Language Assistance Program. Inside this issue. Contact Center. Fourth Quarter Provider Bulletin. Visit our Web site at

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1 Fourth Quarter Provider Bulletin Inside this issue Language Assistance Program 1 Training Support 2 Upcoming Provider Seminars 2 Calendar of Provider Seminars 2 Healthy Families Closed Enrollment 2 Automated Benefits 3 Benefit Changes for SFHK 3 Cultural & Linguistic Corner 3 Specialist Referral 3 Taxpayer ID Number 4 Seminar Form Insert Language Assistance Program Form Insert Contact Center Customer Service: Fax: Contact Center Hours: Monday-Friday 7:00 a.m. to 5:00 p.m. Language Assistance Program Delta Dental is introducing a comprehensive Language Assistance Program (LAP) that supports the goals of California s SB 853 legislation. The legislation requires all health care providers and health plans to make specific language assistance services available to Members with limited proficiency in English. Services offered through our LAP include: Dentist directories that include the self-assessed language capabilities of participating dentist offices and staff. Member Web services in English and Spanish. Applicable Member materials in English, Spanish, and Chinese. Customer Service assistance in over 170 languages. To achieve this level of service, your support and cooperation are vital. We have included several elements in the LAP that describe the dentist s role, including: Notifying Delta Dental of language assistance capabilities available in your office and of any changes in those capabilities. Contacting us for requests for interpretation assistance. Informing your Delta Dental patients about our LAP, including their right to language assistance services free of charge, and that the use of professional interpretive services is advised (instead of reliance solely on family or friends). Informing patients that grievance forms and procedures are available upon request from Delta Dental and that additional information is also available from the California Department of Managed Health Care (DMHC). For your convenience, an LAP form has been included with this bulletin. To download a form or to review an outline of the LAP, including how to arrange for interpretive services, please visit our Web site at If you have any questions or concerns, please call our Customer Service Department at Interactive Phone System Hours: Monday-Friday 5:00 a.m. to 7:00 p.m. Saturday 8:00 a.m. to 12:00 p.m. Visit our Web site at 1

2 Training Support Personal On-Site Visits Dentists needing assistance with Delta Dental State Government Programs (DDSGP) claims processing may request that a Provider Relations Representative visit their office. This personal attention is offered to help you and your office staff better understand DDSGP policies and procedures so you can more easily meet program requirements. Upcoming Provider Seminars 2009 We would like to invite you to a FREE Basic Training Seminar for dentists and dental office staff participating in the Healthy Families and Healthy Kids Programs. This Seminar includes program information, enrollment, eligibility, and claims processing for Delta Dental State Government Programs Providers. Each Delta Dental Seminar is free and provides 3 hours of approved continuing education credit for California licensed dentists. For more information, please visit our Web site at Fresno Friday, January 23, 2009 Four Points Sheraton 3737 Blackstone Fresno, CA Santa Clara Friday, February 6, 2009 Santa Clara Marriott 2700 Mission College Blvd. Santa Clara, CA Rancho Cucamonga Friday, March 13, 2009 Courtyard Rancho Cucamonga Mission Vista Dr. Rancho Cucamonga, CA Paso Robles Friday, April 17, 2009 Courtyard Marriott 120 South Vine St. Paso Robles, CA Calendar of Provider Seminars For your convenience, a list of seminars that will be provided throughout 2009, is provided below. May - Bakersfield June - Orange County July - Stockton August - Ventura September - Fairfield October - San Diego November - Los Angeles December - Sacramento Healthy Families Enrollment Closed to New Members Regrettably, as a result of recent state budget cuts, Delta Dental will close all but one region (Region 2) and two central California counties to new Healthy Families enrollment, effective February 1, New Members will be accepted only in Region 2 counties (Fresno, Imperial, Kern, Madera, Mariposa, Merced, Napa, Sacramento, San Joaquin, San Luis Obispo, Santa Cruz, Solano, Sonoma and Stanislaus), as well as in Mono and Tuolumne counties. Please note that this closure applies only to new enrollment; you should continue to provide services to current Healthy Families Members as usual. State funding and administration for the Healthy Families Program remains a topic of debate, both within the State Legislature as well as in Washington, D.C., where the changes to the formulas for federal matching funds could impact the future of this program. Delta Dental will continue to monitor these developments closely and keep you informed about any further changes to the program. We would like to thank you for your continued dedication in serving Healthy Families Members. If you have any questions, please contact us at (The above listed phone numbers are for directions only.) All seminars are from 9:00 a.m. to 12:00 p.m. with registration beginning at 8:30 a.m. Everyone smiles with Delta Dental! 2

