A Presentation for the Old Dominion Dental Society

1

A New Day For Oral Health In Virginia
Presentation to Dental Advisory Committee April
11, 2008

2
Distribution of Dental Services and Claims
3
Distribution of Paid Claims SFY 2007

• Of the 103,447,016.04 paid claims, 34,816,835
  (34) was paid on Preventive and Diagnostic
  Services.
• The balance, 68,630,231.04 (66), was paid on
  Treatment Services.

4
Distribution of Dental Services SFY 2007

• Of the 1,872,649 services performed, 1,276,578
  (68) of services rendered were for Preventive
  and Diagnostic Services.
• The balance, 596,071(32), of services rendered
  was for Treatment Services.

5
Broken Appointments
6
Broken AppointmentsBest Practices Questionnaire

• In February 2008, Doral conducted a brief
  telephone survey of SFC providers to identify
  best practices for reducing the rate of broken
  appointments among SFC recipients.
• A total of 182 practice locations participated in
  the survey. (Please Note There is variation in
  the total number of respondents as not all
  practice locations responded to every question.)
• Questions and responses related to providers
  perception of broken appointments for SFC
  enrollees are below

Thinking about SFC new patient appointments
only, which statement best describes the broken
appointment rate for new patients. Broken
appointments for SFC new patients appointments
are
In your office, which statement best describes
the rate of appointments for SFC patients as
compared to your commercial insurance patients.
The rate of broken appointments for SFC patients
is
Thinking about the SFC recipients treated in
your office, which response best describes any
problems your office is experiencing regarding
broken appointments
7
Broken AppointmentsBest Practices Questionnaire
(cont.)

• Preliminary Findings
• Only 32 of the offices surveyed have evening or
  extended hours of operation.
• Twenty-three percent of offices surveyed have
  weekend hours of operation.
• Most offices have a process for reminding
  recipients of scheduled appointments.
• A telephone call to the recipient is the most
  frequently used method.
• Seventy-five percent of offices surveyed have a
  No Show policy.

8
SFC Dental NetworkNetwork StatusNational
Practitioner Identifier (NPI)Recredentialing and
Recontracting
9
SFC Network Status

• 445 additional dentists have signed up to
  participate since 7/1/05.
• The total number of providers participating in
  the SFC network as of March 31, 2008 is
• This represents a 72 increase in the network
  from 620 to 1065.

10
National Provider Identifier (NPI)

• Providers should continue to prepare for
  transition to use of the NPI and full NPI
  Compliance effective May 23, 2008.
• Effective April 1, 2008, Doral began requiring
  NPI, National Provider Identification Number, on
  electronic and paper transactions.
• Claims submitted without an NPI number are
  denied.
• On May 1, 2008, the automated voice response
  system will require that you enter your NPI and
  the last four digits of your Tax Identification
  Number or your User Identification Number,
  previously refereed to as Location Identification
  Number and the last four digits of your Tax
  Identification Number.

11
Recredentialing and Recontracting
12
NEWS AND UPDATES
13
Protective Stabilization Policy

• Doral is recommending the adoption and adherence
  to the current guidelines for protective
  stabilization established by the American Academy
  of Pediatric Dentistry (AAPD) Guideline on
  Behavior Guidance for the Pediatric Dental
  Patient. Dorals recommended approach
• Each participating provider in the SFC network
  would have to submit and maintain documentation
  confirming completion of residency program, a
  graduate program, or a Continuing Medical
  Education (CME)-certified course in protective
  stabilization.
• Licensed pediatric dentists would be exempt from
  the requirements due to their advanced pediatric
  dental education.
• New providers joining the network would be
  expected to have completed the necessary training
  prior to treating members.
• Doral would look for documentation of proper
  protective stabilization training when conducting
  audits and/or site reviews.

14
Thank You!