BlueImpressions September 2014 - Vol 11, Issue 3
Contents
1. Carehrst The CareFirst BlueCross BlueShield family of health care plans Bluelmpressions SEPTEMBER 2014 VOL 11 ISSUE 3 We ve Enhanced Our Claims Payment System Want to file your dental claims faster and get your payments without delay If so CareFirst has enhanced its electronic claims submission for dental providers thereby simplifying the method for processing claims and sending payments to dentists New electronic capabilities include E Electric Funds Transfer EFT Allows providers to receive payments electronically A clearinghouse manages provider enrollment and validation date E Electronic Remittance Advice ERA Equivalent to the Notice of Payment Some clearinghouses auto post the ERA and EFT to the patient s account using the providers Practice Management System Our new paperless submission capabilities are designed to improve efficiency reduce administrative complexity and improve turnaround time Claims for FEP members can now also be submitted electronically Other features include E Dedicated dental Electronic Data Interchange EDI staff members E Around the clock systems monitoring E Reliable flexible and secure systems that use state of the art technology If you have questions regarding a member s eligibility benefits or claims status information we encourage you to use one of our self service channels CareFirst Direct or CareFirst on Call For more2. ase Adverse Pregnancy Outcomes Respiratory Disease a And more E Inter professional Management of Patients with Periodontal Disease and Associated Systemic Diseases Role of the Medical Team Implications for Health Role of the Dental Team a Implications for Dental Practice Insurance Companies BLUEIMPRESSIONS gt gt SEPTEMBER 2014 Co ee o Ce ee Announcing CareFirst on Call E Separate options for eligibility benefits deductibles and maximums E Options to manually select the network level for specific information m A fax back option E Frequently requested information The best part CareFirst on Call uses the same telephone numbers and provider and member identifiers as the previous systems Questions Contact your Dental Provider Representative The Impact of Periodontal Disease on General Health Date Friday March 6 2015 Time 8 30 a m to 4 p m Location CareFirst Conference Center Canton Crossing 1501 S Clinton St 17th Floor Baltimore Md 21224 Fee No charge to CareFirst network dentists 295 for out of network dentists Cost includes breakfast lunch parking and Continuing Education certificate CE Credits 6 CEU AGD PACE Parking Parking is available in the lot opposite the building Please bring the issued parking ticket with you to the seminar and validation will be provided Registration begins Nov 3 2014 Please complete registration form eocere
3. d It highlights CareFirst dental news events and updates that you and your office staff might have missed For example did you know that CareFirst created a Dental Provider Link List that takes you directly to the information you need through user friendly easy to remember links Click the In Case You Missed It envelope icon to view other topics including CareFirst on Call for Dental Providers E Bluelmpressions June 2014 In Case You Missed It More dental news and information is available online at www carefirst com providers dental BLUEIMPRESSIONS gt gt SEPTEMBER 2014 closed on Thursday Nov 27 and Friday Nov 28 2014 to celebrate the Thanksgiving holiday Providers are encouraged to utilize CareFirst Direct or CareFirst on Call to verify eligibility benefits and claim status if needed WHAT S HAPPENING CLAIMS AND BILLING ceoecee eee eee eee eee eee ee ee eee eee eee eee eee eee eee ee eee eee ee eee eee eee eee eee eee eee eee eee eee eee eee eee eee eee ee eee eee ere eee eee ee eee eee e eee eee ere eee eee eee eee ee eee eee eee cere eee eee ee eee eeee ee ere eee eee eee ee eee eee eee eeees CLAIMS AND BILLING Diagnostic Imaging CareFirst considers the following imaging series equivalent for benefits and subject to the three year frequency limitation standard plans m D0210 complete series of intraoral radiographic images 14 to 22 periapical and bitewin
4. d using the correct diagnostic procedure codes as required for all non ACA member contracts So you ve just finished reading BlueImpressions and hopefully we ve informed you on the latest dental news regarding CareFirst as well as dental updates and events in the Mid Atlantic region At least that was our intention Did we do our job Was this issue of BlueImpressions or any past issues of BlueImpressions helpful We ve made several enhancements to BlueImpressions over the last year or so and we d like to know what you think It s your turn to sound off Email your comments to newsletter editor carefirst com DENTAL DIRECTOR EDITOR Robert S Laurenzano DMD FAGD Robert Hilson BLUEIMPRESSIONS gt gt SEPTEMBER 2014
