Introduction To The Dental Blue Network And Other Products With Dental .
Introduction to the Dental Blue Network andOther Products With Dental BenefitsAn independent licensee of the Blue Cross and Blue Shield Association. U7430b, 2/11
BCBSNC Dental ProductsDental Blue Products Dental Blue for group Dental Blue SelectSM Dental Blue for IndividualsSM Dental Blue for SeniorsSM Dental Blue For Federal Employee ProgramOther Products With Dental BCBSNC Medical (with limited dental care) BCBSNC Medical Pediatric Oral Health Federal Employee Health Benefit Plan (BCBSNC medicalwith some dental benefits) FEP BlueDental/FEDVIP1
Dental Blue ProductsDental Blue (Group) – offers employers the freedom tocustomize a plan to meet the needs of employees,customizing plans from a choice of available benefitsoptionsDental Blue SelectSM – a competitive voluntary groupdental. Employers have a choice of three dental plans –Standard, Complete and EnhancedDental Blue for IndividualsSM – a consumer-driven dentalplan for individuals and their eligible dependentsDental Blue for SeniorsSM – a consumer dental product forindividuals and their spouse age 65 and olderDental Blue For Federal Employee Program – offersfederal employees a dental supplemental plan tocomplement their medical dental benefits(no longeravailable as of 12/31/15)2
Other BCBSNC Products With Dental Medical Plans – Limited dental benefits where applicable Pediatric Oral Health – Dental Services – Affordable Care Act(ACA) medical plan, which includes pediatric dental services Available to children up to age 19 on an ACA-compliant plan medical plan Federal Employee Health Benefit Plan – provides health carecoverage (including certain dental services) to federalemployees and retirees who choose to enroll in one of twoservice benefits plan options (Standard or Basic)FEP BlueDental/FEDVIP – A dental plan offered through theBlue Cross and Blue Shield Association to federal employees3
DENTAL BLUE
Dental Blue Benefit Categories (Group, Individualand Senior)1.Diagnostic and Preventive– Oral exams, teeth cleanings and scaling– Full-mouth and bitewing X-rays– Fluoride treatment and sealants– Space maintainers2. Basic– Simple restorative services (fillings)– Extractions and oral surgery– Stainless steel crowns– Endodontics3. Major– Bridges and dentures– Periodontics– Crowns, inlays and onlays4. Orthodontics (up to age 18)Please note that groups have the option to customize these benefits.Always call to verify benefits prior to patient’s visit.4
Dental Blue for FEP Benefit Categories1.Diagnostic and Preventive– Oral exams and teeth cleanings– Full-mouth X-rays and bitewing X-rays– Sealants2.Basic– Minor restorative services (fillings)– Extractions and oral surgery– Periodontal scaling3.Major– Root canals– Crowns– Bridges and implants4.Orthodontics (up to age 18 and subject to a 24-month waiting period)5Always call to verify benefits prior to patient’s visit.
