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On behalf of the Board of Directors of FCL Dental and its subsidiaries, OraQuest
Dental Plans, DINA Dental Plans, Dental Source Plans, and Dental Solutions Plus
Plans, I would like to thank all of our partners who have participated and contributed to
the success we have had in administering dental
benefits to all of our members. I can’t believe it has
been more than 30 years since I first stepped foot
into the dental benefit business, but it’s been a very
rewarding ride, especially seeing our members being
the beneficiaries of receiving high quality oral care
from the finest dentists in our network. Through
publishing a quarterly provider newsletter, we would
like to draw closer to our providers by being able to
communicate on a regular basis what’s going on in
the marketplace and share all the good things
happening at FCL Dental that may impact our providers. I certainly hope that this
provider newsletter allows us to strengthen our relationships and serve you better in a
more meaningful way. We sincerely thank you for being part of our network and look
forward to many more years of success. The future is very encouraging and the
potential for growth has never been better.
James Taylor
President and CEO
A N O T E F R O M T H E C E O :
First Continental Life and Accident
Insurance Company, Inc (FCL Dental)
and its subsidiaries provide dental benefits
to individuals, employer groups, self-
funded organizations and health plans that
administer Medicaid and Medicare
Advantage plans. In 1997, the company
opened a small office in Houston, Texas,
with a single DHMO plan. Ever since
then, the company has expanded its
footprint to six other states including:
Louisiana, Tennessee, and Missouri,
Kansas, Mississippi and Illinois. Our
proprietary network consists of over
8,000 dentist locations throughout the
Midwest and Southern regions,
including over 1,500 dental HMO
providers in Texas, Kansas, Missouri,
Mississippi, Tennessee and Louisiana.
S U M M E R 2 0 1 3
V O L U M E 1 , I S S U E 1
I N S I D E T H I S I S S U E :
A N O T E F R O M
T H E C E O
1
T H E P A S T . T H E
P R E S E N T . T H E
F U T U R E .
1
B O A R D O F
D I R E C T O R S
2
M E D I C A R E
C O V E R A G E
3
A P P E A L S &
R E S U B M I S S I O N
O F C L A I M S
3
F C L P R O V I D E R
R E L A T I O N S
4
P R O V I D E R
S E R V I C E S
5
S P E C I A L P O I N T S
O F I N T E R E S T :
Common Coding
Misconceptions
Providing Care to
Family Members
FCL Dental
Community
Involvement
Credentialing Team
Note
Website Redesign
T H E P A S T . T H E P R E S E N T . T H E F U T U R E .
Page 2
M E E T T H E E X E C U T I V E M A N A G E M E N T T E A M :
F I V E C O M M O N M I S C O N C E P T I O N S T H A T L E A D T O I N A C C U R A T E C O D I N G :
Misconception #1: D0180 is a hygienist’s exam code
Truth: D0180 is a comprehensive periodontal evaluation code used to report evaluations performed on patients who
have signs, symptoms, and/or risk factors associated with periodontal disease. The hygienist may gather much of the
information, but the dentist must do the evaluation, diagnosis, and treatment planning. D0180 is a comprehensive
evaluation with an extra focus on the patient’s periodontal status and needs.
Misconception #2: Only Periodontists can bill D0180
Truth: D0180 represents a comprehensive periodontal evaluation performed by any licensed dentist on a patient who
has signs, symptoms, and/or risk factors for periodontal disease.
Misconception #3: D0150 can be billed every three years
Truth: D0150 may be reported for a comprehensive evaluation of an established patient in limited circumstances. Gen-
erally, this requires a significant change in health status or absence from active treatment for three or more years.
Some dental plans only reimburse D0150 once per provider but will pay an alternate benefit of D0120. Other plans will
reimburse D0150 once every three or five years. Even so, the code stipulates that D0150 can only be reported for estab-
lished patients if they have a significant change in health status or have been absent from active treatment for three or
Left to right:
Steven Griffin,
Paul Kwauk,
James Taylor,
Robert Thomas
and
William Eubank
Page 3
Appeals vs. Resubmission of Claims If you receive a denial of a claim, it is important that you understand
the correct form of action to take. Depending upon the reason for the
claim denial, you will either submit a corrected claim to FCL, or
submit an appeal.
