BLUEImpressions - CareFirst

BLUEImpressionsNews for Participating Dental ProvidersSummer 2009 Vol. 6, Issue 2National ElectronicAttachment (NEA) forElectronic Submissionof Dental AttachmentsDental offices may now electronically transmit radiographs and/or othersupporting documentation to CareFirst through National ElectronicAttachment (NEA).INSIDE this issueClaims and Billing2Billing for Multiple-Visit Dental Procedures2Participating Dental Provider ContractGuidelines Regarding Billing Members2System Upgrade and Interest PaymentChanges3Member Benefits Exclude CareRendered by a Relative3Medical and Dental May Be onSeparate Membership Cards4In Office Training and AssistanceAlways AvailableWhat’s Happening45-7Voice Response Unit (VRU) andCareFirst Direct5Dental Advisory Committee5Friendship Dental Laboratories, Inc.and CareFirst Expand Discount Program6E-mail Registration7Chesapeake Dental Conference7CareFirst and CareFirst BlueChoiceHoliday Closings7Note: All references to “CareFirst” in this publicationrefer to CareFirst BlueCross BlueShield. All references to“CareFirst BlueChoice” refer to CareFirst BlueChoice, Inc.If your office uses this service, please remember to place the NEAReference Number in the “Remarks” field on the claim form prior tosubmission. This will enable CareFirst to match the claim with thedocument number in NEA. Providers should only send documents asnoted on the Reference Guide for Required Attachments through NEA.Please do not send claims or primary carrier EOBs through NEA, asthey will not be processed. For a complete list of required attachments,visit www.carefirst.com Providers & Physicians News & Updates Provider Manuals CareFirst Dental Manual.For additional information or to register with NEA, please call NEAat 800-782-5150 and select Option #2 or contact your ProviderService area.Vol 6, Issue 2 Summer 2009 BLUEImpressions1

Claims and BillingBilling for Multiple-Visit Dental ProceduresCareFirst provides the benefits availableunder the member’s contract only uponcompletion of treatment. Therefore, dentalprocedures that require multiple visits, suchas crowns, root canal therapy, etc., should bebilled only at the completion of service. Forcrown restorations, the completion date isthe cementation date.Should you have any questions regardingthis, please contact the appropriate DentalProvider Services area for assistance.Participating Dental ProviderContract Guidelines RegardingBilling MembersDental providers who participate in CareFirst provider networkshave contractually agreed to accept the CareFirst allowed benefitas payment in full. Dental providers may bill the member for anyco-insurance and/or deductible that apply to the services performed,but not for any difference between the allowed benefit paid byCareFirst and the dental provider’s customary fee. Dentists may billtheir full fee for procedures that are specifically excluded from themember’s contract.Providers are reminded that collecting for services in advance withthe intent to refund the member after reimbursement is receivedviolates the provider contract.2BLUEImpressions Summer 2009 Vol 6, Issue 2

Claims and BillingSystem Upgrade and Interest Payment ChangesOn May 1, 2009, CareFirst began migratingemployer groups from one version of ourprocessing system to a new, updated version.Groups will migrate to the new version as theyrenew throughout the year.As a result of this migration, you will notice aslight change in how interest is paid for claimsprocessed outside of the state-mandatedwindow.Interest will now be included on the voucherwhen applicable. You will notice a new lineadded beneath the individual claim linesshould interest be required.Claims processed for employer groups thathave not yet migrated to the new system willcontinue to pay interest on a separate checkuntil the group renews.Member Benefits Exclude CareRendered by a RelativeCareFirst does not provide benefits for services performed by ahealth care practitioner who is related to the member (e.g., themember’s parent, spouse, child, grandparent, or sibling). Thisprovision applies to all contracts for all lines of business andproducts. For further information or specific contract exclusions,the member may reference their employee Benefit Guide or maycontact the employer’s Benefit Administrator.Vol 6, Issue 2 Summer 2009 BLUEImpressions3

Claims and BillingMedical and Dental May Be on SeparateMembership CardsIt is common for members to have a dental membership card that is separate from their medical membershipcard. These cards can have different contact phone numbers, claim submission instructions and even MembershipIdentification numbers.If you do not see dental information listed on a member’s card, this could mean they have a separate dentalmembership card. To ensure that your inquiries and claims are directed to the proper area, please request to see yourpatient’s membership card at every visit to verify where claims are to be submitted and which area you should call forcustomer service.In Office Training and Assistance Always AvailablePlease remember that in-office training presented by your dedicated Dental Provider Relations Specialist is alwaysavailable. Specialists are also available to meet with dentists and their staffs to discuss issues or concerns regarding thetraditional, preferred provider or DHMO dental plans.If you would like to schedule an appointment, please refer to the list below to contact the Specialist assigned toyour area.Dental Provider RelationsSpecialistContact InformationKate McCrackenkate.mccracken@carefirst.comPhone: 410-605-2669 MarylandFax: 410-505-6956N.E. Baltimore County*, E. Baltimore City*, Carroll,Prince Georges and Frederick Counties*Baltimore County/City Zip Codes:21013, 21094, 21030, 21131, 21034, 21204, 21057,21234, 21082, 21284, 21093, 21286, 21202, 21205,21206, 21212, 21213, 21214, 21218, 21224, 21226,21230, 21231, 21239VirginiaFairfax and Loudon CountiesKim Rothmankim.rothman@carefirst.comPhone: 410-605-2694 MarylandFax: 410-505-6905Allegany, Calvert, Charles, Garrett, Montgomery, St.Mary’s, and Washington Counties, N.W. BaltimoreCounty*, S.E. Baltimore County**Baltimore County/City Zip Codes:21022, 21120, 21031, 21133, 21048, 21136, 21053, 21152,21051, 21153, 21071, 21155, 21074, 21161, 21105, 21163,21111, 21208, 21117, 21209, 21021, 21027, 21052, 21085,21087, 21128, 21156, 21162, 21219, 21220, 21221, 21222,21236, 21237Mindy KretschmerPhone: 410-605-2667mindy.kretschmer@carefirst.com Fax: 410-505-25664BLUEImpressions Summer 2009 Vol 6, Issue 2Specific AreaMarylandAnne Arundel, S.W. Baltimore County*, W. BaltimoreCity*, Caroline, Cecil, Dorchester, Harford, Howard,Kent, Queen Anne’s Somerset, Talbot, Wicomico, andWorcester Counties

