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Newsletter | July 2018

Delta Dental of Kansas updates to participating dentists.

One month until the 2018 Annual Seminar & Meeting:
Register Now!

When: Saturday, August 11, 2018 | 8:30 - 11:45 a.m.

Where: DoubleTree by Hilton | Overland Park, Kansas

What: Punked by Plaque seminar by Dr. Brian Nový

3 CEUs

$20 per attendee

*Annual Participating Dentist Meeting immediately after seminar*

 

IMPORTANT NOTICE

Effective July 9, 2018, Delta Dental of Kansas (DDKS) no longer accepts phone inquiries from third party solutions such as Medusind, VSNL America, E-clinical Works, etc. that initiate calls to obtain benefits and eligibility information on behalf of dental offices.

Why?

Per HIPAA, the Privacy Rule generally requires covered entities to take reasonable steps to limit the use or disclosure of, and requests for, Protected Health Information to the minimum necessary to accomplish the intended purpose. Some of these services request benefits for multiple patients, multiple codes, run downs plus complete claims history, which we believe may not meet the minimum necessary requirement under the Privacy Rule.

In addition, it appears that some of these entities are not accredited with the Better Business Bureau and cannot be adequately verified.

Alternate ways to access patient information:

You can access benefits, eligibility and claims status by logging in to your dentist account on the DDKS website. Your Professional Relations Representative will be happy to provide web training as necessary to any dental office staff as needed. You can also use DDKS Fax Back to obtain this information: 877-329-3357.

Happy Office Acknowledgment Program

Help us recognize great work!

The Professional Relations team rewards Customer Service team members who have provided dental offices with excellent customer service through the Happy Office Acknowledgment Program. Pictured above are the two June award winners.

We are requesting that you tell us when you have had a great customer service experience with Delta Dental of Kansas. Please send an email to pr@deltadentalks.com with: the name of the helpful Customer Service team member, the date and time of your call, your name and dentist name.

Thank you!

 

D4355: What Changed?

Why can't I charge an evaluation on the same service date as a full-mouth debridement?

There was an update to the procedure code D4355 made by the ADA CDT Coding Committee on January 1, 2018 that is still causing some questions.

Here is some helpful information from the Kansas Dental Board's (KDB) Dental Hygiene FAQs on this topic:

Q: I have been told that an oral evaluation cannot be charged to a patient on the same date as D4355 full-mouth debridement. Is it legal for a hygienist to perform this treatment without the dentist also performing and charging an evaluation on the same date of service?

A: The dentist must diagnose the need for D4355. This can be accomplished during a brief encounter with the patient where treatment is prescribed but a full exam is not completed, and therefore, not billable to the patient. Documenting this patient encounter in the patient’s chart fulfills K.S.A 65-1456 allowing the hygienist to perform D4355. Completion of the comprehensive oral evaluation should follow the full mouth debridement on a subsequent date giving the debrided area sufficient time to heal/react to the D4355 treatment so that a full oral evaluation can be performed1.

1-http://www.dental.ks.gov/home/dental-hygienists-faqs

 

Restoration Replacement Clarification

Our Policy and Employer Contracts state that a fee for the replacement of amalgam or composite restorations on the same tooth and same surface(s) is disallowed if done by the same dentist/dental office within 24 months of the initial restoration. This means we will benefit each surface of a tooth only once every two years, even if the second restoration is in a different location on a previously paid surface (with the exception of the upper first molars due to the transverse line).

However, we know that sometimes there are extenuating circumstances that exist, such as trauma, poor oral hygiene or patient neglect. In these cases, if we are notified, the replacement fee would not be disallowed; instead it would be denied as the responsibility of the patient. If this is the case, we suggest that you educate your patient on the reasons for filling replacements and document these conversations in your treatment notes. It is also a good idea to obtain your patient's signature signaling that they understand your fee and why they may be responsible for the replacement costs.

Your treatment notes that include the documentation describing the extenuating circumstances are helpful to us when making our determination. 

 

Treatment notes: why we're asking for them & why they're important

In 2018, there has been a renewed emphasis in the Delta Dental National Processing Policy on the importance of treatment/clinical notes over narratives when submitting explanations on your predeterminations and claims. Treatment/clinical notes are considered a legal document, while narratives are not. The Processing Policy now states that “the only acceptable legal written documentation for utilization review are the contemporaneous treatment notes”

We appreciate your cooperation as we continue to request treatment notes over narratives. If you have any questions about this policy, the Professional Relations Team is happy to speak with you.

 

Easy Access to Appeals Form

For quicker and more accurate processing of your appeal make sure you're providing all the information we need by using the Appeal Request form. You can access the Appeal Request form by:

  • Visiting the Dentist forms page on the DDKS website:
  • Logging in to your online dentist account to access forms:
 

Dental Office Deals: Discounts for your Practice

DDKS offers Dental Office Deals – a program for participating dentists that offers discounts for a variety of common dental practice needs. You can register for the Dental Office Deals program for free by logging in to your online dentist account, then selecting Dental Office Deals at the bottom of the left column. After a quick registration, you will have access to information on how to enroll in the specific discount agreements with the companies you choose.

Several new companies have joined the growing list of dental specific discounts. Log in to your dentist account to view the updated list!

 

Delta Dental of Kansas is offering members access to independent dentist reviews

Delta Dental of Kansas offers access to independent reviews on Healthgrades®.

What is Healthgrades®?

Healthgrades® offers information on health care providers as a free service to consumers, patients and other health care professionals. Healthgrades aggregates information related to provider practices from publicly available sources.

How do I get more information?

If you would like to learn more about your Healthgrades® provider profile, click the button below.

A link to dentist reviews is being provided to members as a convenience and for information purposes only; they do not constitute an endorsement or an approval by Delta Dental of Kansas of any of the views or opinions communicated on www.healthgrades.com. Delta Dental of Kansas bears no responsibility for the accuracy, legality or content of this external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

 

DDKS Reminders:

Delta Dental of Kansas office will be closed:

September 3 - Labor Day

November 22 & 23 - Thanksgiving

 

Upcoming Events

Annual Seminar - Punked by Plaque:

August 11, Overland Park, KS

Dental Insurance 101 Seminar Opportunities:

Friday, September 14 - Wichita, KS

Friday, October 26 - Topeka, KS

Friday, November 30 - Wichita, KS

Friday, November 30 - Leawood, KS

 

Dental Office Changes or Updates? Please notify us.

Please contact the Professional Relations team with any dentist and/or office changes or updates. When to notify us:

New and/or change of physical or payment address(es)

New and/or change of phone number(s)

A dentist joining or leaving

Closing of an office

Tax information changes

New and/or changed NPI information

Retirement

Sale or purchase of practice

License status updates

 

Questions?

Contact your Professional Relations Team at

pr@deltadentalks.com or 800.264.1099.

Meet your Professional Relations Representative

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Delta Dental of Kansas | DeltaDentalKS.com | 800.234.3375