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ContentsCompany Updates page 1- New and Renewing Groups- Premera Holiday Closure Notification:

Sept. 4-7

Claims Update page 2-3- Illegible and Highlighted Claims

Cause Delays- Change in the Return of Dental X-rays

Effective June 1, 2009- Treating Self and Family Members- Billing Anesthesia on a Medical

Claim Form- ADA Dental Claim Form Submitting Tips

Consultant’s Corner page 3- Preventing Horizontal Impaction:

Permanent Cuspids

Administrative Resources page 4-5- Revisions Made to the Appeal

Submission Form- Secure Email Capability- Lean Helps Dental Providers Save Time

With Benefit Quotes- Dental Correspondence Project Underway- Filing Electronically and Using

COB Feature

Community Connections page 6-7- Dental Advisory Board Meetings- Inland Northwest Dental Conference- Supporting the Dental School

Summer Fun page 7- August Word Teaser

Company Updates

An Independent Licensee of the Blue Cross Blue Shield Association

August 2009

newsNews from Premera Blue Cross

networkD E N T A L

August 2009 Washington Dental Network News 1

w B.E. Meyers & Co. Inc.

w Ben Bridge Jeweler

w Bureau of Education & Research

w Distant Lands Coffee Roaster

Acquisition LLC

w Floyd Blinsky Trucking Inc.

w Green Diamond Resource Company

w Hargis Engineers Inc.

w IMCO General Construction Inc.

w Jones Soda Co.

w Merrill Gardens LLC

w Minecode LLC

w PACE Engineers Inc.

w Pacific Welding Supplies LLC

w Peter Pan Seafoods Inc.

w PlayNetwork Inc.

w Silver Cloud Inns & Hotels

w Sunnyside Community Hospital

w Trident Seafoods Corporation

w UniSea Inc.

w Vaagen Brothers Lumber Inc.

Premera Holiday Closure Notification: Sept. 4-7

Premera will be closed Friday, Sept. 4 through Monday, Sept. 7, 2009, for an extended Labor Day holiday. This long weekend will be treated the same as any other holiday closure. We selected this particular Friday before Labor Day weekend because of the historically lower call volumes. This closure is one of several measures Premera is taking to reduce operating costs. Providers can access eligibility and claims status information on our provider portal via premera.com/provider.

New and Renewing Groups

Following is a small sampling of some of the new and renewing groups with a Premera Blue Cross dental plan:

2 August 2009 Washington Dental Network News

Claims Update

Illegible and Highlighted Claim Forms Cause Delays

Illegible claim or Explanation of Benefits (EOB) forms create more work for your billing office and can

delay payment by an additional 10 to 15 days compared with standard claims processing time.

Every day, Premera receives a number of illegible claims and EOBs. Using a highlighter pen on these documents is one of the most common causes of illegibility. When the highlighted document is scanned to create an electronic image, that portion of the content shows up as blacked out.

The document then requires manual review, and in some cases, it must be returned to the provider’s office for resubmission. When the claim is resubmitted, it is processed within standard turnaround times.

Assist us in speedy processing of your claims by submitting clear and legible documents. If you are attempting to submit a corrected claim, we suggest you complete and include our Corrected Claims Cover Sheet. This document can be found at premera.com/provider, in the Forms section.

Treating Self and Family Members

Premera follows many Medicare guidelines. Similar to Medicare, we do not reimburse for professional services or supplies that are usually provided free because of the relationship to the patient.

As a reminder, we do not reimburse physicians, dentists, providers, or suppliers who are Premera members for professional services for any of the following when the services are:w performed on themselves;w rendered to family members residing in

the home; orw provided to individuals related to them

by blood, marriage, or adoption.

If you have questions, please call Physician and Provider Relations at 1-877-342-5258, option 4.

Billing Anesthesia on a Medical Claim Form

Follow CPT guidelines when billing general anesthesia on a medical claim form (the most common code is 00170). Anesthesia for medical should be reported on one line item with total minutes in the units field. If more than one anesthesia line is billed for the same date of service, only the first anesthesia services is allowed and all others will be denied.

