Top 3 Appeal Categories 1. Denial of Orthodontic Services (55) 2. Denial of Partial Dentures (5) 3. Denial of Crown (4) Members submitted 42 appeals to DMAS. In those cases where a hearing was held, the Hearing Officer upheld all decisions made by Doral.
DMAS and Doral visited more than 130 provider offices located in each region. In the 4 th quarter, various specialty providers such as Orthodontists, Oral Surgeons, and Endodontists were targeted.
Application assistance activities (dropping off and picking up applications) implemented
Virginia Dental Association (VDA) Component Meetings:
DMAS and Doral attended at least one meeting held by each of the VDAs eight (8) components as well as attended the VDA Annual Conference.
Old Dominion Dental Society (ODDS) Meetings:
DMAS and Doral attended meetings held by two (2) of the ODDS components as well as attended the ODDS Annual Conference.
Provider Verification Project:
Pre-populated forms mailed to 990 provider locations to verify information regarding the provider name, practice name, office addresses(s), telephone number(s), provider specialty, panel status, office hours, and any other panel limitations as directed by the provider:
Implemented production of monthly updated provider directory. Available electronically or printed hard copy.
FAMIS Outreach Project led by the Partnership for Access to Health Care (PATH), Radford, VA: Collaborated with PATH and provided recruitment materials. Group conducted a door-to-door campaign to recruit dentists in southwestern Virginia.
Virginians for Improving Access to Dental Care (VIADC), Richmond, VA: Participated through membership on VIADC and various sub-committees. Quarterly presentation on SFC program updates was added as a standing agenda item.
Virginia Department of Health (VDH) Richmond, VA: Provided reports to VDH to assist with monitoring Dentists participating in the Loan Repayment Program. VDH assisted Doral in securing locations for Non-Participating Provider Informational Seminars.
VCU Dental School: Conducted brief presentation to 3 rd year dental students. Participated in VCU Clinic Day.
Virginia Primary Care Association, Richmond, VA: Participated in annual conference. Primary goals were provider recruitment and increasing program awareness.
Virginia Rural Health Association, Blacksburg, VA: Participated in annual conference. Primary goals were provider recruitment and increasing program awareness.
Mission of Mercy (MOM): Participated in the MOM-Eastern Shore, MOM-Northern Virginia, and MOM-Wise events. Primary goals were provider recruitment and increasing program awareness.
Doral had anticipated a summer roll-out of the EFT process, but as we delved into the process we learned two things:
EFT would truly be a benefit to providers when an electronic remittance would also be available in order for providers to appropriately apply payments. In order to be most effective, Doral decided it would be best to roll out EFT and electronic remittance at the same time.
Significant system development is required to ensure an effective, efficient, error-free transition to these electronic processes.
Doral is currently analyzing the project scope and resources. Doral will be working with a vendor on this project. At this time, a Fall 2007 release date is anticipated.