5. ec cere cece eee eee eee eee eee eee eee ee eee eee eee eee eee WHAT S HAPPENING e CLAIMS AND BILLING Attention Office Managers Who Use CareFirst Direct Office managers should frequently review the list of CareFirst Direct users under your tax ID Be sure to disable the user accounts of staff members who have left your employment or have new job functions that do not require access to the system To change the status of a user who should no longer have access Sign in to CareFirst Direct 5 Click the Modify User button Click on User Management 6 Edit the user end date to today s date Search for the appropriate user 7 Click on Submit 8 Click on the User ID Log out of CareFirst Direct Revised Current Dental Terminology User s Manual The American Dental Association s ADA revised Current Dental Terminology CDT User s Manual will be effective Jan 1 2015 Providers are encouraged to consult the amended CDT manual to accurately report dental procedures To get a copy of the revised manual contact the ADA Catalog Sales Department at 800 947 4746 Holiday Closings eoeeeece eee eee eee eee see eee esses eee ese e eee es eee eee s ee eseeeeeeeee sees seeseeeeeeeee essere eeeeeeeseeeseeeseeeeseeeee esse sees eeeeee CareFirst offices will be In Case You Missed It We know you re busy Thats why we re focused on providing you with the information that matters the most to you In Case You Misse
6. esponse systems CareFirst on Call Medical Director discusses the i provides you with reliable information Mouth Body Connection l i l i and functionality along with the following added features E Speech recognition E Easier navigation m The ability to listen to additional detail on each claim as desired Listen eoeceereec reece eee eee see eee eee eee eee ese eee eee eee eee eee eres eee ee ee eee sree es eereseeeeee eee eee reese ees eeereee ree eee ees eereeeeereeeee CareFirst s Continuing Education Series Seminar The Impact of Periodontal Disease on General Health Join us on Friday March 6 2015 for an informative presentation from Robert J Genco D D S PhD on the Impact of Periodontal Disease on General Health A Distinguished Professor of Oral Biology and Microbiology at the State University of New York Dr Genco has worked on laboratory and clinical studies for more than 30 years to help understand the causes prevention and treatment of oral diseases and their association with systemic diseases such as heart disease stroke and diabetes His presentation could have a significant impact on your practice and your patients health Seminar attendees can learn more about E Current Understanding of Etiopathogenesis of Periodontal Disease E Risk Factors for Periodontal Disease and Their Modification E Periodontal Disease and Its Effects on Systemic Conditions Diabetes Cancer Atherosclerotic Dise
7. g m Any combination of seven or more periapical and bitewing images E D0277 vertical bitewing 7 to 8 radiographic images m D0330 Panoramic radiographic image eocereese ee ese eee eee eee eee eee eee seeeseeeseeeeseeeeseeseeeseeeeseseeeeseeeseeeseeeseeseeeseeeoeeeeeeseeeseeeeeeeeeseeeseeeseeeeesee Practitioners should adhere to the Dental Radiographic Examinations Recommendations for Patient Selection and Limiting Radiation Exposure published jointly by the American Dental Association and the U S Food and Drug Administration as updated in 2012 The District of Columbia has a five year frequency limit for Affordable Care Act pediatric dental products ACA Orthodontic Case Submission Advisory The pediatric dental orthodontic benefit requires pre authorization for medical necessity Many of these orthodontic cases have been delayed or returned for various reasons especially incomplete documentation Below are helpful tips to facilitate your orthodontic cases E Orthodontics will be considered on a pre treatment PTE basis only If you start a case after Jan 1 2014 without first being approved on a PTE basis no benefit will be available The only exception will be transfer and continuation of care cases These cases require original records or Medicaid approval form and date of banding E Only comprehensive cases are covered D8070 D8080 D8090 E Limited interceptive and minor treatment ca
8. information visit the Dental Electronic Claims section of our website WHAT S HAPPENING 2 The Mouth Body Connection Medical Dental Integration CareFirst s Continuing Education Series Seminar The Impact of Periodontal Disease Announcing CareFirst on Call Attention Office Managers Who Use CareFirst Direct Revised Current Dental Terminology User s Manual In Case You Missed It Holiday Closings CLAIMS AND BILLING 4 Diagnostic Imaging Implant Benefits Reminders ACA Orthodontic Case Submission Advisory Orthodontic Services Pre Treatment Estimates Available CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland Inc and Group Hospitalization and Medical Services Inc CareFirst BlueCross BlueShield and CareFirst BlueChoice Inc are both independent licensees of the Blue Cross and Blue Shield Association Registered trademark of the Blue Cross and Blue Shield Association Registered trademark of CareFirst of Maryland Inc WHAT S HAPPENING e CLAIMS AND BILLING WHAT S HAPPENING The Mouth Body Connection Medical Dental Integration CareFirst on Callis the new provider interactive voice response IVR system used to verify member eligibility Listen as Dr Daniel Winn fy 8 ue benefits and claims status information an internist and CareFirst ee l i Replacing the FirstLine and BlueLine Vice President and Senior 3 i i voice r
