

administrative Resources

Dental Correspondence Project Underway

For your convenience, we have merged the Appeals Submission Form and Claim Resolution Form. In addition to the merge, we made these improvements to the form:w Added external review process

informationw Added claim/correspondence

process resolution informationw Updated the appeal levels:

Complaint, Level I, and Level IIThe updated Appeals

Submission Form is available at premera.com/provider in the Library (select Forms, then Miscellaneous Forms).

Revisions Made to the Appeal Submission Form

Thank YouPremera would like to thank our network

dental providers and let you know how

grateful we are for your diligence in

providing quality dental care. We believe

our members—your patients—deserve the

best, and they have it!

Your Provider Network Liaisons

look forward to continuing to work with

you and build our relationship to ensure

we provide our members the best of

service, benefits, and dental care.

We have been studying dental correspondence in an attempt to meet our goal of continuous improvement while looking for ways to work together to improve our relationship with dental providers and members. Our recent focus has been correspondence letters such as additional information requests, benefit advisories, and claims inquiry responses.

Although it has been our practice to provide a personal touch to every correspondence letter, having a standard letter format will help ensure that our correspondence letters are accurate, straight to the point, and professional.

We want our correspondence to meet three objectives. It should be:

Accurate. The accuracy of information in our letters is most important, which is why we are developing a fundamental checklist to be used when creating a letter.

Straight to the point. We recognize that you and your dental staff are busy and your time is valuable, so we are reviewing and removing any unnecessary information, so that our correspondence letters contain only the information you need.

Professional. Correspondence letters free of simple mistakes such as spelling, grammar, and punctuation will deliver a professional business impression.

In all correspondence, we include both the provider and member to ensure both parties are informed.


administrative Resources

Premera continues to use Lean methods to improve our work, and recently we used it to study the effectiveness of dental benefit quotes. Lean is a long-term initiative for Premera that

has become a part of our strategic framework supporting our goal of sustainable healthcare.

Recently, in a customer service Lean workshop on dental benefit calls, our Lean team went out to the floor to listen to associates and customers. We asked ourselves key questions, like “Would the customer be willing to pay for this?” and “Are we delivering value to the customer?” Our ambitious team focused on identifying waste and trying new ideas. We timed our processes, listened to numerous calls and identified those activities that were waste from those that provided value to the customer. To ensure we were on the right track, we contacted some of our dental providers.

What we accomplished

Lean Helps Dental Providers Save Time With Benefit Quotes

As a result of our Lean workshop:w We were able to collect benefit forms from providers so that we could

understand what they needed. We discovered that many providers had a standard process that we weren’t following.

w We developed a repeatable sequence for each dental benefit call. In Lean terms, this is known as standard work.

w We discovered a number of frequently asked questions, so we added them to the standard work. This will save providers from asking the same question on each call.

w We clarified procedures to ensure that questions were answered with greater quality.

Results

The final results were exciting. We were able to reduce the length of calls from 9-11 minutes each to 5-7 minutes. This is time saved for both providers and Premera.

At the same time, we managed to improve the quality because, through standard work, we were able to ensure that we were providing a complete benefit quote each and every time.

Next Step

The next step involves you. With input from multiple dental offices, we created a Dental Insurance Verification Form. It includes areas to complete when making a call to Premera for a dental benefit quote. Using this form for the quote will save you time as it follows our standard flow for dental benefits.

The form is available on our provider portal, premera.com/provider in the Library section (select Forms, then Miscellaneous Forms).

Filing Electronically and Using COB Feature

If you bill primary claims electronically in the HIPAA ANSI X12837 9 version 4010A1, you also can submit secondary claims in that manner.

Once the primary payor has processed a claim, you can send it electronically to Premera. For successful submission, you must include the primary payor processing information on the claim. This includes the primary payor’s:w Namew Member ID for the patientw Allowed amountw Payment amountw Reason for non-payment (i.e., non-

covered service, applied to deductible, benefit max, etc.) in claim note (NTE) field

w Claim adjudication date

If you have questions regarding this process, please call our EDI Department at 1-800-435-2715.

