Dental Dispatch. Provider Directories: Ensure Accurate Information. SPRING/SUMMER 2017 I Vol.6

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1 Dental Dispatch SPRING/SUMMER 2017 I Vol.6 Provider Directories: Ensure Accurate Information Have you ever received a call from a patient asking for an appointment with a dentist that left your practice three years ago? The issue of inaccurate provider directories has been a newsworthy topic. To ensure that our members can find you, please visit our up-to-date online provider directory to verify the information that we have listed for your office. If changes are required, please contact our Dental Network Professional Services at to update information as necessary, or you can complete and submit your change using our new Standardized Provider Maintenance Form. You will fill out and submit a General Office Information Form with each change (only one of these forms is needed if submitting multiple changes). This may be submitted to us via fax, or mail. Call our Professional Services Team at for any questions or assistance on completing the Standardized Provider Maintenance Form. The Standardized Provider Maintenance Form is a fillable PDF form, available at or by contacting Professional Services. Below are some of the dental changes you will be able to fill out and submit to us using this new option: Tax ID change Change in ownership Address change Add/remove providers Add/close a location

2 What s New? Empire Whole Health Connection SM Connecting Medical and Ancillary Plans by Collette Manning, RN CCM ONC, Specialty Clinical Integration Strategy Director and Lynn Appicelli, Specialty Marketing Director As a valued health care partner, we want to keep you informed of the latest Empire programs. In 2014 we launched Empire Whole Health Connection a portfolio of services, tools and benefits which enhances a member s experience with Empire medical, dental, vision, disability and pharmacy plans. Some of these tools for the member are: - Oral Health Risk Assessment Tool - Cost Estimators for Dental Services - Ask the Hygienist box for personalized oral health questions - Enhanced dental benefits for people with certain chronic conditions - Transitions and Polycarbonate lenses free of charge for children - Wellness resources for oral and visual health We believe that when we share data and resources with a member s extended health care team, we create a bigger picture of patient health 1. Empire Whole Health Connection supports an integrated health care experience by consolidating data from primary care physicians, specialists, ancillary providers like eye doctors and dentists, plus pharmacies and labs to improve overall communication between a member and their treating providers. Sophisticated analytics are applied to the data to deliver relevant, HIPAA compliant patient health profiles and actionable insights. These insights are then shared with physicians and care managers to allow for more informed treatment plans and better health outcomes. SPRING/SUMMER 2017 Page 2 How it works 1. Data collection Empire consolidates all claims and benefit information from all coverage lines (medical, dental, vision, disability, pharmacy and behavioral health) in a central repository. 2. Analytics Data is analyzed to deliver condensed, relevant patient health profiles and actionable insights via care alerts and proactive care management referrals. 3. Connect, share and manage Empire connects physicians and eye doctors to this data via the Member360 tool, which is accessed through Empire s provider portals. Sharing of information allows for more informed treatment plans to manage a patient s condition. The data is further shared with care managers. Why is it important to connect dental, vision, disability and pharmacy data to population health? It s important because oral health, eye health and productivity contribute to overall health. The value to a member s extended health care team More efficient data collection. Empire s provider portal supplements the physician s patient health records with the following information: Medications and utilization (if not carved out) Labs (LabCorp) Medical diagnoses (non-sensitive) Other providers and utilization Care Management status