Change in the Return of Dental X-rays Effective June 1, 2009

In an effort to streamline our business processes, we have made these changes to our policy on return of dental x-rays, effective June 1, 2009:w X-ray films or photos will not be returned to the dental office, unless specifically

requested at the time of submission.w If requesting their return, please indicate the patient’s name, account number or

other identifier on the envelope or mounting.w We will not be responsible for lost x-rays or photos. The dental office should

maintain the original copy of the x-ray films or photo in the patient record.

For more information on submitting x-rays or photos electronically please visit the FastAttachTM web site at fast-attach.com.

Thank you for joining our efforts to streamline doing business together.


Consultant’s Corner

Preventing Horizontal Impaction – Permanent Cuspids

by Dr. Ronald Cantu

Intraoral occlusal x-rays are necessary to determine proper eruption of potentially impacted cuspids. When the permanent cuspids have not erupted, this film can aid in determining the location of the permanent cuspids in relation to

the primary cuspids. The goal is to aid in preventing the horizontal impaction of the permanent cuspids. Sometimes this is, unfortunately, only discovered when the patient is a teenager and the primary cuspids are still present. There is really no other film that better displays this area of concern.

In my practice, I occasionally see individuals that have impacted maxillary cuspids. Achieving proper eruption with orthodontics can be clinically difficult. Prevention of this unfortunate outcome would be greatly beneficial to the patient. This is why I continue to work with Premera to help them determine the most appropriate benefits and policies that protect our insured members but makes sense to the dental community.

Premera’s general payment guidelines for intraoral occlusal x-rays are being updated as follows: w Age limit: 4 - 19 w Frequency: Once per arch per year w Primary and permanent teeth w Documentation required: Narrative (The primary reason would be track the

correct eruption pattern of permanent cuspids) w Additional x-ray films on same day of service allowed

The goal is to

aid in preventing

the horizontal

impaction of the

permanent cuspids.

Dr. Ronald Cantu

Claims Update

Here are some tips about submitting dental claims to Premera using the current version of the ADA Dental Claim Form:w In an effort to protect the personal and

private information of your patient and our member, do not submit a Social Security number in box 15, Policyholder/Subscriber ID (SSN# or ID#). Use the ID number found on the member’s ID card.

w In the Patient Information field, complete boxes 20, 21, and 22 (and 19 and 23 if applicable) even when the relationship to policyholder/subscriber is self.

w In box 29, Procedure Code, submit only procedure codes contained in the CDT 2009/2010 reference manual published by the American Dental Association.

w In box 35, Remarks:- Information should be concise and

legible.- Do not highlight.- It is acceptable to indicate how

much the primary insurance plan paid, however we require a copy of the primary explanation of benefits to coordinate benefits as secondary insurance plan when submitting paper claims.

w In the Ancillary Claim/Treatment Information section, complete all applicable boxes (38-47) on every claim, even if you have submitted this information on previous claims for the same patient.

w In the Billing Dentist or Dental Entity section, box 51, SSN or TIN, always indicate the SSN or TIN as reported to the IRS even when submitting your National Provider Identifier.

w In the Treating Dentist and Treatment Location Information, box 53, the dentist signature should be legible.

Following these simple tips will help us process your dental claims and prevent unnecessary delay.

ADA Dental Claim Form Submitting Tips


Secure Email Capability

Premera now has secure email. Using secure email enables you to communicate with us without the

threat of interception by an outside party. “Regular” email is not considered secure. Called Proofpoint Secure Messaging™, the new secure email is encrypted, meaning that the message contents are scrambled and can be read only by the intended receiver. No special software is needed. Here’s how to send a secure message:

To send a message to us:

w In your Internet web browser, go to https://voltage-pp-0000.premera.com/login/

w Sign in by entering your email address, and then click Next.

w At this point, you will be asked to authenticate yourself by answering some questions.

w After you complete the authentication process, a Compose page will be displayed.

w In the To field, enter the recipient’s email address. (To send a message to multiple recipients, enter their email addresses separated by commas, semicolons or blank spaces.)

w In the Subject field, type the subject of your message.

w Type your message in the large text box.w To attach a file, click Browse, locate

and select the file to attach, and then click the Attach button.

w Click Send Secure.