9. ing the following ADA procedure codes separately m D0330 Panoramic radiograph m D0340 Cephalometric radiograph m D0470 Diagnostic casts E D0350 Oral facial images additional reimbursement for this procedure will not be provided as it is considered to be incidental to and included in the allowance for the diagnostic casts The member s lifetime orthodontics benefit is applied to the active treatment which begins with the insertion of the appliance i e banding date and should be reported using the orthodontic procedure code most appropriate to the member s stage of dentofacial development and treatment planned or performed The submission of claims for active treatment will continue to follow current guidelines of the member s dental plan For additional information contact the appropriate Provider service area or refer to the Dental Provider Manual Note Procedure code D8660 is intended to be used to report a pre orthodontic treatment examination to monitor growth and development Many providers have used this procedure code to report orthodontic records for members covered under Affordable Care Act ACA contracts Due to a change in the CDT 2015 as of Jan 1 2015 ADA procedure code D8660 Pre orthodontic treatment visit will no longer be accepted for reporting diagnostic records for ACA members and therefore should not be used Diagnostic records for members covered under ACA contracts must be reporte
10. ovide records that clearly support your case Dentists are advised to submit complete and appropriate records including periodontal charting and periodontal status if appropriate diagnosis recent good quality FMX or panoramic images and listing of missing teeth Rationale for complex or unusual situations is helpful and digital images that are electronically transmitted are best Plain paper prints and faxed images are generally of poor quality and not diagnostic Clinical guidelines and required attachments are available online at www carefirst com providers dental If repairing a periimplant defect with bone graft material use ADA code D6103 When reporting a bone graft done at the time of implant placement use code D6104 ADA codes D4263 and or D7953 should not be used when reporting either of the services listed above WHAT S HAPPENING CLAIMS AND BILLING coc e eee eee eee eee oe eee eee eee eee eee eee eee eee ee eee eee eee eee eee eee eee eee eee eee eee eee eee eee eee eee eee eee eee eoeeecec reece ec eee eee eee eee ee eee eee eee eee eee eee eee eee eee eee eee ee eee eee eee eee eee eee eee eee eee eee eee eee eee eeee CLAIMS AND BILLING Orthodontic Services Billing for Orthodontic Pretreatment Services Diagnostic Work up Providers should bill for orthodontic pretreatment services separately by using the appropriate procedure codes The benefit for pre treatment services is considered diagno
11. ses are not covered E Benefits discontinue at the end of the calendar year of the 19th birthday E Submit all required case records with a completed American Dental Association ADA claim form check the box for Dentist s pre treatment estimate and leave the date of service blank BLUEIMPRESSIONS gt gt SEPTEMBER 2014 E Use the index form required by your State Maryland and the District of Columbia use the Handicapping Labiolingual Index HLD a Virginia requires the Salzmann Deviation Index E Submit a separate claim form with date of service for the records exam x rays models etc E Label all the models with patient name office name and impression date m Package the models so they do not break in transit m Electronic records may be provided in lieu of paper however we must be able to open the files If your assessment of the case results in a low score there is no requirement that you must submit the case for review If the parent insists or the score is close to passing we recommend you submit the case for review Implant Benefits Reminders Implants and implant related services are subject to review by the CareFirst Dental Director With all services that require professional clinical review the approval or denial of the service is based upon coverage limitations CareFirst clinical guidelines and the clinical records provided When submitting services for review pr
12. stic services and paid at the level of coinsurance associated with the member s benefit plan Be sure to verify member eligibility and coverage prior to rendering services We encourage you to use one of our self service channels CareFirst Direct or CareFirst on Call or contact the appropriate customer service area since certain services may be subject to limitations or exclusions under the member s contract Reporting Orthodontic Consultation Providers should not use ADA procedure code D9310 consultation or bill for the orthodontic consultation as this is considered part of the complete case workup Pre Treatment Estimates Available To avoid errors in financial planning for complex procedures before the treatment is done Pre Treatment Estimates PTE are available to dentists and CareFirst members for many services When requesting a PTE check to make sure the procedure s is listed on the Reference Guide for Required Attachments If Dental Director Review and clinical documentation are not required for the service the service is not eligible for Pre Treatment Estimate We suggest that you submit a Pre Treatment Estimate for all implant and complex and or expensive services listed on the Reference Guide for Required Attachments How Are We Doing Reporting Diagnostic Records Diagnostic records that include study models diagnostic photographs cephalometric and panoramic films may be reported by list
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