Dental Blue: Helpful InformationDental Blue: Group, Individual and SeniorDental Customer Service1.800.305.6638Dental ClaimsDental Emdeon payer #61473 (electronic claimsfiling)BCBSNC Dental Blue Claims UnitP.O. Box 2100Winston-Salem, NC 27102-2100Web Sites:Benefits/Claims/Eligibility(Must register first)www.bcbsnc-dental.com6
Health & Dental Blue Sample ID Card (front)Dental Blue logo displayed on acard with a medical plan logolets the dental care providerknow the member’s identificationcard belongs to a member withboth dental and health carebenefits with BCBSNC.GRID Logo identifies a member who isparticipating in the GRID dental network.Claims processing, benefits, and customerservice for these members will be handledby the out-of-state Blue Plan that issuedthe card to the applicable member.7
Health & Dental Blue Sample ID Card (back)Call this numberfor ?s about aBCBSNC dentalplan.Claims mailingaddress andelectronic filingEmdeon numberThe coverage is with BlueCross and Blue Shield ofNorth Carolina (BCBSNC)and not with another BluePlan.Electronic filing Emdeon number #61473 touse for BCBSNC Dental Blue for: Groups Individuals Seniors Federal Employees8
Dental-Only Sample ID CardHealth & Dental Sample IDCardWhether the patient is carrying a dental-only identification card ora health and dental identification card, always file claims forservices that include the patient’s complete identification number,which includes both numbers and letters.The dental-only ID number in this example is W1333333301The health and dental ID number in this example isYPW14343423019
Dental Blue Select: Helpful InformationDental Blue Select: Group Voluntary Dental PlanDental Customer Service1.888.471.2738Dental ClaimsDental Emdeon payer #61474 (electronic claimsfiling)BCBSNC Dental Blue Claims UnitP.O. Box 2400Winston-Salem, NC 27102-2400Web Sites:Benefits/Claims/Eligibility(Must register first)www.bcbsnc-dental.com10
Dental Blue Select Sample ID CardWhen filing claims, pleaseinclude the complete memberID number.Electronic filing Emdeon number#61474 for Dental Blue Select claims11
Dental Blue Claim Submission EDI (Electronic Data Interchange) via EmdeonClearingHouse Emdeon payer numbers identify product lines:– 61473 is used for all Dental Blue products (group, individual,and senior)– 61474 is used only for Dental Blue Select Always refer to the member’s BCBSNC ID card to properlyidentify the correct plan and the correct Emdeon payer IDnumber. Using the incorrect payer ID will delay claimsprocessing. Paper claim form is available at bcbsnc-dental.com Once you register, you will have access to the appropriate dentalclaim forms for each of the Dental Blue products, which includethe correct mailing address on the forms.12
Dental Blue Pre-Treatment Estimate of Benefits When the charges for a proposed course of treatment areexpected to be more than 250, a pre-treatment estimate ofbenefits is strongly recommended before any services areperformed. This allows both the dental care provider and the patient to make aninformed decision regarding potential coverage for a given procedure inadvance.When requesting a pre-treatment estimate of benefits, please send acompleted ADA claim form along with any supporting documentation tothe claims mailing address listed on the member’s ID card.The dental provider e-manual (www.bcbsnc.com) provides informationregarding required documentation needed before a pre-treatmentestimate of benefits can be determined.13
OTHER DENTAL PRODUCTS
Pediatric Dental Benefits (ACA Medical Plan)Service Type(Available up to age 19)Preventive & Diagnostic– exams, cleanings, Xrays, fluoride, sealants,and space maintainersIn Network 25 copayment per visitOut of Network 50 copayment per visitBasic & Major– filings,80% after medicalextractions, oral surgery,deductibleendodontics, periodontics,crowns, bridges, anddentures60% after medicaldeductibleMedically NecessaryOrthodontics (12-monthwaiting period & requiresprior approval)60% after medicaldeductible80% after medicaldeductible14
