firstIMPRESSIONSIn ThIs Issue

Direct Deposit ......................... 2

Processing Policy .................... 2

Clarification Corner ................ 2

Accurate Office ........................ 3

Gone To The Dogs .................. 3

Type 2 NPIs ............................. 3

2006 Achievements ............... 3

DDAZ Foundation .................. 3

Distinguishing Delta Plans ....4

New Groups.............................4

Data You Can Use ...................4

Direct Phone Numbers ...........4

Contact Us ...............................4

Delta Dental of Arizona (DDAZ) Provider NewsletterSummer 2007

As the deadline of May 23rd for using NPIs on electronic transactions draws nearer, there is still much confusion about the different types of identifiers and which are required to ensure compliance with NPI regulations.

There are two basic types of NPIs available; individual, and organizational. Individual NPIs, also known as Type 1 NPIs, are for health care providers, such as dentists. Organizational, or Type 2 NPIs are for use by incorporated businesses, such group practices and clinics. Organizational NPIs can also be assigned to subparts. Subpart NPIs are given to components of organizations, such as owned laboratories. Subparts are not as common in dentistry as they are in other areas of health care such as hospitals, but are worth noting.

Which NPI is right for you? It depends on how you bill for services. If you submit claims or claims attachments electronically, or if you use the Internet to verify eligibility or check on the status of claims, you are required by federal law to obtain an NPI. Even if you do not do any business electronically, you should get an NPI and share it with the specialists to whom you refer patients to make it easier for them to bill for services.

All dentists involved in electronic transactions should apply for an individual NPI. If you submit claims as an individual and receive payments in either your name or under your social security number (or other identifier unique to you as an

individual), the individual NPI is the only number you’ll need.

Organizational NPIs are needed for corporations and other business entities that want payments made to their business or corporate names or under their tax identification numbers (TIN). On a claim, the organizational NPI identifies the payee, and will usually be submitted in conjunction with an individual NPI to identify the dentist who rendered treatment.

For example, you and your partners own Valley Dental with five dentists on staff. Your office submits claims as Valley Dental, Inc. To continue submitting claims and receiving payments from carriers under your corporate name, you’ll need to apply for an organizational NPI. All five of the treating (rendering) dentists in your practice group should also apply for individual NPIs. Once everyone has their numbers, they should be used consistently on electronic claims to ensure efficient, accurate payment and HIPAA compliance.

Once you have received your NPI number(s), please fax a copy to:

Delta Dental Professional Relations (602)-588-3910

or mail a copy to: P O Box 43000

Phoenix, AZ 85080-3000Please call the Provider Relations Team if you have any further questions. Please note that you do not need to submit your NPI numbers on you claim forms prior to May 23, 2007.

two, one or none: How Many nPis Do You need?

2007 CalendarPlease note our office will be closed:Monday, May 28Wednesday, July 4Monday, September 3

First Impressions Delta Dental of Arizona Provider Newsletter Page 2

Want To Get Your Claims Paid Faster? Sign Up For Direct Deposit

Increase staff productivityReduce the risk of theft or fraudPredictable cash flowMore manageable explanations of payment

Whether you file claims electronically or on paper, Delta Dental of Arizona (DDAZ) can automatically deposit claim payments directly into your bank account each week. You can choose to be notified of your deposit by e-mail or fax. Fax notification will include a faxed copy of your Explanation of Payments (EOP). E-mail notification will include a link to the DDAZ web site where your EOP will be available on the Dentist Connection. All offices with direct Deposit can view their EOP’s on the DDAZ web site’s Dentist Connection. EOP’s on the web site can be sorted by subscriber name, by subscriber number, by dentist and subscriber name, or dentist and subscriber number.

All offices that sign up for Direct Deposit by July 1, 2007 will be entered into a drawing for a FREE in-office pizza party, hosted by Delta Dental of Arizona! HURRY and sign up today!

Call DDAZ Professional Relations today at 602-938-3131 or 800-352-

6132 option #5, or visit www.deltadentalaz.com to sign up for DIRECT DEPOSIT and a chance for a FREE Pizza Lunch!