To respond to a message from us:

w You will receive a message from Premera with an attachment.

w Open the attachment and click Read Message which, for first-time use only, will launch the SecureMail ID creation.

w You will be asked to create your SecureMail ID and password.

w Then click Continue and you will be taken to your Premera secure email.

administrative Resources

Dental Correspondence Project Underway

For your convenience, we have merged the Appeals Submission Form and Claim Resolution Form. In addition to the merge, we made these improvements to the form:w Added external review process

information

w Added claim/correspondence process resolution information

w Updated the appeal levels: Complaint, Level I, and Level II

The updated Appeals Submission Form is available at premera.com/provider in the Library (select Forms, then Miscellaneous Forms).

Revisions Made to the Appeal Submission Form

Thank YouPremera would like to thank our network

of dental providers and to let you know

how grateful we are for your diligence

in providing quality dental care.

We believe our members—

your patients—deserve the best

and they have it!

Your Provider Network Liaisons look

forward to continuing to work with you

and build our relationship to ensure we

provide our members the best of service,

benefits, and dental care.

We have been studying dental correspondence in an attempt to meet our goal of continuous improvement while looking for ways to work together to improve our relationship with dental providers and members. Our recent focus has been correspondence letters such as additional information requests, benefit advisories, and claims inquiry responses.

Although it has been our practice to provide a personal touch to every correspondence letter, having a standard letter format will help ensure that our correspondence letters are accurate, straight to the point, and professional.

We want our correspondence to meet three objectives. It should be:

Accurate. The accuracy of the information in our correspondence letters is most important, which is why we are developing a fundamental checklist to be used when creating a letter.

Straight to the point. We recognize that you and your dental staff are busy and your time is valuable, so we are reviewing and removing any unnecessary information, so that our correspondence letters contain only the information you need.

Professional: Correspondence letters free of simple mistakes such as spelling, grammar, and punctuation will deliver a professional business impression.

In all correspondence, we include both the provider and member to ensure both parties are informed.


administrative Resources

Premera continues to use Lean methods to improve our work, and recently we used it to study the effectiveness of dental benefit quotes. Lean is a long-term initiative for Premera that has become

a part of our strategic framework supporting our goal of sustainable healthcare.

Recently, in a customer service Lean workshop on dental benefit calls, our Lean team went out to the floor to listen to associates and customers. We asked ourselves a few key questions, like “Would the customer be willing to pay for this?” and “Are we delivering value to the customer?” Our ambitious team focused on identifying waste and trying new ideas. We timed our processes, listened to numerous calls and we identified those activities that were waste from those that provided value to the customer. To ensure we were on the right track we contacted some of our dental providers.

What we accomplished

Lean Helps Dental Providers Save Time With Benefit Quotes

As a result of our Lean workshop:w We were able to collect benefit forms from providers so that we could

understand what they needed. We discovered that many providers had a standard process that we weren’t following.

w We developed a repeatable sequence for each dental benefit call. In Lean terms this is known as standard work.

w We discovered a number of frequently asked questions, so we added them to the standard work. This will save the provider from asking the same question on each call.

w We clarified procedures to ensure that questions were answered with greater quality.

Results

The final results were exciting. We were able to reduce the length of calls from 9-11 minutes each to 5-7 minutes. This is time saved for both the provider and Premera.

At the same time, we managed to improve the quality because through standard work, we were able to ensure that we were providing a complete benefit quote each and every time.

Next Step

The next step involves you. With input from multiple dental offices, we created a Dental Insurance Verification Form. It includes areas to complete when making a call to Premera for a dental benefit quote. Using this form for the quote will save you time as it follows our standard flow for dental benefits.

The form is available on our provider portal at premera.com/provider in the Library section (select Forms, then Miscellaneous Forms).

