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1Vol 6, Issue 2 • Summer 2009 BLUEImpressions
News for Participating Dental Providers Summer 2009 • Vol. 6, Issue 2
BLUEImpressions
INSIDE thIS ISSuE
Claims and Billing 2
Billing for Multiple-Visit Dental Procedures 2
Participating Dental Provider Contract Guidelines Regarding Billing Members 2
System upgrade and Interest Payment Changes 3
Member Benefits Exclude Care Rendered by a Relative 3
Medical and Dental May Be on Separate Membership Cards 4
In Office training and Assistance 4 Always Available
What’s Happening 5-7
Voice Response unit (VRu) and CareFirst Direct 5
Dental Advisory Committee 5
Friendship Dental Laboratories, Inc. and CareFirst Expand Discount Program 6
E-mail Registration 7
Chesapeake Dental Conference 7
CareFirst and CareFirst BlueChoice holiday Closings 7
Note: All references to “CareFirst” in this publication refer to CareFirst BlueCross BlueShield. All references to “CareFirst BlueChoice” refer to CareFirst BlueChoice, Inc.
Dental offices may now electronically transmit radiographs and/or other
supporting documentation to CareFirst through National Electronic
Attachment (NEA).
If your office uses this service, please remember to place the NEA
Reference Number in the “Remarks” field on the claim form prior to
submission. This will enable CareFirst to match the claim with the
document number in NEA. Providers should only send documents as
noted on the Reference Guide for Required Attachments through NEA.
Please do not send claims or primary carrier EOBs through NEA, as
they will not be processed. For a complete list of required attachments,
visit www.carefirst.com > Providers & Physicians > News & Updates >
Provider Manuals > CareFirst Dental Manual.
For additional information or to register with NEA, please call NEA
at 800-782-5150 and select Option #2 or contact your Provider
Service area.
National Electronic Attachment (NEA) for Electronic Submission of Dental Attachments
2 BLUEImpressions Summer 2009 • Vol 6, Issue 2
Claims and Billing
CareFirst provides the benefits available under the member’s contract only upon completion of treatment. therefore, dental procedures that require multiple visits, such as crowns, root canal therapy, etc., should be billed only at the completion of service. For crown restorations, the completion date is the cementation date.
Should you have any questions regarding this, please contact the appropriate Dental Provider Services area for assistance.
Billing for Multiple-Visit Dental Procedures
Dental providers who participate in CareFirst provider networks have contractually agreed to accept the CareFirst allowed benefit as payment in full. Dental providers may bill the member for any co-insurance and/or deductible that apply to the services performed, but not for any difference between the allowed benefit paid by CareFirst and the dental provider’s customary fee. Dentists may bill their full fee for procedures that are specifically excluded from the member’s contract.
Providers are reminded that collecting for services in advance with the intent to refund the member after reimbursement is received violates the provider contract.
Participating Dental Provider Contract Guidelines Regarding Billing Members
3Vol 6, Issue 2 • Summer 2009 BLUEImpressions
Claims and Billing
CareFirst does not provide benefits for services performed by a health care practitioner who is related to the member (e.g., the member’s parent, spouse, child, grandparent, or sibling). This provision applies to all contracts for all lines of business and products. For further information or specific contract exclusions, the member may reference their employee Benefit Guide or may contact the employer’s Benefit Administrator.
Member Benefits Exclude Care Rendered by a Relative
On May 1, 2009, CareFirst began migrating
employer groups from one version of our
processing system to a new, updated version.
Groups will migrate to the new version as they
renew throughout the year.
As a result of this migration, you will notice a
slight change in how interest is paid for claims
processed outside of the state-mandated
window.
Interest will now be included on the voucher
when applicable. You will notice a new line
added beneath the individual claim lines
should interest be required.
Claims processed for employer groups that
have not yet migrated to the new system will
continue to pay interest on a separate check
until the group renews.