Dental Treatment Covered Under MedicalServices are covered under the member’s medical benefitsfor the following:1.2.3.Accidental injury of the sound teeth, jaw, cheeks, lip, tongue, roof and/or floorthe mouthCongenital deformity, including cleft lip and cleft palateRemoval of tumors, cysts that are not related to teeth or associated with dentalprocedures, or exostoses for reasons other than the preparation for denturesBenefits for dental implants and related procedures, such as bonegrafting associate with any of the three conditions listed above.Benefits are provided for extractions, root canal therapy, crowns,bridges, dentures, and orthodontic bracesPlease note if any of the conditions listed above require surgicalcorrection, the surgery is subject to medical necessity review.15
Helpful InformationDental Services Covered UnderMedical/Pediatric Oral Health BenefitsProvider Customer Service1.800.214.4844Medical Claims (includingpediatric dental/accident/TMJ or submit topatient’s health care plan ifother than BCBSNC)Dental Emdeon payer #61472 (electronic claimsfiling)Web SiteBCBSNC Medical Claims UnitP.O. Box 35Durham, NC s/edi/bluee16
Medical / Dental Pediatric Sample ID CardMember ID must includethe full subscriber ID withthe member suffix(example:YPPW1220668902) whenfiling the claimWhen filing a pediatric medical dental claim,please note the dental Emdeon number #61472 iffiling electronically.17
Filing Medical Dental Claims Medical Providers should bill with either the HCFA form using CPT codes or anADA form using CDT codes. Pediatric Dental Claims Providers should bill with an ADA form, using the appropriate CDT code The 2012 ADA form is encouraged; however, we will still accept the 2006version until IDC-10 goes into effect on October 1, 2015. Claim(s) Mail to P.O. Box 35, Durham, NC 27702-0035, or Submit electronically to Emdeon #61472 Claims should include the patient’s complete IDnumber, which may include letters and numbers as indicatedon the member’s ID card. All participating dental providers are also part of the BCBSNCmedical network.18
Coordination of Benefits – Pediatric Dental Only Coordinate benefits with Dental Blue policies, ifapplicable. The pediatric dental policy will be considered primary, and theDental Blue policy will be secondary. Currently, claims must be submitted to the pediatric medicalpolicy first, and then a claim/EOB will be sent to Dental Blue forsecondary processing. Members may have a separate ID card for their medicaland dental policies. Make sure you ask for both ID cardsat each office visit, if applicable.19
Dental Claims for Services Covered As MedicalBenefit Claims coded with accidental injury, ACA-pediatric dental,or dental services covered under the FEP Service planare processed under the member’s medical coverageinstead of his or her dental coverage. Oral surgical services and services rendered as a resultof an accidental injury that are covered by the medicalplan must be submitted using the member’s medical IDnumber and include a diagnosis code.20
PRIOR REVIEW
Prior Review for Dental Services Prior review is required for orthognathic surgery. If requesting prior review for an orthognatic surgery,please call BCBSNC Health Management Operations at1.800.672.7897. Prior authorization will be required for pediatric dentalmedically necessary pediatric dental orthodontiabeginning in 2015.21
FEDERAL EMPLOYEES
Federal Employee Program (FEP) Medical PlanOptions Standard Option – covers preventive & diagnostic,minor restorative, and extractions; pays a very limited flatfee based on the service provided, provides coverage forin- and out-of-network services. Basic Option – covers routine exams, cleanings, Xrays, fluoride and sealants; 25 copayment per visit forin-network only, and no coverage for out-of-networkservices.22
Federal Employee Health Benefit Plan(BCBS medical coverage includes some dentalbenefits)Customer Service1.800.222.4739Dental Claims covered underFederal Employee HealthBenefit Plan filed with CDTcodes on ADA formDental Emdeon payer #61472 (electronicclaims filing)Medical Claims(Medical/accident/TMJ filedwith CPT codes)Enrollment for electronic medical claimsavailable through the Web at:BCBSNC ClaimsP.O. Box 35Durham, NC 27702-0035BCBSNC ClaimsP.O. Box 35Durham, NC 27702-0035Web ex.htmwww.opm.gov/insure/index.aspx23
