Quality health plans & benefitsHealthier livingFinancial well-beingIntelligent solutions

Fall 2014

Highlighting news, programs, policies and tips for our participating dentists

Inside this issue

IMPROVING HEALTH OUTCOMES 1

ELECTRONIC SOLUTIONS 2

CLAIMS TIPS 3

DENTAL MEDICAL INTEGRATION 4

SIMPLIFYING INTERACTIONS 5

WORKING WITH YOU 6-7

CONTACTS 8

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Dental Dialog

Improving health outcomes through partnerships

www.aetnadental.com

Racial and ethnic minorities in the United States are more likely to show higher rates of diabetes, heart disease, periodontal disease and other chronic conditions. These differences can be addressed by enhancing the partnership of minority health care providers, as they are more likely to practice in communities with larger percentages of racial and ethnic minorities.1

Creating an AllianceOn April 4 the leaders of the National Dental Association (NDA), National Medical Association and The National Black Nurses Association convened at Aetna’s Hartford office to discuss the formation of the National Alliance for Healthier Communities. This strategic Alliance is intended to strengthen leadership and interprofessional collaboration between the three organizations.

The achievement is bittersweet; only a few months later the NDA announced the passing of their president, Dr. Alison P. Riddle Fletcher, on Tuesday, July 1, 2014. The NDA lost a dedicated and dynamic leader. She was a dear friend, colleague and an inspiring mentor. She leaves behind a legacy of commitment, service and strength.

Reflecting on her participation in the April 4 meeting, Dr. Riddle-Fletcher said “improved health for our vulnerable communities can only be achieved through our committed collaborative efforts. All of our health providers must demonstrate an increased awareness of the oral-systemic link and a willingness to interact on all levels for better integration and coordination of patient care.”

Going forwardNDA President-elect, Dr. Carrie B. Brown, who also provided valuable input during the convening, will serve as acting president. The Alliance will continue to promote coordinated care that is focused on patient, family and community goals. These three associations combined represent the majority of practicing African American health professionals in the United States. Their unified action can encourage team-based practice for improved patient health outcomes.

1�Source: U.S. Department of Health and Human Services. HHS Action Plan to Reduce Racial and Ethnic Disparities: A Nation Free of Disparities in Health and Health Care. Washington, D.C.: U.S. Department of Health and Human Services, April 2011.

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Top 5 reasons to use electronic claims

From banks to insurance companies to dental offices, the world is going paperless. Many dental practices aren’t convinced it is the right step for them. To help practices take the leap to an EDI solution for claims, here are five clear advantages to sending your dental claims online.

Save moneyEliminate the cost of postage and find out how much money your practice can save by using DentalXChange’s Claims Calculator.

Quicker reimbursement It can take up to 45 days to receive a payment if you mail claims. In as little as 48 hours, your claims can be processed electronically.

Save timeClick, capture and send. That’s all it takes to send claims through ClaimConnect. You can call 1-800-576-6412, ext. 455 for a free demo.

Reduce errors ClaimConnect’s state-of-the-art Claim Validation system checks for errors on your claims. The system will let you know within minutes of uploading a claim with errors.

Real-time claim statusGet up-to-date information for most dental insurance companies with ClaimConnect’s Real-Time Eligibility and Claim Status package.

Electronic solutions

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Claim Tips

• Send only one claim: Our system will automatically reject/deny exact duplicates of claims previously submitted.

• Claim attachments are not always necessary: Review the Claim Documentation Guidelines or send claims without attachments. We’ll request any attachments, if needed. Note: Encounter submissions never require attachments.

• Consider sending attachments electronically: Use an electronic attachment vendor, such as National Electronic Attachment (NEA).

• Send your actual fee on the claim form: Our system will automatically convert the benefit to the contracted amount. It’s important that you consistently report only your actual fee, so that claims data reflects the correct fee information.

• Completed dental work: Dental work is considered completed on the actual date the patient receives the crown/denture/bridge. Enter this date when you submit claims for these procedures.

• Initial placement of a denture or bridgework: Include the numbers of all missing teeth extraction dates.

• Dentures or bridgework: Include the date the original appliance was placed, the date that any other teeth were extracted and the teeth numbers for any other teeth missing in that arch.

• Crowns: Note if it’s the initial placement or include the date of prior placement.

For more claim tips, visit www.aetnadental.com.

Get quick claim tips

What you need to know

Starting January 1, 2015, Aetna will consider CDT D0460 Pulp Vitality Tests as incidental to an examination. Members may not be balance billed for this service.