3 Earlier detection of medical conditions. For example, a vision exam could be the first indicator of a chronic condition like diabetes. The vision claim diagnosis of diabetes would be populated in the Member360 tool for viewing by PCPs and care managers. Proactive care management for improved health outcomes. That same vision claim could trigger a member care alert to the PCP or a referral to Empire Care Management allowing for proactive outreach to the member by the PCP and care manager. Reduced cost of care. A recent American Journal of Preventive Medicine study shows that patients with chronic disease or pregnancy who treat their periodontal disease have 6%-74% lower medical costs and hospitalizations 2. Opportunities for your dental practice As an integral part of a member s care team, dental practices have an opportunity to be included in this integrated health care experience. Empire automatically identifies, enrolls and notifies Dental Prime and Complete members with certain conditions of an additional cleaning benefit. 3 Your office can encourage Empire members to complete the oral health risk assessment, and bring it with them to their appointments. This will help you have a discussion on the state of their oral health, and their risk for oral cancer. In the future, Empire will also be making the patient health records mentioned earlier in this article available to our dental providers through a new portal. These services and tools will all help reinforce a long-term, trusting relationship between you and your Empire patients. Directory Accuracy Requirements - We Need Your Help! To ensure our members are able to easily and quickly access in-network dentist, we verify the accuracy of our network every year. We need your help to be successful. Within the next few months, Empire will be contacting you by phone to verify your information. Please be prepared to answer the questions so that we may continue your participation without interruption. To remain in our directory and in our networks, you will need to confirm: Dentist s name Address Individual NPI number Phone number Fax number address (optional) Wheelchair accessibility Specialty (if applicable) Languages spoken at location (optional) 1 Empire Whole Health Connection is available to employer groups that have purchased an Empire pharmacy, dental, vision or disability plan, in addition to their medical plan. Network participation 2 Impact of Periodontal Therapy on General Health. American Journal of Preventive Medicine (August 2014): ajpmonline.org. 3 Applies to Empire Dental Blue, Dental Prime or Dental Complete members who are actively engaged in an Empire Care Management program for the following conditions: pregnancy, diabetes, heart conditions (heart disease, an enlarged heart, and mitral or aortic valve prolapse), organ or bone marrow transplant, cancer (any type) treated with chemotherapy, and head or neck cancer treated with chemotherapy and/or radiation therapy. Not included for Affordable Care Act dental plans. We thank you in advance for your cooperation! SPRING/SUMMER 2017 Page 3

4 Online Options Doing business with Empire has never been easier. To save your office time, you can use our online portals to submit claims, look up benefits, check procedure codes and more For our Dental Prime and Dental Complete members whose claims are submitted to the mailing address in Minnesota, use the appropriate link below based on the logo that appears on the members ID card:. Blue Cross and Blue Shield of Georgia The online portal is available by selecting Dental Prime and Dental Complete Portal Identifiers: Member ID card has Blue Cross and Blue Shield of Georgia logo. Anthem Blue Cross and Blue Shield (CO, NV, OH, IN, KY, MO, WI, VA, CT, ME, NH) The online portal is available by selecting Anthem Dental Prime, Anthem Dental Complete and Anthem Smart Access Self-Service Identifiers: Member ID card has Anthem Blue Cross and Blue Shield logo. Member ID card indicates Dental Prime or Dental Complete as the network or product. Member ID card indicates Dental Prime or Dental Complete as the network or product. Anthem Blue Cross The online portal is available by selecting Anthem Dental Prime, Anthem Dental Complete and Anthem Smart Access Self Service Identifiers: Member ID card has Anthem Blue Cross logo. Empire New York The online portal is available by selecting Empire Dental Prime and Empire Dental Complete Self-Service Tool Identifiers: Member ID card has Empire logo. Member ID card indicates Dental Prime or Dental Complete as the network or product. SPRING/SUMMER 2017 Page 4

5 For our members whose claims are submitted to the mailing address in San Antonio, Texas, the SecureTrack Dental Portal is available online to assist with select Empire product s eligibility, claim and remittance needs. To register, go to: SecureTrack portal highlights: Check patient eligibility Submit claims directly to Empire at no charge View remittances directly from website User friendly solution Save time and money with the SecureTrack dental portal Registration is simple. Simply click Register and follow the instructions. For help during registration, click Registration Help to access the user guide. We will continue to make web enhancements, providing you with a comprehensive and complete solution for your day-to-day needs, saving you time and making it easier for your dental practice to do business. For questions related to looking up eligibility, benefits, or claim status: Call , option 4, option 1, option 1. For questions related to registering, accessing, or other account maintenance for SecureTrack: Call , option 4, option 1, option 2. Eliminate phone calls to check patient eligibility and claim status Free claim submission to Empire and other payers Use the following link to access the portal: SPRING/SUMMER 2017 Page 5