Submitting a Corrected Claim
Your office may identify that a claim has been denied in error. If a
claim is denied due to a lack of supporting documents or incorrect
information, the correct course of action is to resubmit the corrected
claim. FCL will request specific documentation needed in order to
review the claim. Submit your corrected claim to the Claims
department using these steps:
Resubmit the claim on a new ADA claim form
Include the phrase “corrected claim” clearly in the remarks
section of the form and claim identification number
Include all information on the new claim that was identified as
missing or incorrect from the original claim.
If applicable, attach all requested documentation, ensuring the
items are of diagnostic quality
After reviewing the resubmitted information, FCL may still maintain
the denial of the claim. If you believe at that point the claim has been
denied in error, the appropriate course of action is to submit an appeal
to the Grievances and Appeals (G&A) department.
Submitting a Provider Appeal
If for any reason you feel your claim has been denied incorrectly, you
may submit an appeal within 120 calendar days of the date of the
explanation of benefits. You may appeal denials that were issued due
to: untimely filing, no authorization, non-covered benefits, or medical
necessity.
You can use the appeal form located in your Provider Manual. In lieu
of the appeal form, a letter may be submitted on your official
letterhead that contains: the member’s name, a statement that the
request is for an appeal, and sufficient information to reasonably
identify the claim or claims being appealed. This information should
include: date of service, provider name, procedure, and claim number.
Ensure the letter also contains your signature.
Submit appeals to the Grievances and Appeals department by fax
at 1-877-493-6282.
FCL Dental
Attn: Provider Claims Appeals
101 Parklane Boulevard, Suite 301
Sugar Land, TX 77478
Appealing a Denial Due to Untimely Filing
A claim can be denied due to untimely filing if an office submits it to
FCL after 95 calendar days from the date of service. If a claim is
denied for this reason, but your office submitted it within the
appropriate time frame, you may appeal the denial. Your written
appeal must be accompanied by sufficient proof of the timely filing of
the claim. FCL will accept either confirmation of delivery by mail or
submission confirmation through an electronic clearinghouse. Without
this proof of the original date of submission for your claim, the denial
Payment for items and services furnished
by the beneficiary’s immediate relatives
and members of the beneficiary’s
household will not be made as these
items and services are ordinarily
furnished gratuitously because of the
relationship between the beneficiary and
the provider or supplier.
A beneficiary’s immediate relatives
include the following degree of
relationship:
Husband and wife
Natural or adoptive parent, child, and
sibling;
Stepparent, stepchild, stepbrother,
and stepsister;
Father-in-law, mother-in-law, son-in-
law, daughter-in-law, brother-in-law,
and sister-in-law;
Grandparent and grandchild; and
Spouse of grandparent or grandchild
If the marriage upon which a step-or in-
law relationship is terminated through
divorce or death, the excluded
relationship continues to exist.
Members of the beneficiary household
include the following who share a
common abode with him or her as part of
a single family unit:
Individuals who are related by blood,
marriage, or adoption, domestic
employees; and
Other individuals who live together
as part of a single family unit (does
not include roomers or boarders)
C M S R U L E O N T R E A T I N G
I M M E D I A T E R E L A T I V E S :
F C L D E N T A L I M P O R T A N T
2 0 1 3 D A T E S & H O L I D A Y C L O S I N G S :
May 27 Memorial Day
July 4 Independence Day
September 2 Labor Day
November 28-29 Thanksgiving
December 25 Christmas
Greetings from the Provider Relations staff at FCL Dental:
We are here to assist you with your network administrative questions or requests for information. The easiest
way to contact us is to send us an email. Or call us at 1-877-493-6282, and ask to speak to the representative for
your state. Our goal is to establish and maintain a long and mutually beneficial relationship with you.
We will provide you with accurate and timely information to ensure your success as a participating dentist for
your designated market. We do our best to support you in every way possible.