Clarification CornerWhat to do when claim is denied due to missing or incorrect information? Do not send in a new claim with this information, it will only further delay the process. You may call Delta Dental of Arizona and give us the missing tooth number or quadrants. (Some corrections to patient’s history may require a copy of the patient’s treatment notes.) If x-rays or student status is required you can attach this information to the copy of your Explanation of Payment (EOP) and send it to us.

How should you post adjustment or write-offs when the patient has dual insurance? The primary adjustments should not be posted until the secondary carrier’s adjustment information is available, otherwise the member’s account could result in a credit balance. In the example below, payments total $1425 total write-offs would be $242 to equal total submitted charges of $1667.

Office submitted

Metlife approved

Write-off to Metlife

Met Payment

1667 1200 467 960

Office submitted

Delta approved

Write-off to Delta

Delta Payment

1667 1425 242 465

••••

Implant Benefit ClarificationAn implant procedure has three parts: the implant body, the post (called an abutment), and the false tooth or crown. The implant body replaces a natural tooth root. The implant itself is a small device that serves as a base for the replacement tooth. The false tooth or crown is attached to the implant using a post. The post is adjusted to put the crown in a natural position.

Implant BodyA. The implant body is a benefit when all of the following

benefit rules are met:1. For ages 16 or older,2. For a single missing tooth with teeth both sides – not

for spaces between teeth where a tooth is not missing3. The teeth on each side must not:a. Need restoration a crown, inlay or onlay;b. Have an untreated abscess, c. Have significant bone loss or d. Periodontal pockets of 5mm or greater.

B. The implant body is covered at “major” with the same coinsurance as the group contract.

C. The implant body benefit is limited to $1,000 per tooth per life time and applies to the plan year maximum.

The Post or AbutmentA. If the implant body meets benefit rules, the post noted

above is also a benefit.

B. If the implant body does NOT meet benefit rules, the post noted above is NOT a benefit.

C. The post is covered at “major” with the same coinsurance as the group contract.

The False Tooth or CrownIf the group contract provides for “major” services, the crown is a benefit.

Claims Processing Policy Changes Approved by DDAZ Board of DirectorsProcessing policy changes requested by member dentists and approved for implementation by the Dental Policy Committee and the Board of Directors – i.e., a benefit will be given on the same date of service for the D4910 as the D0120, D0140, D0150, D0160, D0170, and D0180 subject to contract frequency limitations.

First Impressions Delta Dental of Arizona Provider Newsletter Page 3

Gone To The DogsDog lovers, are your sweet dreams interrupted by the intrusion of a hot, foul wind? You waken to realize it’s dog breath, because your adoring pooch is panting only inches away from your face. Good news, a cure for the major cause of canine halitosis may be

available.

The veterinary pharmaceutical division of Pfizer has recently promoted a new vaccine that may reduce the occurrence of periodontitis in dogs. According to the literature, 85% of dogs over 3 years of age have some degree of periodontal disease. If left untreated periodontal disease manifests much the same in dogs as in humans: gingivitis, inflammation, bad breath, infection, and tooth loss.

Accurate office: Dentist records Vital for Claims Processing

Dentist information submitted on a claim form MUST match the information you have provided us on your Premier Participating Provider Agreement or your claims will be denied.

1. Check the provider license number. Be sure the license number matches the name of the treating dentist.

2. Check the provider location. Be sure it includes the physical location of where the treatment was provided and not a PO Box. The provider location does not affect the address the check will be mailed. If you have moved, please let us know by calling 866.746.1834 option

3. Check the Tax Identification Number (TIN). It must match the one on file with Delta Dental of Arizona. You can view your TIN by logging onto the Dentist Connection and using the edit profile option (left side of page on toolbar). If you need to change the TIN we have on file, send a copy of the IRS confirmation to Professional Relations.

If your office or location has changed or will be changing any of the following information, please let us know immediately:

• Adding or deleting a dentist• Using a new tax identification number (TIN)• Moving or adding a new location

If any information on your Explanation of Payment (EOP) is incorrect, please contact our Provider Relations Department @ (602) 938-3131 or (800) 352-6132 then choose “5”.

