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DENTAL PROGRAM UPDATESCDA Annual ConventionMay 5, 2012
MUTUAL GOALS FOR THE HEALTHYCONNECTIONS DENTAL PROGRAM Cost-Effective Administration– DentaQuest’s technology and processes deliver compliant andcost-effective administration of government-provided dentalservices. Commitment to Improving Oral Health & Access to Quality Care– Ensuring eligible beneficiaries access to appropriate dental care– Analyzing policy through data analysis, stakeholder input, andreview of successful models elsewhere
INTRODUCTIONS DENTAQUESTRebekah Mathews, SC Executive DirectorEllen Rattey, Market DirectorTycie Sellers, Provider Relations RepresentativeDoyle Williams, Senior Dental Director SC DEPARTMENT OF HEALTH & HUMAN SERVICESValeria Williams, Director of Health Services
PROGRAMOVERVIEW ANDOPERATIONALDATA
MEDICAID OVERVIEW: ENROLLMENTApproximately 50,000 new beneficiaries expected to joinHealthy Connections before close of FY2012Projected growth of 32,000 new beneficiaries in FY2013Average monthly Healthy Connections membership at900,000Average monthly membership of dental eligibles:533,000 Children and MR/RD Waiver members282,000 Adults
MEDICAID OVERVIEW: FUNDINGSCDHHS allocating 98M for dental program in FY2013Funding is a Maintenance of Effort (MOE) RequestRepresents 2% of overall agency Medicaid Assistancebudget
MEDICAID OVERVIEW: POLICYDecember 8, 2011 Dental Provider BulletinIssued to clarify:1. Frequency limitations2. Exceptions to Elimination of Adult Benefit3. Availability of emergency medical services rendered byoral surgeons4. Broken Appointment Tracking functionality on DQProvider Web Portal
MEDICAID OVERVIEW: POLICYDental Advisory CouncilEstablished Spring 2012Diverse representation from participating providers, publichealth, organized dentistry and DentaQuestCharged with reviewing policy to identify areas for qualityimprovement and cost savingsLed by SCDHHS
MEDICAID OVERVIEW: EHR INCENTIVESElectronic Health Record (EHR) Incentive ProgramImplemented by federal Center for Medicare and MedicaidServices (CMS)Dentists are part of Eligible Professional providers who canparticipateTo date, 89 SC dentists receiving 1.9M in EHR incentivesQuestions?Information available through www.scdhhs.gov/hit orHITSC@scdhhs.gov
MEMBERSHIP SNAPSHOTMarch 2012March 2011South Carolina HealthyConnections Adult278,156277,869South Carolina HealthyConnections Under 21and MR/RD Waiver530,512521,721
CLAIM VOLUMETotal Claims Count year 2Total Claims Count year 1
CLAIM RECEIPT BY SUBMISSION 2011 08/2011 09/2011 10/2011 11/2011 12/2011 01/2012 02/2012 03/2012Total Paper Claims for the 0,594Total Electronic Claims for the 56563,191On average, 85% of claims received areelectronic submissions**
SERVICES RENDERED AND Jan‐12Feb‐12Mar‐12Total Services ,262218,967278,536Services Paid ,364204,022258,553 2012 DentaQuest . DentaQuest is a registered trademark of DentaQuest, LLC (“DentaQuest”). All rights reserved.
RATIO OF SERVICES PAID TO SUBMISSIONS**Currently over 92% of services .00%
MOST COMMON DENIAL REASONSIssueProcessing PolicyDuplicateSubmission2029This procedure is a duplicate of a service previously processed.FrequencyLimitation2090Service exceeds benefit allowance. This service is allowed once every 6months.COB2051Member's enrollment file indicates other insurance coverage may beprimary for these services. Please submit primary carrier's explanation ofbenefits showing payment or denial for these services.FrequencyLimitation2098Similar restorations are allowed once per 36 months per patient per toothrestored. The patient's history shows a similar restoration in the past 36months.COB2001The patient was covered on the date(s) of service by another insurancecompany which is the primary carrier. After the prime carrier hasdetermined its liability, resubmit this claim with a copy of the prime carrier'sEOB.
SC Healthy Connections Member Calls(Abandonment Objective %1,0001.5%1.0%5000.5%0.0%0Apr 2011May 2011June 2011July 2011August 2011 September2011CALLS RECEIVEDOctober2011November2011% ABANDONEDDecember January 20122011February2012March 2012
SC Healthy Connections Provider Calls(Abandonment Objective 002.0%1.5%1,0001.0%5000.5%00.0%Apr 2011May 2011June 2011July 2011August 2011 September2011CALLS RECEIVEDOctober2011November2011% ABANDONEDDecember2011January2012February2012March 2012
PROVIDERWEBPORTAL
WEB PORTAL HOME PAGE
MEMBER SERVICE HISTORY ENHANCEMENT
BROKEN APPOINTMENT TRACKING 150 unique offices using the Provider Web Portal brokenappointment log as of April 30, 2012 Reports will be shared with SCDHHS quarterly
OFFICEREFERENCEMANUAL
UPDATE TO THE DENTAL ORM Latest version released 05/01/2012 Recent Updates Include:– SCDHHS Dental Services ProviderManual as Appendix E– Availability of emergency CPT proceduresfor adults– Clarifications to policy– Broken appointment tracking reference– New design format for benefit tables Available: https://govservices.dentaquest.com/and www.scdhhs.gov
OUTREACH ANDNEW PROGRAMS
INSURE KIDS NOW OUTREACHInsure Kids Now- Federal initiative to connect kids to coverage Part of the Children’s Health Insurance ProgramRenewal Act of 2009 Mandates state Medicaid agencies to supply quarterlyprovider directories that reflect up-to-date data on officelocations and more detailed information on office hours,languages spoken, and special capabilities www.insurekidsnow.gov DentaQuest issued outreach forms to each enrolled HealthyConnections dentist in fall 2011 and winter 2012
INSURE KIDS NOW OUTREACH RESULTS 46% response rate to dateTHANK YOU! If your office has notsupplied this form back toDentaQuest, please do so assoon as possible. Additional copies availableon Provider Web Portal andfrom customer service andfrom Tycie today
SUPPORTING THE SC BIRTH OUTCOMES INITIATIVE
30Questions?
DENTAQUEST Rebekah Mathews, SC Executive Director Ellen Rattey, Market Director. Tycie Sellers, Provider Relations Representative. Doyle Williams, Senior Dental Director SC DEPARTMENT OF HEALTH & HUM
