Dental Dialog Fall 2017 Highlighting news, programs, policies and tips for Aetna participating dentists 43.22.802.1-FA A (10/17) aetna.com
Dental Dialog Fall 2017 Inside this issue The opioid epidemic... 3 Avoid changes in your participation status complete your 2017 FDR attestation today... 4 Announcements...5 New 2018 CDT Code details... 5 New dental plans starting January 1, 2018... 5 Timely and accurate customer service results... 5 Supercharge your practice and kick paper to the curb... 6 Submit claims electronically with Change Healthcare Dental Connect... 6 Electronic claims submission our preferred method... 7 Helpful information...7 Working with Aetna...8 Aetna Dental Access network... 8 Aetna Dental Administrators... 8 Important numbers and addresses... 9 Dentist HotLine... 9 Addresses... 9 Aetna PPO grievance and appeals... 9 CA Language Assistance Program... 9 Dental Dialog is published biannually. Dental benefits and dental insurance plans are offered, underwritten and/or administered by Aetna Life Insurance Company, Aetna Dental Inc., Aetna Dental of California Inc., Aetna Health Inc. and Aetna Health of California Inc. 2
The opioid epidemic We all recognize that the United States is in the grips of an opioid epidemic. The question is what do we do about it? On July 22, we sponsored the National Dental Association convention President s Symposium on the Opioid Crisis, Managing Dental Pain and Prescribing Controlled Substances. Presenters from the DEA, Public Health, Pharmacy and Risk Management discussed strategies for dentists to reduce their opioid prescribing, while continuing to improve the lives of patients by eliminating pain and improving health outcomes and overall well-being. Dentists and prescription rates On an average day in the U.S., more than 650,000 opioid prescriptions are dispensed. Dentists prescribe 12 percent of all immediate-release opioids, behind only family physicians, who prescribe 15 percent. For patients aged 10 to 19 years, dentists are the main prescribers. Everyone has a role to play. Patients, families, medical and dental professionals, insurers, addiction counselors and the public at large all play a role in combatting this epidemic. We are applying data analytics, clinical insights and collaborations along the continuum of addiction and recovery to drive improved outcomes. We re working to prevent misuse and abuse, intervene when we identify at-risk behavior and support those who are addicted through evidence-based treatments. By 2022, we are committed to the following goals: Increase treatment of chronic pain with an evidencebased multimodal approach by 50 percent. Increase treatment of opioid use disorder with medication-assisted therapy and other evidence-based treatments by 50 percent. Reduce inappropriate opioid prescribing for our members by 50 percent. For the third goal, we took a proactive approach by using data resources to work with doctors to reduce opioid prescribing. Many states have placed a seven-day limit on opioid prescriptions. To align with those regulations, we recently sent letters to dentists and oral surgeons who were identified by claims data to have prescribed a greater than seven-day supply of an opioid at least five times in the last two years for routine procedures. To work closely with prescribers, we ve set up a dedicated email address where they can respond to these letters and request more information on their prescribing patterns compared to their peers. There is no single front line in the war against opioid addiction. Rather, we must continue to wage the fight in our dental offices, communities and homes. If we are to beat this epidemic, everyone must take a stand. Get quick claims tips. 3
Avoid changes in your participation status complete your 2017 FDR attestation today As a participating provider servicing our Medicare and/or Medicare-Medicaid plan (MMP) members, you re considered a first tier entity. As such, you must meet the Centers for Medicare & Medicaid Services compliance program requirements for first tier, downstream and related (FDR) entities. To avoid changes in your participation status, you must also confirm your compliance with these requirements through an annual attestation. If you ve already completed your 2017 attestation, you may disregard this notice. How to complete your attestation Resources and materials related to FDR requirements have been updated for 2017. These include: CMS Medicare Parts C and D Fraud, Waste, and Abuse Training CMS Medicare Parts C and D General Compliance Training Aetna Code of Conduct and Medicare Compliance Program Policies You ll find the resources you need to ensure compliance with these requirements on the Medicare Compliance Attestation page of aetna.com: Go to aetna.com. Hover over Health Care Professionals and choose Medicare under Products & Programs for Health Care Professionals. Click See our Medicare compliance program guide or See our office manual under Need more information? Once you review and ensure you ve met the requirements, you re ready to complete your attestation. Simply click the link on the Medicare Compliance Attestation page that corresponds to your contracting status. A single annual attestation meets all your Aetna, Coventry and/or MMP compliance obligations.questions? We re here to help. If you have compliance-related questions not addressed in our guide, just call us at 1-800-624-0756. Or you can send us a secure email: Go to aetna.com. Select Contact at the top of the page. Select Contact us online. Choose Submit a medical or behavioral health question or comment. If you re an MMP-only provider, you can also email us at medicaidmmpfdr@aetna.com. 4