DENTAL INSURANCE VERIFICATION FORM Use this form as a template for documenting dental benefits when calling Customer Service for a dental benefit quote.

Date: ________________

PATIENT/SUBSCRIBER INFORMATION

Patient Information Subscriber Information

Patient Name: ___________________________________ Subscriber Name: ________________________________

Date of Birth: ____/____/________ Age: _______ Date of Birth: ____/____/________

SSN#: ______________________ Subscriber ID#: __________________________________ Plan/Group#: _________________ Employer Name: _________________________________

Insurance Information Insurance Name: _________________________________ Year Type: Calendar / Plan

Insurance Address: _______________________________ Individual Deductible: $________ Met to date: $_________

Insurance Phone: _______________ Payor ID: _________ Family Deductible: $_________ Met to date $_________

Insurance Effective Date: ____/____/________ Deductible applies to: Preventive / Basic / Major

Standard COB: Y / N

Dental Maximum: $_______________

Waiting Period: Y / N

DENTAL BENEFITSClass I: Preventive_____%

Class II: Basic_____%

Routine oral exam - Frequency: _____________________ Fillings - Frequency: ______________________________

Routine prophylaxis - Frequency: ____________________ Bitewings - Frequency: ____________________________ Panoramic/FMX - Frequency: _______________________ Fluoride - Frequency: ______________ Age Limit: ______ Sealant - Frequency: ______________ Age Limit: ______ (Sealants limited to Permanent Teeth Only)

Class III: Major_____% Crowns, inlays, onlays, labial veneers, bridge, dentures Prosthetic Replacement Limitation: ___________________ Missing Tooth Clause: ___________________ Implants Benefits: Y / N

Posterior composites reduced on 2nd or 3rd molars: Y / NSimple extractions Periodontal maintenance - Frequency: ________________

Allowable under Basic or Major: Endodontic: Basic / Major Perio Scaling: Basic / Major - Frequency: ______________ Osseous Surgery: Basic / Major - Frequency: ___________ Surgical Extractions: Basic / Major Oral Surgery: Basic / Major Nightguards (Bruxism): Basic / Major - Frequency:_______

Orthodontia: _____% Orthodontia Lifetime Deductible: $__________ Orthodontia Lifetime Deductible Met to date: $___________

Diagnostic & Banding Maximum (applies to Orthodontia Lifetime Max): $___________

Lifetime Orthodontia Maximum: $_______________ Age Limit: _______ Disclaimer: This is a summary of plan benefits and is not intended to be a contract. Actual coverage will be determined when the claim is processed

subject to all contract terms, including, but not limited to, member benefits, benefit maximums and subscription charge payment covering the actual

dates of service. This is not a dental pre-determination of benefits or a guarantee of payment.

All services are subject to review of Premera processing policies, medical vs. dental benefit application, dental necessity, cosmetic, and/or alternative

benefit.

An Independent Licensee of the Blue Cross Blue Shield Association

020291 (03-2009) www.premera.com


Community Connections

Building a Network, Building Your Business

Premera Blue Cross Blue Shield of Alaska is the largest insurer in the state, so it would stand to reason

we would have the largest dental network, but that is not so—at least not yet. We are not far behind our competitor; however, we are still working on expanding our dental network, including specialists.

Premera has three Provider Liaisons serving Alaska: Debbe Hopper, Sylvia Aksdal and Teresa Triggs. They are available to share information about what it means to be a network provider.

Debbe Hopper made a trip to the Anchorage and Juneau areas the first week in April, while Sylvia Aksdal made a two-week trip the latter part of April to take in Anchorage and surrounding areas, including the Kenai peninsula. She finished her trip by exhibiting at the Alaska Dental Society Conference in Fairbanks.