Confused By Type 2 NPIs?Why is the government call center for NPPES (National Plan and Provider Enumeration System) is sometimes providing incorrect information to dental offices? Because of inconsistent definitions of “sole practitioner”. Dentists take that to mean it is a one dentist office. In the world of NPPES, Sole Practitioner is the dentist that is not incorporated, or other such legal arrangement.

Single doctor filing his business federal income taxes under his personal SSN requires a Type 1 and is not eligible for a Type 2 (ineligibility is noted in the federal register)

Single doctor filing his business federal income taxes under a TIN other than his personal SSN requires a Type 1 for himself and at least one Type 2 for the business (confirmed with NPPES).

Group practice filing the business federal income taxes under a TIN, other than anyone’s SSN, requires a unique Type 1 for each dentist and at least one Type 2 for the business (this example is specifically noted in the federal register).

To find out more information about NPI compliance, visit the American Dental Association website at: http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=2451

2006 DDAZ Achievements

Delta Dental strives to provide the best service and value in the dental benefits industry for our subscribers, employers, and treating dentists. Our dedicated, hard-working staff has made the following achievements in 2006:

Dollars paid out for dental treatment: $102 million

Number of claims processed: 634,200

Total Delta Dental of AZ primary subscribers: 174,805 Total Delta Dental subscribers living in Arizona regardless of Plan affiliation: 545,000

Foundation AchievementsLast year, Delta Dental of Arizona Foundation gave 1,800 children a reason to smile! Through the Delta Dental Sealant Program™, school-age children are receiving dental screenings, referrals and sealants to protect and preserve their healthy teeth.

Working with school principals, nurses and teachers, the Program helps children with no type of dental insurance. Also, teaching proper brushing techniques and giving children all the tools they need is critical to fighting tooth decay. To learn more or to make a contribution, please visit www.deltadentalaz.com/foundation.

First Impressions Delta Dental of Arizona Provider Newsletter Page 4

Once again Delta Dental of Arizona is the Number 1 dental benefit plan in Arizona, according to the 2007 Business Journal’s Book of Lists, Ranking Arizona and Arizona Women Who’s Who in Business.

How to determine which Delta plan your patients have and how to distinguish the difference between Delta Dental of Arizona

(DDAZ) and other Delta Dental Member Companies (DDMC)

• DeltaPremier - This is Delta Dental’s original fee-for-service program whereby dentists sign a contract to participate and agree to accept payment based on Delta Dental’s maximum reimbursable amount fee concept. Eligibility is received from DDAZ and claims payments are processed by DDAZ. This is the only product DDAZ offers to Arizona based companies. Patients from other DDMC’s may also have this plan but eligibility and claims payments come from the corresponding DDMC.

• Delta Dental PPO - This is a discounted flat fee program whereby dentists sign a contract to participate and agree to accept the amount of the PPO Fee schedule. Dentists must be a DeltaPremier provider to participate and contracting

is provided through DDAZ. The PPO product is not sold or administered by DDAZ but there are DDMC subscribers in AZ with this product. Eligibility is obtained from the other DDMC, the state where the corporation’s headquarters is located - available from your patient, and all claims are processed by the same DDMC as validated eligibility.

DeltaCare - This is Delta Dental’s HMO-type program whereby dentists sign a contract to participate and agree to accept the patient one or more of the following reimbursement methodologies: capitation, co-payments, or co-payment amounts in addition to a supplemental payment. This program is administered by PMI Dental Health Plan, a subsidiary of Delta Dental of California.

DDAZ Welcomes Our New Groups Data You Can Use:• Children who receive dental sealants are 78% less likely to get subsequent restoration.• Children who receive dental sealants and about one fluoride treatment per year are 87% less likely to get subsequent restorations.• Children who receive dental sealants and about two fluoride treatments per year are 93% less likely to get subsequent restorations.

Dentist Direct Phone numbers:A). Toll free - 866-746-1834B). Local 602-588-3982C). Options: Press 1 - Faxback of eligibly and benefit information Press 2 - Automated claim information Press 5 - DDS contract questions/Professional Relations Press 6 - To verify claims status, benefits and eligibility information/Customer Service

Contact Us:15648 N. 35th Avenue, Suite 111Phoenix, AZ 85053www.deltadentalaz.com

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