Announcements New 2018 CDT Code details You can now find the new CDT 2018 code information on our secure website. The new codes become effective on January 1, 2018. You can find details about the handling for the new procedure codes on aetnadental.com. Please look for the Network Bulletin regarding CDT 2018 in the back of the Dental Office Guide. Please read the Network Bulletin carefully and save the link for future reference. New dental plans starting January 1, 2018 We have two new plans under our DMO product. Plan 2ba is a new coinsurance plan and plan 56x is a new copayment plan. You ll find more details about both plans on our provider portal, aetnadental.com. Go to Helpful Links in section VIII of the online DMO Dental Office Guide. Timely and accurate customer service results We strive to make it as easy as possible for you to do business with us. So we closely monitor our results. This helps ensure that your communication with us is timely and accurate. Here are some results through the first quarter: Percentage of dental claims paid within 15 days: 98.3% Percentage of financially accurate claims paid: 99.8% Average time within which calls are answered: 18 seconds Percentage of calls answered within 30 seconds: 90.2% Percentage of calls abandoned before answered: 0.8% 5
Supercharge your practice and kick paper to the curb Paper can be a waste of your money and your office manager s time. Renaissance Electronic Services has a full suite of tools to help your practice go paperless. We offer dental s most affordable eclaims service: At $49.95 a month with free attachments, Remote Lite saves practices an average of $1,300 annually over other eclaims services. There s no contract and your first month is free. Stop scanning and filing Explanation of Benefits (EOB) statements: Our free service, Electronic Payments, allows practices to retrieve EOBs electronically within Remote Lite and notify patients of their balance at the time of service. You ll also get paid faster: Waiting for checks in the mail requires an eventual trip to the bank. With Electronic Payments, your practice can accept payments from insurance companies within 24 48 hours, without having to leave your computer. Visit dentalhero.com or call 1-866-712-9584 to get started. Submit claims electronically with Change Healthcare Dental Connect Change Healthcare s easy-to-use, web-based application, Dental Connect, can save your practice time, effort and money. By submitting your dental claims electronically, you could save more than 85 percent over the cost of paper claims submissions. To make the transition even more beneficial, Change Healthcare is providing you with free electronic dental transactions for your first three months. With Dental Connect, you can: Submit claims electronically, even if you don t have a practice management system Submit attachments electronically Quickly verify patient eligibility and benefits coverage Confirm claims status and receive EOBs electronically How you benefit Reduce the cost of paper, printing, envelopes and postage Save time spent on paper processes, enabling staff to focus on more important tasks Get paid faster Signing up for Dental Connect It s simple. Go to dental.changehealthcare.com, click Register for Dental Connect and follow the prompts. Be sure to enter the special partner code EDC0330 to receive your first three months free. Your free three-month offer is for a limited time, so please don t delay. For questions, call 1-888-255-7293. 6
Electronic claims submission our preferred method Electronic claims submission is our preferred method of getting your claims. That includes primary and coordination of benefits (COB, also known as secondary) claims. If you re already working with a vendor or clearinghouse to submit claims electronically to another payer, ask them how you can submit claims electronically to us. If you re not already working with a vendor, we can help you. To send individual, direct entry dental claims at no cost, use ClaimConnect, powered by DentalXChange. Get to ClaimConnect from our dental provider website at aetnadental.com. Mouse over the Log In/Register box in the upper right corner and click on the link under New User? and register. Once you log in, click on Access Electronic Services. Once you register for ClaimConnect, you ll have access to their tools to submit electronic claims, check claims status, patient eligibility and more. For a list of other vendors we work with (vendor fees may apply), visit us at aetnadental.com to review the list. Regardless of the vendor you use, we suggest you register for our secure provider website anyway. After you register, you can get electronic copies of your EOBs and more. Helpful information For office or provider update information, please visit us at aetnadental.com. Click on Helpful Links, then click on