td>
« back to results for ""
Below is a cache of http://www.deltadentalmn.org/content/files/Dentists/Newsletters/spededfall_03_mn_7a.pdf. It's a snapshot of the page taken as our search engine crawled the Web.
The web site itself may have changed. You can check the current page or check for previous versions at the Internet Archive. Yahoo! is not affiliated with the authors of this page or responsible for its content.
Special Edition Please share
this newsletter
with your
hygienists and
administrative
staff
Special Edition
Fall 2003
Patient Fraud
Inside:
Dental Education:
Recommendations
On Using Fluoride
Community News
Supporting
the MN Dental
Access Advisory
Committee
Updates Online
and More...
Claims Tips
Important information for accurately submitting claims
and receiving prompt payment
D
ental providers and
their office staff will
save time and
avoid delays
in payments
by reviewing
procedure
codes to
ensure they
follow the
American
Dental
Associations
most current version
of the Code on Dental
Procedures and
Nomenclature, or CDT-4.
The ADA adopted the
CDT-4 codes effective as
of January 2003.
In order for dental claims
to be paid under any Delta
Dental Plan of Minnesota
(DDPMN) Benefits
Programs, the
claims must be
coded using
CDT-4. Dental
providers were
notified through
newsletters and
mailings about
this change.
With accurate coding,
DDPMN is able to provide
prompt claims payment.
The grace period for
filing under old codes has
ended. As of April 1, 2003,
all claims and pre-estimates
must be submitted using
CDT-4 codes, regardless
of the date of service.
DDPMN is concerned that
we continue to receive large
numbers of claims with
invalid codes. Invalid
claims are being denied,
with rejection notices
stating the following:
Invalid or no procedure
code submitted on claim.
Please resubmit with
the most current ADA
procedure code (CDT-4).
A
.M. Best and Standard
& Poor have reaffirmed
ratings for Delta Dental
Plan of Minnesota
(DDPMN) as, respectively,
A (Excellent) and AA-,
making DDPMN one of the
highest rated dental plans in
the country.
We are pleased to
receive a strong, independent
affirmation of our financial
stability, especially in the
context of todays economic
environment, said Michael
F. Walsh, President and
CEO of Delta Dental Plan
of Minnesota.
The ratings were
based on a number of
characteristics found at
DDPMN, such as:
A strong identity and
presence in the local
dental market.
An excellent infrastructure
of information technology
systems to support the
organization.
A strong core market
business position.
Very strong capitalization
and modest debt.
Delta Dental Plan of Minnesota Receives
Re-affirmed Strong Financial Ratings
Avoid the Cost of
Resubmitting Claims
Use New CDT-4 Codes
Continued on page 2 2
Some of the invalid
coding indicates that
dental offices may not have
updated claim codes for
several years. For example,
a significant number of
claims continue to be
submitted under procedure
codes 00110 and 00130,
which were replaced with
new codes over three years
ago in January 2000.
Among the more
common procedures where
invalid codes need to be
replaced and updated are
shown at right.
Questions about
CDT-4 codes? Please
contact the ADA at
1-800-621-8099,
ext. 2753.
Invalid Codes for Some Common Procedures:
Claims Tips continued
A
lthough cases of
member fraud and
identity theft are
rare in the dental
industry, the cases hurt
the consumer and hurt the
dentists who are operating
legitimate practices.
The most effective
means to address the problem
is through consistent office
processes. Delta Dental Plan
of Minnesota (DDPMN) will
continue to maintain our
systems to stop instances
of fraud. When there are
possible cases of fraud,
we are actively supporting
investigations against the
individuals involved. Over
the last year or so, through
the collective efforts of
dental offices, local law
enforcement and DDPMN,
we have been successful
in those efforts.
Identity theft in the
dental industry occurs in a
variety of ways. In some
cases, non-eligible DDPMN
individuals are receiving
dental benefits. The member
may have knowledge of the
fraud, by knowingly sharing
their dental identification
card or identifiable
information. In other
cases, a members personal
identifiable information
has been compromised by
an unknown individual.