Aetna Dental Dialog | Fall 20143

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Dental Medical Integration (DMI)

New Aetna Dental® white paper

We’ve been working together with Columbia University since 2006 on research to determine if good dental health can reduce medical costs and improve overall health.1 Results of our research show a strong correlation between dental and medical health. Our Dental Medical Integration (DMI) program turned this research into action. We’ve identified 1.7 million at-risk members and provided $40 million in enhanced dental benefits.²

Integrating dental and medical data helps identify potentially chronic and expensive health conditions. It also can improve patient health and lower benefits costs. Dentists, physicians, insurance carriers and employers are now communicating

and taking advantage of these findings. Collaboration among dental and medical practitioners will play an important role in increasing the effectiveness of this integration.

We’ve created a technical paper that explains how the Aetna DMI program helps dental and medical benefits work together for better overall health and value. This new white paper dives into the research and analysis behind the program. Validation from the profession’s leaders and up-to-date statistics show why the program is so successful.

Download a free copy of our Aetna DMI white paper to learn more.

¹ Ongoing, statistically valid analysis of Aetna Dental Medical Integration customers. Aetna Informatics, 2010 – 2012.² Aetna Dental Medical Integration Program Book of Business report, as of March 2014.

Aetna’s participating in several oral health conferences this fall

We’ve been invited to share our Dental Medical IntegrationSM Program data and our experiences at three different conferences this fall.

We sponsored a symposium at the Harvard School of Dental Medicine that took place on October 15 and 16 titled, “Put Your Money Where Your Mouth Is: The Economic Imperative of Oral Health.” We addressed new economic research which indicates that increased oral care can improve health outcomes for those with chronic disease.

Dr. Louis Sullivan was our keynote speaker. He’s the former US Secretary of Health and Human Services under President George H.W. Bush.

Center for Oral Health (COH)

On November 6, the COH will host “Oral Health 2020: A Vision for Integrated Care,” a one-day symposium in Long Beach, CA. This conference will focus on engaging a spectrum of health care providers in identifying health care delivery models that innovate and lead to integration. Our data will be presented in a panel discussion on “Aligning Healthcare Financing with Evidence: A Case for Integration.”

AmeriHealth Caritas Partnership

On November 13 – 15, the AmeriHealth Caritas Partnership’s third annual “D. Walter Cohen, D.D.S. Integration of Dental and Medical Conference” will be held in Philadelphia, PA. Our statistics will be presented in a panel discussion on “Current Integrative Program & Provider Compensation Models & System Changes.”

Online registration for both November conferences is open to dentists and dental hygienists. Visit Center for Oral Health and AmeriHealth Caritas Partnership for more information.

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Dentists in California: Use Language Assistance Program for non-English-speaking members

As a reminder, participating dentists in California must use our Language Assistance Program (LAP) when providing care to non-English-speaking Aetna members. There is no charge for this interpretation service. Call 1-800-525-3148 to reach an interpreter. This number bypasses our Dental Service Center and connects directly to qualified interpreters.

Simplifying interactions

Timely and accurate customer service results

We continually strive to make doing business with us as easy as possible for you and your office staff. We work hard and closely monitor our results to help make sure contacts you have with us are timely and accurate.

Here are some results through the 2nd quarter:

• Percentage of dental claims paid within 15 days: ....................................98.9%

• Percentage of financially accurate claims paid: .......................................99.6%

• Average time calls are answered within: . ........................................ 9.7 seconds

• Percentage of calls answered within 30 seconds: ...................................91.9%

• Percentage of calls abandoned before answered: ................................... .0.5%

Handling information/record requests for domestic violence victims

New York law requires insurers to develop a confidential way to handle information/record requests for victims of domestic violence. We must follow the protocol that the privacy office created.

View the protocol document. Please print the notice and hang it in your office.

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Working with you

Let us know about any demographic changes

Help us ensure that we have accurate information for your office. Tell us about changes to:

• Name

• Tax identification number (TIN)

• Address/location

• Change of practice ownership

• Change in associate status in your practice (to help prevent claims payment errors, you must send us a new W-9)

• Phone numbers

• E-mail/website addresses

It’s easy to let us knowJust log in to www.aetnadental.com. Go to the DMO or PPO welcome page, and select the appropriate form to send back to us.

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Aetna Dental Access® and Aetna Dental® Administrators continue to grow. Here is a quick reference guide to help you easily welcome these participating patients to your office.