System Upgrade and Interest Payment Changes
4 BLUEImpressions Summer 2009 • Vol 6, Issue 2
Claims and Billing
It is common for members to have a dental membership card that is separate from their medical membership card. These cards can have different contact phone numbers, claim submission instructions and even Membership Identification numbers.
If you do not see dental information listed on a member’s card, this could mean they have a separate dental membership card. To ensure that your inquiries and claims are directed to the proper area, please request to see your patient’s membership card at every visit to verify where claims are to be submitted and which area you should call for customer service.
Medical and Dental May Be on Separate Membership Cards
Please remember that in-office training presented by your dedicated Dental Provider Relations Specialist is always available. Specialists are also available to meet with dentists and their staffs to discuss issues or concerns regarding the traditional, preferred provider or DHMO dental plans.
If you would like to schedule an appointment, please refer to the list below to contact the Specialist assigned to your area.
In Office Training and Assistance Always Available
Dental Provider Relations Specialist
Contact Information Specific Area
Kate [email protected]
Phone: 410-605-2669Fax: 410-505-6956
MarylandN.E. Baltimore County*, E. Baltimore City*, Carroll, Prince Georges and Frederick Counties*Baltimore County/City Zip Codes:21013, 21094, 21030, 21131, 21034, 21204, 21057, 21234, 21082, 21284, 21093, 21286, 21202, 21205, 21206, 21212, 21213, 21214, 21218, 21224, 21226, 21230, 21231, 21239VirginiaFairfax and Loudon Counties
Phone: 410-605-2694Fax: 410-505-6905
MarylandAllegany, Calvert, Charles, Garrett, Montgomery, St. Mary’s, and Washington Counties, N.W. Baltimore County*, S.E. Baltimore County**Baltimore County/City Zip Codes:21022, 21120, 21031, 21133, 21048, 21136, 21053, 21152, 21051, 21153, 21071, 21155, 21074, 21161, 21105, 21163, 21111, 21208, 21117, 21209, 21021, 21027, 21052, 21085, 21087, 21128, 21156, 21162, 21219, 21220, 21221, 21222, 21236, 21237
Mindy [email protected]
Phone: 410-605-2667Fax: 410-505-2566
MarylandAnne Arundel, S.W. Baltimore County*, W. Baltimore City*, Caroline, Cecil, Dorchester, Harford, Howard, Kent, Queen Anne’s Somerset, Talbot, Wicomico, and Worcester Counties
5Vol 6, Issue 2 • Summer 2009 BLUEImpressions
Claims and BillingWhat’s Happening
Need to reduce the administrative time spent waiting to speak with a CareFirst representative to check the status of a claim or benefits and eligibility? If so, CareFirst has two remedies:
Voice Response UnitCareFirst uses state of the art technology in its Voice Response Units with real time information allowing providers to obtain the following:
Claim status, which provides:n Allowed and paid amountsn Date of payment along with check information and
claim numbern Any member liabilityn Denial reason with the narrative
Patient eligibility and benefits provides:n The effective date of coverage and any termination
datesn Type of coverage including group numbern Limitationsn Deductible n Timely filing periods
CareFirst Direct
CareFirst Direct is an on-line tool that allows providers to obtain the following:n Claim statusn Patient eligibility and benefits, including limitations and coinsurance information
To get started or learn more about CareFirst Direct, visit www.carefirst.com > Providers & Physicians > Electronic Services > CareFirst Direct.
Voice Response Unit (VRU) and CareFirst Direct: Your Answer to Reduce administrative Cost and Increase Productivity
Dental Advisory CommitteeAs announced in the Winter 2008 issue of Blue Impressions, CareFirst Dental Director Dr. Robert Laurenzano is establishing a Dental Advisory Committee and seeks general practitioners and other dental specialists who may wish to participate.
The committee’s objectives are to discuss issues related to dental plans, clinical guidelines, new technologies, etc. Interested dental providers may submit a statement of interest and experience or resume via e-mail to [email protected].