3 Automated Summary Benefits Now Available We ve modified our automated telephone system to make summary eligibility and benefits information available via or through our fax back. Now when you request eligibility and benefits for a Member, you ll get only the information you need. Remember, you can always hear benefit details at a procedure code level by following the eligibility and benefits path. Please note: We must have your address on file before you can use the option. Using the Interactive Phone System Tips and Tricks Here are a few tips to make using our interactive phone system easy: Always use your Tax Identification Number (TIN), including any leading zeros; not your provider ID. If there is an alpha character in the Member ID number, please say the entire ID into the system including the alpha characters. Include any leading zeros in all ID numbers. For example, if the ID number is , enter or say Date of birth > When entering a date of birth on the key pad, use a two digit month, two digit day, and four digit years. For example, March 1, 1998 would be entered > When saying the date of birth, say the month, day and four digit year. For example, March 1, 1998, would be spoken March first, nineteen ninety-eight. If you re a frequent user and you re familiar with the options, you don t have to listen to all the choices just say your option. Benefit Changes for San Francisco Healthy Kids Due to the current budget crisis being faced by state and local governments, and in an effort to continue providing quality dental care to its Members, San Francisco Healthy Kids (SFHK) has informed Delta Dental they will be implementing two changes to the current SFHK benefit structure. Effective July 1, 2009, SFHK will only cover Members from 0-18 years of age, therefore, eliminating the portion of the program that covers adults from ages SFHK will also be instituting a new yearly benefit maximum of $ per Member also effective July 1, The benefit maximum will be based on a 12-month period effective July 1, 2009 through June 30, Cultural and Linguistic Corner Delta Dental s Cultural and Linguistic Program provides 24-hour interpreting services to Members and dental offices. This includes telephonic interpreting services as well as face-to-face interpreting services. These services can be accessed by Providers through our Customer Service Department at These services are available free of charge to eligible Members and participating dental Providers when coordinated through Delta Dental. Please ensure that Members and dental office staff are aware of the following items: Members/Providers that schedule an interpreter with Delta Dental need to contact Delta Dental directly if the dental appointment has been canceled to avoid unnecessary charges. Delta Dental makes every effort to provide a face-to-face interpreter; however, it may be necessary to use telephonic interpreters when necessary. Members can access free language assistance by contacting Delta Dental s Customer Service Department toll-free at Delta Dental discourages the use of minors, family members, and friends as interpreters except in extraordinary cases. The Member has a right to request an interpreter during discussions of medical information, such as diagnoses of medical conditions, proposed treatment, explanations of plans of care, or other discussions with Providers. The Member has a right to receive member materials in Delta Dental s threshold languages, which are English, Spanish, and Chinese. The Member has a right to file a grievance if linguistic needs are not met. Delta Dental would like to thank you for taking the time to ensure the success of the Cultural and Linguistic Program. Specialist Referral In the event it is necessary to refer a Member to a specialist for treatment, please be sure to refer the Member to a network provider. You may look in the Delta Dental State Government Programs Provider Directory to locate a network specialist in your area. The Provider Directory may be viewed online at If you cannot locate a specialist in your area you may contact our Customer Service Department at If you are considering a referral to an oral surgeon for the extraction of impacted third molars, please keep in mind the surgical extractions of impacted teeth (Procedures D7220-D7240) is a covered benefit only when evidence of pathology exists. After July 1, 2009, you can call our Customer Service Department at to check the benefit maximum before you see a SFHK Member! Need a form? Most forms are available to print immediately from the Web site. Providers can also check for the latest training seminar dates and handbooks, and even locate a specialist or find a dentist in a specific area via the online Provider Directory. 3