Federal Employee Health Benefit PlanSample ID CardBasic OptionStandard OptionAlways file claims for services that include the completeidentification number, which includes both numbers and letters.Federal Employee member ID numbers begin with the letter “R”24
FEP BLUEDENTAL (FEDVIP)
FEP BlueDental: Helpful InformationFEP BlueDental (FEDVIP)Dental Customer Service1-855-504-BLUE(2583)Dental ClaimsFEP BlueDental ClaimsP.O. Box 75Minneapolis, MN 55440-0075Web Sitewww.fepblue.org25
Category of Benefits – FEP BlueDental (FEDVIP)HighIn NetworkHighOut of NetworkStandardIn NetworkStandardOut of jor50%40%35%20%Orthodontics(Adults andChildren50%50%50%50%Annual Max 10,000 3,000 1,500 750Deductible 0 50 0 75LifetimeOrtho Max 3,500 3,500 2,000 2,00026
OTHER DENTAL INFORMATION
GRID
GRID GRID is administered by the Grid Dental Corporation(GDC). It is a national dental network and includesmany of the nation’s Blue Plans. Providers in BCBSNC’s dental network areautomatically included in the national GRID network. Your name will be included as a participating providerin the directory of the other GRID Blue Plans. The fee schedule contracted under the BCBSNCagreement applies to other GRID Blue Plans.27
BILLING AND REIMBURSEMENT
Claim Form Completion Dental claim forms must besubmitted with all requiredfields complete, usingacceptable data and codingsets needed to completeprocessing of a claim. Claim submissions shouldreport all rendered servicesand include procedure codesfrom the most current ADACurrent Dental Terminology(CDT) User’s Manual.28
Dental Claim Form29
Dental Claim Form30
Common Places for Errors to Occur31
Billing Dentist Or Dental Entity48. Name, Address,City, State, ZIP Code:Enter the name andcomplete address of adentist or the dentalentity (corporation,group, etc.).49. NPI (National Provider Identifier): Enter the appropriate NPI type for the billingentity. A Type 2 NPI is entered when the claim is being submitted by an incorporatedindividual, group practice or similar legally recognized entity. Unincorporatedpractices may enter the individual practitioners Type 1 NPI.50. License Number: If the billing dentist is an individual, enter the dentist’slicense number. If a billing entity (e.g., corporation) is submitting the claim,leave blank.51. SSN or TIN: Report the: 1) SSN or TIN if the billing dentist is unincorporated;2) corporation TIN of the billing dentist or dental entity if the practice isincorporated; or 3) entity TIN when the billing entity is a group practice or clinic.32
Treating Dentist / Treatment Location Information53. Certification: Signature of the treating or rendering dentist and the date theform is signed. This is the dentist who performed, or is in the process ofperforming, procedures, indicated by date, for the patient. If the claim form isbeing used to obtain a pre-estimate or pre-authorization, it is not necessary forthe dentist to sign the form.54. NPI (National Provider Identifier): Enter the treating dentist’s Type 1 –Individual Provider NPI in Item # 54.55. License Number: Enter the license number of the treating dentist. This mayvary from the billing dentist.33
Timely Filing of Claims To be eligible for payment, claims must be received nolater than 180 days from the date of service. Participating dental providers may not collect, or attemptto collect, payment from BCBSNC members for any claimthat was not first submitted within the 180-day timeperiod. To ensure your claims process correctly, please use theexact spelling of your name as entered on your dentalcontract with BCBSNC.34
Fee Schedule Regardless of the BCBSNC contracted fee schedule,always file the full charge for each service. For example, if provider’s charge amount is 95 for D0120, andBCBSNC’s contracted fee schedule is 60, then provider shouldfile 95. Failing to file the correct charge may impact future feeschedule increases.35
Payment Guidelines Providers are notified of payment determination via the Notification ofPayment (NOP). Participating dental providers are eligible for payment only when theservices provided are clinically necessary and covered as part of themember’s benefit plan. The issuance of the member’s benefit payment amount is consideredpayment in full, with the exception of any applicable deductible,coinsurance, and/or copayment amounts that can be collected from thepatient. Blue Cross and Blue Shield of North Carolina (BCBSNC) will onlyissue claim(s) payments directly to participating providers. Members receiving services from a nonparticipating dental providerwill receive payment directly and will be responsible for reimbursingthe nonparticipating providers.36