Yes NoPCD selection required ❏ ✓❏

PCD referral required ❏ ✓❏

Submit claims to Aetna ❏ ✓❏

Collect copay from patient ✓❏ ❏ at the time of visit

Overview:

• These programs are not insurance.

• ID cards: Program names and brands will vary. Look for the Aetna Dental Access logo; it will appear on all ID cards.

• No claims filing required.

• Patient responsible for entire payment at time of service; based on PPO fee schedule.

• Call number on patient’s ID card with questions.

• Visit www.aetnadental.com for a list of current plans that the Aetna Dental Access network supports.

Yes NoPCD selection required ❏ ✓❏

PCD referral required ❏ ✓❏

Submit claims to address on ✓❏ ❏ ID card (may not be Aetna)

Overview:

• These programs may be administered by third-party administrators and other payers. Program designs may vary.

• ID cards: Program names and brands will vary. Look for the Aetna Dental Administrators logo; it will appear on all ID cards.

• Submit claims to the address on the ID card only.

• Call number on patient’s ID card to verify eligibility.• Visit www.aetnadental.com for a list of current plans

that Aetna Dental Administrators supports.

Discount programs supported by the Aetna Dental Access network

Aetna Dental Access®

Look for this logo!

Aetna Dental Administrators

Aetna Dental® Administrators

Look for this logo!

Aetna Dental Access will appear on different ID cards in different places.

Aetna Dental Administrators will appear on different ID cards in different places.

Vital Savings by Aetna® and Aetna ValuePassSM are some programs supported by the Aetna Dental Access network.

Working with you

Dental DialogA newsletter for Aetna participating offices Dental Dialog is published biannually. Dental benefits and dental insurance plans are offered, underwritten and/or administered by Aetna Life Insurance Company, Aetna Dental Inc., Aetna Dental of California Inc., Aetna Health Inc. and Aetna Health of California Inc.For more information about Aetna plans, refer to www.aetna.com. Plan features and availability may vary by location and group size.ClaimConnect is a product of EHG (EDI Health Group, Inc.) and its subsidiaries. NEA is a registered trademark of National Electronic Attachment, Inc. All electronic claim and other vendors are independent contractors and not employees or agents of Aetna. While some programs provide access to certain discounts for participating network dentists, Aetna does not endorse any vendor, product or service offered as part of the program.The opinions expressed or articles in this publication are not intended to provide dental/medical nor legal advice nor any endorsement by Aetna of any specific product, vendor, drug or pharmaceutical.Articles or opinions written by individual contributors do not necessarily reflect the views of Aetna.Aetna does not assume any liability in connection with the use or implementation of any techniques, policies or procedures discussed in this newsletter.While this information is believed to be accurate as of the print date, it is subject to change. For more information about Aetna networks, refer to www.aetnadental.com.We welcome your comments and suggestions. Please send to Aetna, Dental Dialog, 980 Jolly Road, Mail Stop U13S, Blue Bell, PA 19422, Attn: L.Mott. Or, e-mail DentalDialogNewsletter@aetna.com.

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Important numbers and addresses

Dentist hotline• National Dentist Line: Have a question about the

network, claim status, member eligibility, contact information or DMO supplies? Call the National Dentist Line at 1-800-451-7715.

• Dentist Contracting Hotline: For PPO contract information, call the Dentist Contracting Hotline at 1-800-776-0537.

Dentist web address www.aetnadental.com

Addresses• All claims and specialist referrals

Aetna Dental PO Box 14094 Lexington, KY 40512-4094

• Encounters & encounter listings

Aetna Dental PO Box 14530 Lexington, KY 40512-4530

• Aetna DMO grievance and appeals

- Northeast region — (CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VA, VT, WV)

Aetna Dental PO Box 14080 Lexington, KY 40512-4080

- South region — (AL, AR, FL, GA, LA, MS, NC, OK, SC, TN, TX)

Aetna Dental PO Box 14597 Lexington, KY 40512-4597

- West region — (AZ, CA, CO, HI, IA, ID, IL, IN, KS, KY, MI, MN, MO, NE, NM, NV, OH, OR, UT, WA, WI)

Aetna Dental PO Box 10462 Van Nuys, CA 91410

• Aetna PPO grievance and appeals

- Call the Dentist Contracting Hotline at 1-800-776-0537 for the correct mailing address.

• CA Language Assistance Program

- For free interpretation services, call 1-800-525-3148.

Please note: The PO Box number and the last four digits of the ZIP code vary with each address.

Aetna Dental PO Box 44020 Jacksonville, FL 32231A newsletter for Aetna

participating offices

Dental Dialog