4 Please Verify your Taxpayer Identification Number Delta Dental is required to annually report to the Internal Revenue Service (IRS) the amount paid to each dentist during the proceeding tax year. The payee s name and the Taxpayer Identification Number (TIN) associated with all payments must match exactly with the dentist or business name and TIN on file with the IRS. If this information does not match, the IRS requires Delta Dental to withhold 31% from future payments until the issue is resolved. There are two types of TINs: Social Security Numbers (SSNs) and Employer Identification Numbers (EINs). The TIN Delta Dental uses to report payments made to you to the IRS can be found on the top of the check you receive from Delta Dental, and on the top of the claim detail pages that follow. (Look for the boxes above your name and address on your Explanation of Benefits or Notice of Payment (EOB/ NOP) forms.) Please look for this number and verify that the TIN on your next check from Delta Dental is correct. If you find that the TIN Delta Dental is using is incorrect or if your name or the name of your corporation or partnership has changed recently, please notify Delta Dental immediately. You may obtain a form for this purpose from Delta Dental s Web site at gov. As this year comes to a close, we at Delta Dental would like to take this opportunity to thank you for your participation in Delta Dental State Government Programs. Without your continued support, the children in our communities would not have access to much needed dental care. Happy Holidays! You will also find your name and TIN on the printed mailing labels that the IRS supplies for quarterly tax payments. Or you can contact the IRS to request a letter (#147C) that will confirm its official record of your name and TIN. The IRS phone number is If two or more names are used (such as Chris Jones, DMD, dba Main Street Dental), please report the first name as it appears on the IRS records. 4

5 State Government Programs We would like to invite you to a FREE Basic Training Seminar for dentists and dental office staff covering the Healthy Families and Healthy Kids Programs. The Seminar includes program information, enrollment, eligibility, and claims processing for Delta Dental State Government Programs providers. Earn three continuing education credits from the Dental Board of California by attending. Please check each box for every seminar you would like to attend. Fresno Friday, January 23, 2009 Four Points Sheraton 3737 Blackstone Fresno, CA Santa Clara Friday, February 6, 2009 Santa Clara Marriott 2700 Mission College Blvd. Santa Clara, CA Rancho Cucamonga Friday, March 13, 2009 Courtyard Rancho Cucamonga Mission Vista Dr. Rancho Cucamonga, CA Paso Robles Friday, April 17, 2009 Courtyard Marriott 120 South Vine St. Paso Robles, CA (The phone numbers provided above are for directions only.) All seminars are from 9:00 a.m. 12:00 p.m. with registration beginning at 8:30 a.m. To register, call us toll-free at or FAX this form to Make your reservation today. Limited seating Billing Provider Address: City: ZIP: Telephone Number: ( ) Billing Provider Number: Number of Attendees:

6 Delta Dental of California: State Government Programs Dentists and Staff Language Capabilities Disclosure Form The California Department of Managed Health Care has adopted new language assistance regulations (CCR ) that require providers and office staff to certify to their non-english language proficiency. In order to ensure that there are appropriate levels of language proficiency at dental offices for those participating providers who list bilingual or multilingual capabilities in the provider directory, we ask you to please complete the form below. Proficiency in languages other than English includes 1) demonstrated conversational fluency with use of correct grammar and adequate vocabulary, 2) fluency in dental terminology and comprehension of language relating to dental care, 3) training to take or assist in gathering information for an accurate dental history, and 4) an ability to demonstrate cultural sensitivity. Please return this form to Delta Dental State Government Programs: Attention Dentist Network Administration and Contracting, P.O. Box , Sacramento, CA , or fax to Print Legal Name of Contracting Dentist, Dental Group, Dental Clinic or Public Entity: First Last License #: Provider Tax ID Number: National Provider Identifier Number: Office Address: City: State: Zip: For those who indicate a fluency in a non-english language in our online provider directory, please indicate dentist or staff, print their name, enter language capabilities and *sign in the corresponding box. If you need additional pages, please copy this form. LAP Disclosure #51506-CPP (rev. 10/08)