Presentation to: Dental Advisory Committee


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Presentation to: Dental Advisory Committee

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