DENTAL INSURANCE VERIFICATION FORM Use this form as a template for documenting dental benefits when calling Customer Service for a dental benefit quote.

Date: ________________

PATIENT/SUBSCRIBER INFORMATION

Patient Information Subscriber Information

Patient Name: ___________________________________ Subscriber Name: ________________________________

Date of Birth: ____/____/________ Age: _______ Date of Birth: ____/____/________

SSN#: ______________________ Subscriber ID#: __________________________________ Plan/Group#: _________________ Employer Name: _________________________________

Insurance Information Insurance Name: _________________________________ Year Type: Calendar / Plan

Insurance Address: _______________________________ Individual Deductible: $________ Met to date: $_________

Insurance Phone: _______________ Payor ID: _________ Family Deductible: $_________ Met to date: $_________

Insurance Effective Date: ____/____/________ Deductible applies to: Preventive / Basic / Major

Standard COB: Y / N

Dental Maximum: $_______________

Waiting Period: Y / N

DENTAL BENEFITSClass I: Preventive_____%

Class II: Basic_____%

Routine oral exam - Frequency: _____________________ Fillings - Frequency: ______________________________

Routine prophylaxis - Frequency: ____________________ Bitewings - Frequency: ____________________________ Panoramic/FMX - Frequency: _______________________ Fluoride - Frequency: ______________ Age Limit: ______ Sealant - Frequency: ______________ Age Limit: ______ (Sealants limited to Permanent Teeth Only)

Class III: Major_____% Crowns, inlays, onlays, labial veneers, bridge, dentures Prosthetic Replacement Limitation: ___________________ Missing Tooth Clause: ___________________ Implants Benefits: Y / N

Posterior composites reduced on 2nd or 3rd molars: Y / NSimple extractionsPeriodontal maintenance - Frequency: ________________

Allowable under Basic or Major: Endodontic: Basic / Major Perio Scaling: Basic / Major - Frequency: ______________ Osseous Surgery: Basic / Major - Frequency: ___________ Surgical Extractions: Basic / Major Oral Surgery: Basic / Major Nightguards (Bruxism): Basic / Major - Frequency:_______

Orthodontia: _____% Orthodontia Lifetime Deductible: $__________ Orthodontia Lifetime Deductible Met to date: $___________

Diagnostic & Banding Maximum (applies to Orthodontia Lifetime Max): $___________

Lifetime Orthodontia Maximum: $_______________ Age Limit: _______ Disclaimer: This is a summary of plan benefits and is not intended to be a contract. Actual coverage will be determined when the claim is processed

subject to all contract terms, including, but not limited to, member benefits, benefit maximums and subscription charge payment covering the actual

dates of service. This is not a dental pre-determination of benefits or a guarantee of payment.

All services are subject to review of Premera processing policies, medical vs. dental benefit application, dental necessity, cosmetic, and/or alternative

benefit.

An Independent Licensee of the Blue Cross Blue Shield Association

020290 (03-2009) www.premera.com

Filing Electronically and Using COB Feature

If you bill primary claims electronically in the HIPAA ANSI X12837 9 version 4010A1, you also can submit secondary claims in that manner.

Once the primary payor has processed a claim, you can send it electronically to Premera. For successful submission, you must include the primary payor processing information on the claim. This includes the primary payor’s:w Namew Member ID for the patientw Allowed amountw Payment amountw Reason for non-payment (i.e., non-

covered service, applied to deductible, benefit max etc.) in claim note (NTE) field

w Claim adjudication date

If you have questions regarding this process, please call our EDI Department at 1-800-435-2715.


Community Connections

Dental Advisory Board Meetings

At the October 2008 meeting of our Dental Advisory Board, Premera’s manager of the

Provider Network Representatives (PNR) Team, Theresa Gonzales, reported her department’s activities on behalf of the contracted providers. If a PNR cannot help the contracted provider with a question, the provider’s call will be forwarded to their contracting representative or Provider Liaison.

