The Advantage Dental and PacificSource Partnership: What`s In It for

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PacificSource Health Plans Dental Provider Newsletter • December 2010
The Advantage Dental and PacificSource
Partnership: What’s In It for You
Last July, PacificSource Health Plans acquired Advantage Dental’s
35,000 commercial plan members and made Advantage its exclusive
dental network.
In this issue...
The Advantage Dental and
PacificSource Partnership...... 1
As a dental provider, it is advantageous for you and your practice to
sign up with the Advantage Dental Network of providers for several
reasons:
Healthy KidsConnect and
the Oregon Health Plan.......... 1
• Becoming a part of the network will give you access to new patients
insured by PacificSource and the new Healthy KidsConnect Program
in addition to potential patients through the Oregon Health Plan.
• Advantage is collaborating with PacificSource to work on improved
overall health outcomes.
• Advantage offers all of its contracted providers special discounted
pricing on products from all the major dental supply companies,
including: Henry Schein, Dentsply, Tusla, and Patterson.
• Advantage offers additional services for network dentists, such as
consulting, patient financing, and HR services.
• Advantage is owned and managed by dentists and works to ensure
dentists have a voice in the changing future of dentistry.
• Advantage offers ownership for those interested.
• Advantage offers participation in a statewide call program for
emergency, urgent, and after-hours dental care.
Clear One Healthy
KidsConnect Moving to
Advantage Network................ 2
Changes to InTouch Access
for Providers............................ 2
Administrative News
and Reminders........................ 3
PacificSource Performance
at a Glance............................... 3
Who to Call Reference............ 4
PacificSource newsletters are
provided for general information
only, and are not to be used to
determine benefits.
Recently, there has been confusion around the differences between
the state-run Oregon Health Plan (OHP) Medicaid program and the
private market insurance component, the Healthy Kids program. In
fact, the entire OHP Medicaid program for children is now called the
Healthy Kids program. Advantage Dental Services, LLC is a direct
contracted provider for the Healthy Kids OHP Medicaid program.
Healthy KidsConnect is a subsidized insurance plan for children whose
families earn too much to qualify for the Oregon Health Plan, but can’t
afford private health insurance. PacificSource is the direct statewide
De
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Healthy KidsConnect and the Oregon Health Plan:
What Is the Difference?
www.AdvantageDental.com
PacificSource.com
Continued on page 2.
Sign Up with the Advantage Network –
It’s Easy and Free!
To learn more about signing up with Advantage
Dental as a provider, visit www.AdvantageDental.com
and click Become a Provider. Or call Advantage’s
Provider Relations Department toll-free at
(866) 315-6865.
Continued from page 1.
contractor for the Healthy KidsConnect program and Advantage Dental
Plan, Inc. is the dental subcontractor to PacificSource for that program.
Below is an outline showing the differences between the two plans and
how they are processed.
Healthy KidsConnect
OHP
Carrier
PacificSource Health Plans
Advantage Dental Services, LLC
Network
Advantage Dental Network
Advantage Dental Network
Customer service number
888.684.5220
541.504.3900
Web site
PacificSource.com
www.AdvantageDental.com
Claims mailing address
PO Box 70088
442 SW Umatilla Ave. Ste 200
Eugene, OR 97401
Redmond, OR 97756
Out-of-area network benefits
No
No
Eligibility
Children age 19 and under only All ages
Coverage area
Statewide
Specific Oregon counties
Clear One Healthy KidsConnect Members Moving to
Advantage Dental Network
As some of you may know, Clear One Health Plans was acquired by
PacificSource in May 2010. As part of the transition, Healthy KidsConnect
members currently covered through Clear One Health Plans will change
dental networks from Willamette Dental to Advantage Dental on January
1, 2011. Members were informed of the change via letter in early
December. Please continue to send claims for these members to the
claims address on the back of the member’s current ID card.
Important Changes to InTouch Access for Providers
In cooperation with the Oregon Health Leadership Council,
Oregon health plans, including PacificSource, have partnered with
OneHealthPort, Inc. to launch OneHealthPort Oregon. This Web portal
provides access to all participating Oregon health plans and other payor
administrative secured Web sites, including PacificSource InTouch for
Providers, through a single log in process.
For us to provide access to OneHealthPort Oregon, it was necessary
to make changes to our registration process. Current InTouch users
will need to register with OneHealthPort to gain access to
InTouch for Providers. As of November 1, 2010, your existing InTouch
user ID and password will no longer work. A link to “Registration
Information” is available from the upper right area of any page of
our Web site, PacificSource.com, or simply go to PacificSource.com/
aboutproviderintouch.