If you’re interested in becoming a contracted provider, please call our Physician and Provider Relations at 1-800-722-4714, option 4.

Alaska Dental Conference: Supporting Those Who Support You!By Sylvia Aksdal

Premera Blue Cross Blue Shield of Alaska was pleased to participate in the 2009 Alaska Dental Society (ADS) Conference in Fairbanks in May. This was our fourth conference with the ADS and we are very grateful for the opportunity to support the organization.

In Fairbanks, where things change very quickly, I arrived with the receding of ice flows from the Chena River. Branches on the birch and aspen trees looked like sticks. One day later, I saw buds on some trees, no ice on the river and some green in the grass.

This city is a mixture of old and new, rustic and modern. A few miles out of town you can see the old mines and the new pipeline, and in town you find the ultra-modern architecture of the Museum at the U of A. One thing does not change, and that is the friendliness of the people. Everywhere, you are welcomed as though you belong. No one is a stranger for long in Fairbanks.

Even though the weather was like summer (but without mosquitoes), the conference was well-attended. Classes started on Wednesday and continued on through Saturday. Fifty-five dentists were registered and approximately 25 approached our exhibit booth or introduced themselves at social events.

We appreciate everyone who stopped by our booth to say hello, picked up promotional gift items, and entered to win our giveaway. We had 28 entrants into the drawing for a $50 Visa card.

Premera would like to thank the Alaska Dental Conference and the committee members who made all the social events happen. We are proud to be included in the event and to support your organization.

Congratulations to Christine Kneiszel (above left), the winner of

a $50 Visa card. Christine works for Drs. James A. Miears Jr. and

W. L. Payne in Fairbanks.

Sylvia Aksdal at the Premera exhibit booth during the

Alaska Dental Society Conference in May.


Community Connections

August Word TeaserUnscramble each of the clue words. Copy the letters in the numbered cells to other cells with the same number.

summer Fun

KNPI

NITHIWNEG

CIFFOE SITVI

CASLLUCO GURDA

LOWYEL

LULF MOTHU SIESER

LAFL

TEJ NIGSIK

TUNSES

PINMALT

MRWA HTNISG

TESDERNU

MUTUAGDROH

WDLI WOLREFS

4

2 18

6 15

5

16 7

10 8

9 14

17 3

1

12

11

13

19

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Ans

wer

s on

page

8.

Supporting the Dental School

With an eye to the future, Premera is proud to support the University of Washington School of Dentistry.

In March we received a nice thank you from Dean Martha J. Somerman for our gift to the Dentistry Dean’s Fund for Excellence and Innovation. “You may be sure your continued support will serve as an inspiration and as a catalyst for future achievements,” her letter stated.

Debbe Hopper and Sylvia Aksdal from Premera attended a “Partners in Diversity” dinner on May 15 at the Northwest African American Museum in Seattle and had the pleasure of sitting with Dr. Daniel Chan, assistant dean of students at UW Dental School, and Dr. Rick Taylor, Bellevue endodontist.

We were pleased to see students who will benefit from these scholarships from Spain, Alaska, and St. Lucia, as well as the lower 48 states. Many diverse cultures, including some Aleut and American Indians, are represented.

5


Please post or circulate this newsletter in your office

Answers to Summer Fun puzzle words:PinkWhiteningOffice Visit Occlusal GuardYellowFull Mouth SeriesFallJet SkiingSunsetImplantWarm NightsDenturesMouthguardWild FlowersAnswer: Hope you enjoyed summer.

PRESORTED STANDARD

U.S. POSTAGE PAIDSEATTLE, WA

PERMIT NO. 2944

Premera Blue Cross Blue Shield of Alaska

P.O. Box 327

Seattle, WA 98111

014554 (08-2009)

Back issues of Network News are on our web site at premera.com/provider in the Library under Communications.

Network News

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