Billing BCBSNC Members Participating providers agree not to bill members forservices until after receipt of the BCBSNC issuednotification of benefits, except for member copayments. Participating providers may not balance bill BCBSNCmembers for the difference between billed charges andthe amount allowed on the Notification of Payment for aprocessed claim.37
Claims Review BCBSNC has partnered with P&R Dental Strategies, Inc.to facilitate utilization management and review servicesfor our dental programs. Although P&R Dental Strategies, Inc. is based in NewYork, dentists who review claims are licensed in NorthCarolina. You may receive a letter when a dental claim has pended forreview requiring additional information. Please send theinformation directly to P&R Dental Strategies at the address onthe letter. Sending it to the normal dental claims address willdelay the review.Note: BCBSNC’s agreement with P&R Dental Strategies, Inc. does notimpact claims processed under a member’s medical benefit.38
ICD-10
ICD-10: Federal Mandate ICD-10 codes must be used on all HIPAA transactions,including outpatient claims with dates of service and inpatientclaims with dates of discharge on and after October 1, 2015. Otherwise, claims and other transactions will be rejected and will needto be resubmitted. It is important to begin preparing for the implementation ofICD-10 codes in the fall of 2015. Delays may impact your reimbursements If submitting a claim using an ADA form, the 2012 version must be usedas of October 1, 2015.39
ICD-10: SummaryToday: ICD-9Tomorrow: ICD-10ICD-9-CM vol. 1 & 2 (Diagnosis)3-5 digitsICD-10-CM (Diagnosis)3-6 alphanumeric plus qualifier(e.g., 821.01 – Closed Fracture of shaft of femur) 13,500 unique codesICD-9-CM vol. 3 (Procedure)3-4 digits(e.g., 47.01 – Laparoscopic appendectomy) 4,000 unique codes(e.g., S72.344 – Displaced spiral fracture of shaft ofright femur) 68,000 unique codesICD-10-PCS (Procedure)7 alphanumeric(e.g., ODTJ4ZZ – Laparoscopic appendectomy) 72,000 unique codes40
ICD-10: Important Payment ImpactsSupports Timely Reimbursements– Use of HIPAA 5010 transactions– Changing business processes todescribe diagnosis using ICD-10CM– Changing inpatient businessprocesses to describe inpatientprocedures using ICD-10-PCSAdverse Impacts to Reimbursement– Use of ICD-9 after 10/1/2015– The use of truncated codes– Use of “Not OtherwiseSpecified” codes when specificcodes are availableTo be compliant with federal regulations, BCBSNC will onlyaccept claims with ICD-10 diagnosis codes for services renderedon or after October 1, 2015.41
Provider Readiness Phases2011201220132015 Complete ImpactAssessment Gap Analysis OrganizationalStrategy Risk Assessment Project BudgetEstimate Project ScheduleEstimate Vendor Contracts Financial Plan System UpdateSchedule Begin SoftwareModifications Begin Process/DataModifications Train Project Team onSystem Changes Complete SystemModifications Conduct Systems Testing Audit System andProcess Results ComprehensiveTraining Revise System andProcesses Finalize Go-LiveSchedule Finalize Budget Activate Go-Live Plan 2014Implementation Delayed until 10/1/15Copyright: AHIMA42
ICD-10 Summary ICD-10 will allow extensive detail and flexibility for use indescribing disease states. 3-7 characters and 68,000 codes The switch to ICD-10 will change the way providersdescribe patient diagnosis and inpatient procedures andallow for more specificity. Claims with dates of service prior to October 1, 2015,must use ICD-9. Claims with dates of service on or after October 1,2015, must use ICD-10.43
ICD-10 Resources islative/icd10.htm CMS: www.cms.gov/ICD10/ AHA: www.ahacentraloffice.com/ahacentraloffice app/ICD10/ICD-10.jsp AHIMA: www.ahima.org/icd10/ AAPC: www.aapc.com/ICD-10/ NCHICA: www.nchica.org/HIPAAResources/icd10.htm44
PROVIDER RESOURCES
Spanish Resources for Patients Website:www.bcbsnc.com/azul/ Spanish-speaking customer service 1-877-258-333445