Update Office Information. Don t forget to submit your annual DMO fee profile. For more information on how to submit, where to submit or why to submit visit us at aetnadental.com. Click on Working with us, then click Submit your annual DMO fee profile. Signed treatment plans be sure to tell your patient which procedures are covered by the plan and which are optional so they can make an informed choice. Handling information/record requests for domestic violence victims New York law requires insurers to develop a confidential way to handle information/record requests for victims of domestic violence. We must follow the protocol that the privacy office created. View protocol document. Please print the notice and hang it in your office. Dentists in California: Use the Language Assistance Program (LAP) for non-english-speaking members As a reminder, participating dentists in California must use the LAP when they provide care to non-english-speaking Aetna members. There s no charge for this service. Call 1-800-525-3148 to reach an interpreter. This number bypasses our Dental Service Center. It connects members directly to qualified interpreters. 7
Working with Aetna The Aetna Dental Access network and Aetna Dental Administrators continue to grow. Here s a quick reference guide to help you easily welcome these participating patients to your office. Aetna Dental Access Discount programs supported by the Aetna Dental Access network Aetna Dental Administrators Benefits plans supported by the Aetna Dental Access network Yes No Yes No PCD selection required PCD selection required PCD referral required PCD referral required Submit claims to Aetna Submit claims to address on ID card (may not be Aetna) Collect payment from patient at the time of visit Program overview: Program overview: Discount programs are not insurance. ID cards: Program names and brands will vary. Look for the Aetna Dental Access logo; it will appear on all ID cards. You don t need to file a claim. Patient is responsible for entire payment at time of service. The payment is based on PPO fee schedule. Call with questions. You ll find the number on patient s ID card. Visit aetnadental.com for a list of current plans that the Aetna Dental Access network supports. Third-party administrators and other payers may administer these programs. Program designs may vary. ID cards: Program names and brands will vary. Look for the Aetna Dental Administrators logo; you ll find it on all ID cards. Submit claims to the address on the ID card only. Call number on patient s ID card to verify eligibility. Visit aetnadental.com for a list of current plans that Aetna Dental Administrators supports. Aetna Dental Access will appear on different ID cards in different places. The Vital Savings by Aetna program is supported by the Aetna Dental Access network. Aetna Dental Administrators will appear on different ID cards in different places. 8
Important numbers and addresses Dentist Hotline National Dentist Line Dentist web address Have a question about the network, claim status, member eligibility, contact information or DMO supplies? Call the National Dentist Hotline at 1-800-451-7715. Go to aetnadental.com to: Dentist Contracting Hotline View Dental Office Guides For PPO contract information, call the Dentist Contracting Hotline at 1-800-776-0537. Update your personal information, including your NPI and email address Get continuing education courses and more Addresses All claims and specialist referrals Aetna DMO grievance and appeals Aetna Dental PO Box 14094 Lexington, KY 40512-4094 Northeast region (CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VA, VT, WV) Encounters and encounter listings Aetna Dental PO Box 14530 Lexington, KY 40512-4530 Aetna Dental PO Box 14080 Lexington, KY 40512-4080 South region (AL, AR, FL, GA, LA, MS, NC, OK, SC, TN, TX) Aetna Dental PO Box 14597 Lexington, KY 40512-4597 West region (AZ, CA, CO, HI, IA, ID, IL, IN, KS, KY, MI, MN, MO, NE, NM, NV, OH, OR, UT, WA, WI) Aetna Dental PO Box 10462 Van Nuys, CA 91410 Please note: The PO Box number and the last four digits of the ZIP code vary with each address. Aetna PPO grievance and appeals CA Language Assistance Program Call the Dentist Contracting Hotline at 1-800-776-0537 for the correct mailing address. For free interpretation services, call 1-800-525-3148. Aetna Dental Dialog Fall 2017 9
NEA is a registered trademark of National Electronic Attachment, Inc. All vendors are independent contractors and not employees or agents of Aetna. The opinions expressed or articles in this publication are not intended to provide dental/medical nor legal advice nor any endorsement by Aetna of any specific product, vendor, drug or pharmaceutical. Articles or opinions written by individual contributors do not necessarily reflect the views of Aetna. Aetna does not assume any liability in connection with the use or implementation of any techniques, policies or procedures discussed in this newsletter. While this information is believed to be accurate as of the print date, it is subject to change. For more information about Aetna networks, refer to aetnadental.com. Comments and suggestions are welcome. Please email DentalDialogNewsletter@aetna.com. 2017 Aetna Inc. 43.22.802.1-FA A (10/17) aetna.com