Examples of member fraud:
Filing dental claims for
services not rendered.
Altering or forging bills
or dental claim forms
submitted to DDPMN.
Use of another individuals
dental insurance card and/
or member identification
number and date of birth.
Processes to assist in
preventing identity theft
Dental offices play a key
role in fraud prevention. Two
critical office process steps:
At each visit, as an
office policy, request
the patients current
dental insurance card.
Make a copy of it, date
it and place it in the
patients chart.
Request photo identification,
at least for all new patients.
It is imperative that this
information also be
copied and placed in
the patients chart.
It is in everyones best
interests to stop member
fraud. Not only is DDPMN
affected, but the dental office
will be stuck with the unpaid
portion of the individuals
bill. Consumers are hurt
because fraudulent claims
raise the cost of health care
benefits for everybody.
This translates into higher
premiums, increased out-of-
pocket expenses and reduced
benefits or coverage.
How to report
possible fraud
Call DDPMNs Fraud
Hot Line at 651-994-5492,
e-mail to reportfraud@delta-
dentalmn.org or write to us
at: Delta Dental Plan of
Minnesota, P.O. Box 9304,
Minneapolis, MN 55440
Attention: Report Fraud.
Identify Theft Impact to the Dental Industry
INVALID
INVALID
INVALID
INVALID
Initial Oral Examination 00110
This code was established under CDT-1 and is no longer valid.
Emergency Oral Examination 00130
This code was established under CDT-1 and is no longer valid.
Resin Restorations D2336 THROUGH D2388
The American Dental Association has eliminated the distinction between primary teeth
and permanent teeth. As a result, all of the previous codes used for posterior resin
restorations were deleted. You must now use CDT-4 codes: D2390, D2391, D2392,
D2393, D2394.
Extractions D7110, D7120, D7130
These codes were replaced in CDT-4 with D7111 and D7140. Please review the
descriptions in order to submit the claim with an accurate code.
Reminder Anesthesia codes
In order for anesthesia related claims to be processes, dentists must use these codes:
Intravenous conscious sedation (IV sedation/analgesia) D9241/D9242
This is the most common form of anesthesia provided as a dental service and can be
performed in a dental office. Anesthesia services without these claims will be rejected.
Delta Dental Plan of Minnesota will no longer be benefiting for deep sedation/general
anesthesia (D9220/D9221), which is performed in a hospital setting by a licensed
anesthesiologist or certified nurse anesthetist and is usually covered under a group
medical plan. 3
T
oday, all U.S. residents are exposed to fluoride to
some degree, and widespread use of fluoride has been a
major factor in the decline in the prevalence and severity of
dental caries. Although caries have declined, these decreases
in caries prevalence and severity have been uneven across the
general population: the burden of disease now is concentrated
among certain groups and persons.
Populations believed to be at
increased risk for dental caries are
those with low socioeconomic
status (SES) or low levels of
parental education, those who do
not seek regular dental care, and
those without dental insurance or
access to dental services. Persons
can be at high risk for dental caries
even if they do not have these
recognized factors. Individual
factors that possibly increase risk
include active dental caries; a
history of high caries in older siblings or caregivers; root
surfaces exposed by gingival recession; high levels of infection
with cariogenic bacteria; impaired ability to maintain oral
hygiene; malformed enamel or dentin; reduced salivary flow
because of medications, radiation treatment, or disease; low
salivary buffering capacity (i.e., decreased ability of saliva to
neutralize acids); and the wearing of space maintainers,
orthodontic appliances, or dental prostheses. Risk can increase
if any of these factors are combined with dietary practices
conducive to dental caries (i.e., frequent consumption of refined
carbohydrates). Risk decreases with adequate exposure
to fluoride.
1-4
Risk for dental caries and caries experience exists on a
contin