What’s andHappeningClaimsBillingVoice Response Unit (VRU) and CareFirst Direct: YourAnswer to Reduce administrative Cost and IncreaseProductivityNeed to reduce the administrative time spent waiting to speak with a CareFirst representative to check the status of a claimor benefits and eligibility? If so, CareFirst has two remedies:Voice Response UnitCareFirst uses state of the art technology in its VoiceResponse Units with real time information allowingproviders to obtain the following:Claim status, which provides:n Allowed and paid amountsn Date of payment along with check information andclaim numbern Any member liabilityn Denial reason with the narrativePatient eligibility and benefits provides:n The effective date of coverage and any terminationdatesn Type of coverage including group numbern Limitationsn Deductiblen Timely filing periodsCareFirst DirectCareFirst Direct is an on-line tool that allows providers to obtain the following:n Claim statusn Patient eligibility and benefits, including limitations and coinsurance informationTo get started or learn more about CareFirst Direct, visit www.carefirst.com Providers & Physicians Electronic Services CareFirst Direct.Dental Advisory CommitteeAs announced in the Winter 2008 issue of Blue Impressions, CareFirst Dental Director Dr. Robert Laurenzano is establishinga Dental Advisory Committee and seeks general practitioners and other dental specialists who may wish to participate.The committee’s objectives are to discuss issues related to dental plans, clinical guidelines, new technologies, etc. Interesteddental providers may submit a statement of interest and experience or resume via e-mail to robert.laurenzano@carefirst.com.Vol 6, Issue 2 Summer 2009 BLUEImpressions5

What’s HappeningFriendship Dental Laboratories, Inc. and CareFirstExpand Discount ProgramCareFirst and CareFirst BlueChoice are pleased to announce the extension of the dental laboratory discount agreementwith Friendship Dental Laboratories, Inc., to offer a special discount on more lab services, effective immediately.Friendship Dental Laboratories, Inc., is a full service, state-of-the-art dental laboratory in Baltimore and has servedthe Mid-Atlantic region since 1973. Friendship Dental Lab specializes in the fabrication of crowns, bridges, implantrestorations, partial and complete dentures, and is dedicated to customer satisfaction via personalized customer service.This CareFirst exclusive agreement will offer a discount on the following services (the negotiated prices indicatedrepresent a 20 to 30 percent discount on laboratory services):Crowns – All inclusive fee includes models, dies, metal alloy and porcelain.n Non-Precious PFM Crown 79.00n Noble Alloy PFM Crown 99.00n High-Noble White Gold PFM Crown 139.00n E.max Lithium Disilicate (All-Ceramic) Crown 139.00Bridges – All inclusive fee includes models, dies, metal alloy, connectors and porcelain.n Non-Precious PFM Bridgen Noble Alloy PFM Bridgen High-Noble White Gold PFM Bridge 83.00 103.00 143.00Removable Prosthodontics – All inclusive fee includes custom trays, models,bite blocks, articulation, teeth, set-up and finish.Denturesn Complete Full Denture 205.00n Complete Premium Full Denture* 305.00*Premium denture price includes your choice of premium denture teeth(Vita, Bioform IPN, or Portrait IPN).Partialsn Complete Cast Partial 230.00n Complete Premium Cast Partial* 390.00*Premium partial price includes your choice of premium denture teeth(Vita, Bioform IPN, or Portrait IPN).CareFirst, CareFirst BlueChoice and Friendship Dental Laboratories, Inc., invite you to take advantage of these specialdiscounts available to you as a CareFirst provider. As mentioned, the discount arrangement is exclusive to CareFirst,therefore, it will only apply to CareFirst, CareFirst BlueChoice and The Dental Network (TDN) members.To receive your discount, simply attach a copy of the member’s CareFirst, CareFirst BlueChoice or TDN membershipcard to the prescription prior to submitting the request to Friendship Dental Laboratories, Inc.To learn more about Friendship Dental Laboratories, Inc., call 410-780-7700 or visit their Web site at www.friendshipdentallab.com. For questions or concerns, please contact your Provider Service area.6BLUEImpressions Summer 2009 Vol 6, Issue 2