6 BLUEImpressions Summer 2009 • Vol 6, Issue 2
What’s Happening
CareFirst and CareFirst BlueChoice are pleased to announce the extension of the dental laboratory discount agreement with Friendship Dental Laboratories, Inc., to offer a special discount on more lab services, effective immediately.
Friendship Dental Laboratories, Inc., is a full service, state-of-the-art dental laboratory in Baltimore and has served the Mid-Atlantic region since 1973. Friendship Dental Lab specializes in the fabrication of crowns, bridges, implant restorations, partial and complete dentures, and is dedicated to customer satisfaction via personalized customer service.
This CareFirst exclusive agreement will offer a discount on the following services (the negotiated prices indicated represent a 20 to 30 percent discount on laboratory services):
Crowns – All inclusive fee includes models, dies, metal alloy and porcelain.n Non-Precious PFM Crown $79.00n Noble Alloy PFM Crown $99.00n High-Noble White Gold PFM Crown $139.00n E.max Lithium Disilicate (All-Ceramic) Crown $139.00
Bridges – All inclusive fee includes models, dies, metal alloy, connectors and porcelain.n Non-Precious PFM Bridge $83.00n Noble Alloy PFM Bridge $103.00n High-Noble White Gold PFM Bridge $143.00
Removable Prosthodontics – All inclusive fee includes custom trays, models, bite blocks, articulation, teeth, set-up and finish.
Denturesn Complete Full Denture $205.00n Complete Premium Full Denture* $305.00*Premium denture price includes your choice of premium denture teeth (Vita, Bioform IPN, or Portrait IPN).
Partialsn Complete Cast Partial $230.00n Complete Premium Cast Partial* $390.00*Premium partial price includes your choice of premium denture teeth (Vita, Bioform IPN, or Portrait IPN).
CareFirst, CareFirst BlueChoice and Friendship Dental Laboratories, Inc., invite you to take advantage of these special discounts available to you as a CareFirst provider. As mentioned, the discount arrangement is exclusive to CareFirst, therefore, it will only apply to CareFirst, CareFirst BlueChoice and The Dental Network (TDN) members.
To receive your discount, simply attach a copy of the member’s CareFirst, CareFirst BlueChoice or TDN membership card to the prescription prior to submitting the request to Friendship Dental Laboratories, Inc.
To learn more about Friendship Dental Laboratories, Inc., call 410-780-7700 or visit their Web site at www.friendshipdentallab.com. For questions or concerns, please contact your Provider Service area.
Friendship Dental Laboratories, Inc. and CareFirst Expand Discount Program
What’s Happening
7Vol 6, Issue 2 • Summer 2009 BLUEImpressions
Claims and BillingWhat’s Happening
Providers interested in receiving CareFirst updates via
e-mail are encouraged to register their e-mail address
with CareFirst. the information you provide will be used
only for maintaining an e-mail list and never be used for
solicitation, nor will the list be sold or rented to others.
to register, please visit www.carefirst.com > Providers
& Physicians > News & updates and click on Receive
News via E-mail.
E-mail Registration
The CareFirst and CareFirst
BlueChoice offices will be closed on
the following date:
CareFirst and CareFirst BlueChoice Holiday Closings
Friday, July 3, 2009 —
Independence Day
Make plans to attend the 2009 Chesapeake Dental Conference to hear an assortment of internationally recognized lecturers. The conference will run from September 25 through September 27 at the Ocean City Convention Center.
While there, be sure to stop by the CareFirst and CareFirst BlueChoice booth (# 210) to meet your Dental Provider Relations Specialists.
Registration information is available on the Maryland State Dental Association Web site at www.msda.com.
We look forward to seeing you there!
Chesapeake Dental Conference
8 BLUEImpressions Summer 2009 • Vol 6, Issue 2
10455 Mill Run Circle Mailstop CT06-24Owings Mills, Maryland 21117
DENTAL DIRECTOR EDITOR Robert Laurenzano, D.M.D Robert Hilson [email protected]
Blue Impressions is published quarterly by CareFirst BlueCross BlueShield’s Corporate Communications Department.
CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are independent licensees of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc.
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