If you are already registered with OneHealthPort, you may access
InTouch for Providers once you are logged in to OneHealthPort. You
may also access the OneHealthPort login page by clicking the Provider
InTouch login button at PacificSource.com.
If you have questions, or need more information about
OneHealthPort Oregon and InTouch changes, visit: PacificSource.com/
aboutproviderintouch.
2
Administrative News and Reminders
Policy for Payment on Crown Build-ups
Please be aware that PacificSource dental plans cover tooth build-ups
that occur prior to crown preparation (code D2950) only when the tooth
has had previous root canal therapy. It is not the intent of PacificSource
to make judgments regarding the need for this service; it is simply not
a covered procedure. Codes D2952 (post and core in addition to crown,
indirectly fabricated) and D2954 (prefabricated post and core in addition to
crown) are covered as by definition, following root canal therapy.
If you have any questions about this policy, please call PacificSource
Customer Service at (866) 373-7053.
Alternate Procedures on Crowns
In the transition to PacificSource Health Plans from Advantage Dental,
there have been some questions regarding alternate procedures (AP) on
crowns.
Effective November 15, 2010, all claims for molar crowns will be processed
at the high noble metal crown allowable fee. When you bill for any kind of
porcelain crown, it will be paid at the high noble metal crown allowable
fee, and you may bill the patient the difference between what is allowed on
the high noble metal crown and your fee.
On pre-molar (bicuspid) through all anterior teeth, all crowns will be paid
at the porcelain high noble metal crown allowable fee. Any crowns made
from porcelain, porcelain to porcelain, or other porcelain-like materials
will be paid out at the porcelain to high noble metal allowable fee, and
you may bill the patient the difference between the porcelain to high noble
allowable fee and your fee.
Please be sure to have a discussion about the types of materials you use
with your PacificSource patients so they will not be surprised if they are
billed. Also document the discussion in the patient’s record.
If you have any questions about this policy, please call Advantage’s
Customer Service Department at (866) 261-9615.
A Convenient, Cost-effective Way to Send Claims Attachments
If you’re not familiar with NEA (National Electronic Attachment, Inc.), we
encourage you to look into it. NEA’s Web-based “FastAttach” service allows
dental providers to attach supporting documentation, such as X-rays,
charts, and narratives, to their electronic claims. Here are some of the
benefits of using this service:
•
•
•
•
•
PacificSource Performance
At a Glance - October 2010
Dental Claims Processing
Target
Turnaround: 10 days
Accuracy: Actual
11.9 days
99%95.6%
Customer Service
Answer speed
(seconds):
Actual Target
2930
Abandonment
rate: 1%3%
Fast Facts
PacificSource dental
members: 96,572*
Number of Advantage
Dental providers: 722
Advantage Dental Network
geography: Oregon, Idaho,
and Washington
*Includes members who have dentalonly plans as well as those with
medical and dental coverage with
PacificSource.
Numbers accurate as of October 2010.
Improve your revenue cycle
Save on postage and printing costs
Avoid lost or damaged attachments
Stop sending unnecessary attachments with claims
Reduce your follow-up with payors
For more information, visit their Web site: http://www.nea-fast.com/.
Tips for Fast Claims Turnaround
To help speed the processing of claims:
•
•
•
•
•
•
Verify that the member’s ID number is correct.
Include X-rays when necessary.
Include periodontal charts, when necessary.
Include narratives when necessary.
Chart notes can help clarify the claim.
When submitting an orthodontic claim, remember that we require a
monthly or quarterly claim.
Your attention to these details ensures quick and proper processing of your
patients’ claims. Thank you!
3
PRSRT STD
US POSTAGE
PAID
EUGENE OR
PERMIT NO.16
PO Box 7068
Eugene OR 97401-0068
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PacificSource Dental Customer Service Advantage Provider Relations
For Questions Concerning:
For Questions Concerning:
• Member benefits or eligibility
• Status of a specific claim or EOP
• Becoming a contracted provider
• Provider contracts
E-mail
[email protected]
E-mail
[email protected]
advantagedental.com
Phone
541.225.1981 (Eugene)
866.373.7053 (all other areas)
Phone
866.268.9616, Option 3
Web site PacificSource.com
Web site
www.AdvantageDental.com
Fax
Fax
866.268.9318
541.225.3655