6 Health Watch Opioids and Dentistry Abuse of prescription opioids continues to be a national epidemic and public health issue. Drug overdose is the leading cause of accidental death in the United States. 1 Opioid pain relievers are commonly prescribed following surgery or injury, or for health conditions such as cancer. While opioids can be effective treatment for managing chronic pain and other conditions when properly administered, they carry significant risk when misused or abused. Regular monitoring and identification of early risk factors is critical to recognizing patients who are most at-risk for prescription drug abuse issues and those who are in need of treatment. Commitment across the healthcare industry is needed to effectively fight prescription opioid abuse. What we are doing: Empire s pharmacy team is working to minimize the risk of misuse and addiction through: Enhanced quantity limits and prior authorization requirements for coverage of prescription opioid drugs Identifying members with opioid use patterns of concern and alerting their prescriber(s) through our Controlled Substance Utilization Monitoring program Identifying members who meet criteria for possible misuse and requiring them to designate one pharmacy for filling their prescriptions (Pharmacy Home Program) Expanding access to medications used to treat substance use disorder What you can do: Dentists have a significant role in ensuring appropriate prescription opioids use. During 2016, 8% of opioid prescriptions filled by Empire pharmacy members were prescribed by a dentist. The American Dental Association has adopted two statements addressing opioid prescribing: Statement on the Use of Opioids in the Treatment of Dental Pain 2 and Statement on Provision of Dental Treatment for Patients with Substance Use Disorders 3. These statements outline opioid management considerations including the importance of: Registering with and utilizing prescription drug monitoring program (PDMP) Discussions with patients regarding their responsibilities for preventing misuse, abuse, storage and disposal of prescription opioids Consideration of nonsteroidal anti-inflammatory analgesics as the first-line therapy for acute pain management. Consideration of coordination with other treating doctors, including pain specialists when prescribing opioids for management of chronic orofacial pain. Encouragement to seek consultation with the patient s physician, when the patient has a history of alcoholism or other substance use disorder. 1 American Society of Addiction Medicine website. Opioid Addiction 2016 Facts & Figures (Available at: asam.org.) (Accessed November 2016) 2. American Dental Association. Statement on the use of opioids in the treatment of dental pain. Available at: (Accessed March 2017) SPRING/SUMMER 2017 Page 6 3. American Dental Association. Statement on Provision of Dental Treatment for Patients with Substance Use Disorders. (Available at: ada-positions-policies-and-statements/provision-of-dental-treatment-for-patients-withsubstance-abuse) (Accessed March 2017)

7 Helpful Dental Claims Processing Guidelines Do you have questions about which services may be covered for a member? When in doubt about member coverage, it is best to submit a pre-estimate for a planned treatment. Pre-estimate for periodontal treatment Submit the claim form with planned treatment, dates of root planning or periodontal maintenance if appropriate, current full mouth X-rays, and full mouth periodontal pocket charting. If the treatment plan includes gingival grafting procedures, also include the amount of attached keratinized attached gingiva. Frequently offices submit periodontal charts without mucogingival junction measurements, which make the evaluation for medical necessity impossible. As a reminder, our consultants need a diagnostic bitewing to evaluate caries, fracture, and restorability and an undistorted periapical X-ray to evaluate alveolar bone and the periapical region. Pre-estimate for crowns, bridges, and endodontics When adjudication of a claim requires review, as is frequently the case, our licensed dental consultants evaluate the procedure using X-rays and narratives. Please submit diagnostic X-rays, a bitewing and periapical, or a high resolution panoramic X-ray of the tooth in question. PHI Handling Dental providers and facilities are required to review all member s information received from Empire to ensure no misrouted PHI (Protected Health Information) is included. Misrouted PHI includes information about members that a provider or facility is not currently treating. PHI can be misrouted to providers and facilities by mail, fax, , or electronic remittance. Dental providers and facilities should review claims and documents carefully before submitting for payment to ensure that the member ID and name listed on the claim is accurate. Taking these additional steps will help eliminate explanation of benefits being sent to the wrong member and prevent HIPAA violations from occurring. Dental providers and facilities are required to immediately destroy any misrouted PHI or safeguard the PHI for as long as it is retained. In no event are providers or facilities permitted to misuse or re-disclose misrouted PHI. If providers or facilities cannot destroy or safeguard misrouted PHI, immediately contact Customer Service or call the number listed on the documentation received to report receipt of misrouted PHI. SPRING/SUMMER 2017 Page 7

