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Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
Presentation to: Dental Advisory Committee
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Presentation to: Dental Advisory Committee

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Transcript

  • 1. Presentation to: Dental Advisory Committee April 14, 2006 A New Day For Oral Health In Virginia
  • 2. Dental Network Overview
  • 3. 159 Additional Dentists Have Signed Up
  • 4. Total Individual Providers By Specialty
    • General Dentists – 582
    • Pediatric Dentists – 77
    • Orthodontists – 50
    • Periodontists - 6
    • Oral Surgeons – 50
    • Endodontists – 9
    • Prosthodontists – 3
    • Dental Anesthesiologists - 2
  • 5. Enrolled v. Actively Billing Providers
    • Based on claims paid, the percentage of network providers actively participating in Smiles For Children has increased from 58% to 78%.
  • 6. Provider Recruitment
  • 7. Recruitment Activities Implemented
    • Application Assistance Activities:
      • Doral and DMAS are assisting providers with the application process by dropping off and picking up applications
    • Attendance/Presentation at VDA Component Meetings:
      • Southwest Dental Society – March 10, 2006
    • Attendance/Presentation at ODDS Component Meeting:
      • Peter B. Ramsey Dental Society (Richmond Area) - February 21, 2005
    • VCU School of Dentistry Clinic Day – April 5, 2006
      • Interacted with approximately 100 visitors
      • 4 recruitment packets distributed; Commitment received from 1 provider
    • Follow-up with E-Medicaid Providers:
      • Follow up currently underway with providers that participated in the E-Medicaid program but are not participating in SFC
    • Provider Meetings and Office Visits:
      • Doral and DMAS are continuing to conduct recruitment visits to provider offices:
        • January – 27
        • February – 14
        • March - 21
  • 8. SW VA Recruitment Activities
    • Added 6 new providers between January 1 and March 31, 2006:
      • 4 General Dentists
      • 2 Endodontists
    • PATH members, led by Rhonda Seltz, visited 14 providers in the area to distribute materials about Smiles for Children as well as contracts and applications .
    • Conducted a presentation at the Southwest Dental Society on March 10, 2006. There were 63 providers in attendance. Commitment received from one provider.
    • Received a list of attendees from the Southwest Dental Society Meeting. Follow up with providers in attendance at the meeting currently underway
    • Identified 2 potential orthodontists in the area. Efforts to recruit these orthodontists have been initiated.
    • FORBA (Small Smiles) will be opening a new clinic in Roanoke in June 2006.
  • 9. Provider Education & Training
  • 10. Training Objectives Accomplished
    • Presented updates regarding progress towards program goals and the latest changes to the program
    • Clarified and addressed issues related to eligibility
    • Provided clarification regarding the prior authorization process for hospital cases
    • Outlined the process for requesting authorization for orthodontic treatment
    • Reviewed claims processes and procedures and provided helpful hints for timely reimbursement
    • Discussed issues related to enrollee access and introduced new enrollee outreach activities
    • Provided a brief overview of provider resources
    • Encouraged greater utilization of the Doral provider website
  • 11. Attendance & Survey Results Excellent – 66.6% Good – 32.7 Fair – .7% 188 Overall Excellent – 74% Good – 26% 29 Chesapeake Excellent – 80% Good – 20% 16 Newport News Excellent – 68% Good – 32% 29 Richmond Excellent – 50% Good – 50% 33 Fairfax Excellent – 50% Good – 46% Fair – 4% 25 Charlottesville Excellent – 83% Good – 17% 15 Danville Excellent – 68% Good – 32% 20 Blacksburg Excellent – 79% Good – 21% 21 Bristol Overall Effectiveness of Training Number of Attendees Location
  • 12. Upcoming Recruitment Activities
    • Continued provider office visits and application assistance
    • Development of provider to enrollee ratios and needs assessment to determine adequacy of network and areas requiring more focused recruitment
    • Attendance/Presentation at VDA and Old Dominion Dental Society Component Meetings
    • Non-Participating Provider Informational Sessions:
      • Conduct at least one Informational Meeting per region: Northern, Northwest, Southwest, Eastern, Central
  • 13. Claims
  • 14. Time Frame for Claims Adjudication Average Number of Claims Processed Per Month: 28,292 Average Turnaround Time (July 2005 – February 2006) – 19.70 Days
  • 15. Prior Authorization Activity
  • 16. Summary of Prior Authorization Activity
  • 17. Prior Authorization – Orthodontic Denials First Level Review Criteria Implemented
  • 18. Call Center
  • 19. Member Calls
  • 20. Provider Calls
  • 21. Grievances and Appeals
  • 22. Grievances & Appeals
  • 23. Appointment Standards
  • 24. Appointment Standards
    • Standards:
    • Emergency: 95% of offices will see member within 24 hours
    • Urgent: 95% of offices will see member within 48 hours
    • Routine: 95% of offices will see member within 6 weeks
  • 25. Enrollee Outreach
  • 26. Broken Appointments
    • Broken appointments are:
      • A major concern for DMAS, VDA, ODDS, and Doral
      • Recognized as expensive for dentists
      • Lead to dentists unwillingness to participate in the program
    • Information is needed to better track, trend, and understand the issue
    • Doral will use the information to:
      • Educate families regarding the importance of appointments and compliance with treatment plans
    • Dentists can assist by completing the Broken Appointments Log and faxing to Doral’s Outreach Coordinator
    • Medicaid Transportation is available for dental appointments (contracted through the health plans)
  • 27. Appointment Reminder
    • Mailed to enrollees who have not accessed care
    • Postcard mailing campaign
      • Richmond – May 2006
      • Norfolk – May 2006
      • Alexandria – June 2006
      • Roanoke – June 2006
  • 28. Coming Soon! Beginning Summer 2006, Doral will enhance its on-line services!
  • 29. Electronic Funds Transfer (EFT)
    • EFT permits the direct electronic deposit of Smiles For Children claim reimbursements into a bank account designated by the provider whether claims are filed electronically or on paper
    • Advantages of EFT include:
      • No lost checks or Post Office delay.
      • Savings of administrative and overhead costs.
      • No standing in line at the bank.
      • Faster access to funds; many banks credit direct deposits faster than paper checks
      • Easier reconciliation of payments with bank statements
  • 30. Provider Web-Site Enhancements
    • Ability for providers to view status of claims and prior authorizations
    • Provider information component, including:
      • On-line newsletter
      • Program Information
    Enhanced services will include:
  • 31. Thank You!

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