There are numerous provider inquiries related to contract issues handled in Provider Relations:w Provider contract application statusw Provider address/name changesw Credentialing and re-credentialing

status inquiriesw Providers seeking to enroll in our

networkw Fee schedule comparisons

Project Manager Karleen Barich reported that the second highest volume of questions coming to Customer Service is related to dental claims and benefits. While claims and benefit inquiries account for 94 percent of provider Customer Service call tasks, they represent only 31 percent of activity on our secure web site. She presented enhancements made to our secure site to make it easier for providers to use.

In June 2009, the board heard from Jon Wilson, vice president of Application Systems, who headed a team involved in increasing Customer Service efficiency and accuracy for dental benefit quotes. The team has reduced call time standards by four minutes, saving you time on the phone, while increasing quality scores. As a part of this streamlining effort, a Dental Insurance Verification Form is now available on our provider portal,

premera.com/provider, in the Library section (select Forms, then Miscellaneous Forms). We recommend using the form when calling in for a dental quote, because the benefits are laid out in the order a Customer Service Representative goes through them with you.

Deborah Drinkwater, director of HCDS Dental, provided an update on Premera’s plans to grow and remain competitive with a new “Select Network,” while Karen Landro, senior project manager in Provider Services, introduced the Real-Time Estimates/Claims tool recently launched for medical offices. At a future date, this tool will also be available for dental ADA codes, with calculations based on member benefits and the provider contract.

The next Dental Advisory Meetings will be held this fall.

Inland Northwest Dental Conference

This year’s Inland Northwest Dental Conference was held in Spokane on April 24 and 25. It was great to see so many familiar faces and to meet several new people who stopped by the Premera booth. This year, Premera held a drawing for two $50 Visa gift cards. Congratulations to our winners: Rhonda Bishop from Dr. Robb Heinrich’s office, and Dana Beltrame, from Dr. Brooke Cloninger’s office. We look forward to seeing everyone again next year.

Winners Rhonda Bishop (pictured

left) and Dana Beltrame (above).


Community Connections

August Word TeaserUnscramble each of the clue words. Copy the letters in the numbered cells to other cells with the same number.

summer Fun

KNPI

NITHIWNEG

CIFFOE SITVI

CASLLUCO GURDA

LOWYEL

LULF MOTHU SIESER

LAFL

TEJ NIGSIK

TUNSES

PINMALT

MRWA HTNISG

TESDERNU

MUTUAGDROH

WDLI WOLREFS

4

2 18

6 15

5

16 7

10 8

9 14

17 3

1

12

11

13

19

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Ans

wer

s on

page

8.

Supporting the Dental SchoolWith an eye to the future, Premera is proud to support

the UW School of Dentistry. In March we received a nice thank you from Dean Martha J. Somerman for our gift to the Dentistry Dean’s Fund for Excellence and Innovation. “You may be sure your continued support will serve as an inspiration and as a catalyst for future achievements,” her letter stated.

Debbe Hopper and Sylvia Aksdal from Premera attended a “Partners in Diversity” dinner on May 15 at the Northwest African American Museum and had the pleasure of sitting with Dr. Daniel Chan, assistant dean of students at UW Dental School, and Dr. Rick Taylor, Bellevue endodontist. We were pleased to see students who will benefit from these scholarships from Spain, Alaska and St. Lucia, as well as the lower 48 states. Many diverse cultures, including some Aleut and American Indians, are represented.

5


Please post or circulate this newsletter in your office

Network NewsBack issues of Network News are on our

web site at premera.com/provider in the Library under Communications.

001400 (08-2009)

Premera Blue Cross

P.O. Box 327

Seattle, WA 98111

PRESORTED STANDARD

U.S. POSTAGE PAIDSEATTLE, WA

PERMIT NO. 2944

Answers to Summer Fun puzzle words:PinkWhiteningOffice Visit Occlusal GuardYellowFull Mouth SeriesFallJet SkiingSunsetImplantWarm NightsDenturesMouthguardWild FlowersAnswer: Hope you enjoyed summer.

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