8 Who Ya Gonna Call? If you re trying to obtain information about For Prime and Complete All Other Dental Products Paper Claims Address Please review the back of the member s ID card to determine the appropriate dental claims mailing address. (Address varies by group.) In the absence of an address, call the number on back of the ID card for instructions on where to submit the claim Please review the back of the member s ID card to determine the appropriate dental claims mailing address. (Address varies by group.) In the absence of an address, call the number on back of the ID card for instructions on where to submit the claim Electronic Claims Follow current process or contact your clearinghouse Follow current process or contact your clearinghouse Customer Service #s See back of patient s ID card or call Grievance/Appeals *Sending to a PO Box different than the following, may result in a delay in your appeal. Attn: Dental Claims Appeals & Grievances P.O. Box 551 Minneapolis, MN Appeals: First Level Appeals Review P.O. Box 551 Minneapolis, MN Professional Services SPRING/SUMMER 2017 Page 8

9 Is Your Practice Information Up to Date? As a participating dentist, it is critical that we have the most accurate data about your practice, especially when changes occur. This information is vital for accurate claims processing and payment. This also helps us give dental members (your patients) the most accurate contact information about your practice, where you re located, and who they should call to make dental appointments. Be sure to contact us if any of the information below has changed to ensure we have all the correct information from your office. Notify us whenever there is a change in: Location - A dentist adds, changes or ends a location. (Please double-check that we have your correct billing address and mailing address.) Name - Clinic name change, dentist name change, legal name change, or the DBA name changes. License - Include the treating dentist license number as issued rather than a shortened version. Tax Identification Number (TIN) - Complete and submit a W-9 form along with a note requesting the TIN change, the effective date of the TIN change, and any other office changes. Please provide a list of what networks the change will affect. If you are unsure of your network participation, please feel free to contact Professional Services by calling National Provider Identifier (NPI) - Please be sure we have your individual NPI as well as the clinic NPI. Ownership change - Please provide the clinic name, date of purchase and W9 if the TIN is not currently on file. Please include a list of dentists associated with this TIN and with what networks they currently participate. Adding/removing associates - If an associate retires, leaves, or a new associate is added to your practice. Call our Professional Services Team at to verify the accuracy of your location and providers listed or if you have any questions related to network participation or the required information to make any of the above changes. SPRING/SUMMER 2017 Page 9

10 Updating your dental practice information when changes occur will assist us in processing your dental claims accurately and timely. We are able to relay correct information to dental members (your patients), regarding who they should call to make dental appointments, your practice s contact information and where you re located. As a participating dentist, it is critical that we have the most accurate data about your practice. This information is vital for accurate claims processing and payment. Be sure to contact us if any of the information below has changed to ensure we have all the correct information from your office. Are you properly listed in our directory? See inside for more information. Notify us whenever there is a change in: Location - A dentist adds, changes or ends a location. (Please double-check that we have your correct billing address and mailing address.) Name - Clinic name change, dentist name change, legal name change, or the DBA name changes. License - Include the treating dentist license number as issued rather than a shortened version. Coming up Save the Date! We will be at the 2017 America s Dental Meeting in Atlanta October (Booth #2622) and Greater New York Dental Meeting in November Stop by and say hello. We look forward to seeing you and your staff there. Watch for our Fall/Winter 2017 Dental Dispatch Newsletter coming out in December. Services provided by Empire HealthChoice Assurance, Inc., a licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. SPRING/SUMMER EMPIREBCBS Page 9