Do you need a copy of your current fee schedule? Do you know whether all of the dentists in your office
participate in our network? Do you have any suggestions or comments for us? If so, send our Provider Relations
Department an email. You may also contact your Provider Relations Representative directly by telephone from
the hours of 8:00am to 5:00 pm Central Standard Time. Find your state above to find the representative
responsible for your territory.
101 Parklane Blvd., Suite 301
Phone: 877-493-6282
Fax: 281-313-7155
website: www.fcldental.com
F C L D E N T A L FCL DENTAL
PROVIDER RELATIONS TEAM
Top Left:
Millie Thibodeaux,
Aaron Bradley
and
Flor Gutierrez
Bottom Left:
Sammie Barrett
and
Donna Vogler
Page 4
Aaron Bradley
Provider Relations Representative
Texas & Louisiana
281-276-1044
Flor Gutierrez
Provider Relations Representative
Texas
281-276-1025
Dental Solutions PLUS
Donna G. Vogler
Director of Provider Relations and
Network Development
281-276-1061
Millie Thibodeaux
Provider Relations Representative
Texas, Tennessee, Kansas, & Missouri
281-276-1012
Sammie Barrett
Provider Relations Representative
Texas
281-276-1000
In our continued commitment to serve
our community we at FCL are proud to
have made a donation of a specialized
drug/explosive sniffing K-9 to the Fort
Bend County Sheriff Department. In
June, CEO James Taylor presented a
check to Fort Bend County Sheriff Troy
E. Nehls, to purchase this special K-9 to aid in the war against
drugs being transported and sold in the county. The dog is also
able to detect explosives an important means used to fight the war
on terror, keeping our first responders with the tools they need to
keep the community safe. We at FCL are always looking for ways
to serve our members, partners and our community.
Page 5
V O L U M E 1 , I S S U E 1
Our online services are available to address any questions you may have or to request
information.
FCL is proud to provide you with our provider website portal FCL. Our website helps you
efficiently complete many functions with ease. We encourage you to explore our website and
learn how it can benefit your practice.
After successful registration, your provider portal account will be active and ready for use.
Some of the functionalities available to you through our website include but are not limited
to:
Verify Eligibility
Login and Registration Support
FCL Dental PDP Dental Plans Inquiries
FCL Dental/MNM 1997 dba OraQuest Dental Plans Inquiries
FCL Dental/DINA Dental Plans Inquiries
FCL Dental/Dental Source of KS, MO Inquiries
Provider Application
Provider Agreement
Provider Manuals
Provider Fee Schedules
Credentialing
Team Note
With over 24 years of
credentialing experience,
and active memberships in
both NAMSS and GHMSS
Associations, our
credentialing staff remains
very involved in the
Credentialing community
to ensure FCL keeps up-to
-date on regulatory
requirements set forth by:
NCQA, URAC, TDI and
CMS. Our knowledgeable
experienced credentialing
staff has focused their
expertise in developing a
credentialing program that
strives for excellence in
the credentialing
application process. The
department ensures the
practitioners approved for
participation in our
organization are qualified
to provide dental care to
our members. This is the
only way to make sure
there are no limitations
imposed on the
practitioners and that he or
she received and
completed all the requisite
education and training.
F C L S P O N S O R S F O R T B E N D
C O U N T Y ’ S S H E R I F F K - 9 :
F C L D E N T A L O N L I N E S E R V I C E S
T Y L E R M I L L I K E N F O U N D A T I O N :
FCL Dental is a Gold
Sponsor of the Tyler
Milliken Second Annual
Golf Tournament. Tyler
was a high school student
at Foster High School and
was killed in a tragic
vehicle accident in
February 2011. With the
support of friends and
family, his foundation was
established in May 2011.
The mission of the
foundation is to promote
teen safety and to deliver
an eternal inspirational
message. All proceeds from
the tournament go directly
to the foundation, which to
date has granted in excess
of $20,000.00 in youth
scholarships and grants to
educational and “faith
based” organizations. You
can read more information
on their website at
www.tylermillikenfounation.org
.