Available on the WebOnline resources –bcbsnc.com/providers/We’re serious about health care reform. Here’s how to make it work.Online resources –bcbsnc-dental.com46
BCBSNC Network Management Responsible for developing and supporting relationshipswith dental providers and their staff – serve as a liaisonbetween you and BCBSNC. Available to assist your practice with the followingissues: Questions regarding BCBSNC contracts, policies, and procedures Changes to your organization including:– Opening/closing locations– Change in name or ownership– Change in Tax ID#, address or phone number– Merging with another group practice48
Network Management Specialists Can assist with the following: Obtaining copies of your fee schedule Making any necessary demographic changes – notice address, billingaddress, etc.– Requests can be emailed to us at NMSpecialist@bcbsnc.com Add/remove providers from your practice– Failure to enroll/credential new providers in your office may result inclaims being paid at the out-of-network benefit level. Contact us toll free at 1.800.777.1643 Email us at NMSpecialist@bcbsnc.com49
Thank You for Participating in BCBSNC’sDental Networks
Dental Blue for Individuals. SM - a consumer-driven dental plan for individuals and their eligible dependents . Dental Blue for Seniors. SM - a consumer dental product for individuals and their spouse age 65 and older . Dental Blue For Federal Employee Program - offers federal employees a dental supplemental plan to
May 02, 2018 · D. Program Evaluation ͟The organization has provided a description of the framework for how each program will be evaluated. The framework should include all the elements below: ͟The evaluation methods are cost-effective for the organization ͟Quantitative and qualitative data is being collected (at Basics tier, data collection must have begun)
Silat is a combative art of self-defense and survival rooted from Matay archipelago. It was traced at thé early of Langkasuka Kingdom (2nd century CE) till thé reign of Melaka (Malaysia) Sultanate era (13th century). Silat has now evolved to become part of social culture and tradition with thé appearance of a fine physical and spiritual .
On an exceptional basis, Member States may request UNESCO to provide thé candidates with access to thé platform so they can complète thé form by themselves. Thèse requests must be addressed to esd rize unesco. or by 15 A ril 2021 UNESCO will provide thé nomineewith accessto thé platform via their émail address.
̶The leading indicator of employee engagement is based on the quality of the relationship between employee and supervisor Empower your managers! ̶Help them understand the impact on the organization ̶Share important changes, plan options, tasks, and deadlines ̶Provide key messages and talking points ̶Prepare them to answer employee questions
Dr. Sunita Bharatwal** Dr. Pawan Garga*** Abstract Customer satisfaction is derived from thè functionalities and values, a product or Service can provide. The current study aims to segregate thè dimensions of ordine Service quality and gather insights on its impact on web shopping. The trends of purchases have
Chính Văn.- Còn đức Thế tôn thì tuệ giác cực kỳ trong sạch 8: hiện hành bất nhị 9, đạt đến vô tướng 10, đứng vào chỗ đứng của các đức Thế tôn 11, thể hiện tính bình đẳng của các Ngài, đến chỗ không còn chướng ngại 12, giáo pháp không thể khuynh đảo, tâm thức không bị cản trở, cái được
DENTAL SCIENCES 1 Chapter 1 I Dental Assisting— The Profession 3 The Career of Dental Assisting 4 Employment for the Dental Assistant 4 The Dental Team 6 Dental Jurisprudence and Ethics 12 Dental Practice Act 12 State Board of Dentistry 12 The Dentist, the Dental Assistant, and the Law 13 Standard of Care 13 Dental Records 14 Ethics 14
Certifications: American Board of Radiology Academic Rank: Professor of Radiology Interests: Virtual Colonoscopy (CT Colonography), CT Enterography, Crohn’s, GI Radiology, (CT/MRI), Reduced Radiation Dose CT, Radiology Informatics Abdominal Imaging Kumaresan Sandrasegaran, M.B., Ch.B. (Division Chair) Medical School: Godfrey Huggins School of Medicine, University of Zimbabwe Residency: Leeds .
