Updatea quarterly newsletter for dentists and staff

3 ProviderSpotlight

4 ConvertingaPre-Determination

toaClaim

5 ClassesandSeminars

6 ImplantCoverageToBenefit

SubscribersAndProviders

8 ProgramIntegrity

IN THIS ISSUE

SPRING 2012

The Delta Dental of Colorado Board of Trustees recently voted to designate a “Good Ideas Fund” to support Colorado’s communities. As a local non-profit with a mission to “improve the oral health of the communities we serve,” we are pleased to announce the following grants which support Delta Dental’s mission:

1) OralHealthWinnableBattles -$100,000: This grant supports the Office of the Governor in efforts to address policy issues related to oral health.

2) OralHealth in theMedia -$50,000: I-news Network of Colorado will produce in-depth journalism related to oral health issues. Funds will be used for researching, reporting, and production of in-depth multi-media packages on oral health. Multi-media communications produced will use a variety of platforms including print, TV, radio, and online media. The ultimate goal of this funding is to raise awareness of the important correlation between oral health and overall health.

3) PublicServiceAnnouncements -$100,000: Funds will go toward public service announcements using the successful No Kidding! campaign theme to demonstrate the link between oral health and overall health. Messaging also includes the importance of childhood cavity prevention and early dental visits.

continuedonpage2

The Good Ideas Fund

Our Mission: To improve the oral health of the communities we serve.

delta dental of colorado update page 2

4) PediatricOralHealthforLow-IncomeChildren-$50,000: This grant supports the work of Dr. Patricia Braun of Denver Health, who is determined to strengthen collaborationbetweenthemedical/dentalcommunities.Thisgrantwilladdressthe connection between oral health and systemic health, focusing on developing strategies to improve the oral health of low-income children.

5) UniversityofColoradoSchoolofDentalMedicine,FrontierCenter$1,000,000: This grant will support the Delta Dental of Colorado Foundation Early Childhood Caries Endowed Chair. It will help recruit a candidate to hold the endowed Chair position – supporting Colorado’s leadership in research and teaching related to early childhood caries prevention.

continuedfromcover

New large group for Delta Dental of Colorado means more patients for you!

Delta Dental of Colorado is pleased to announce a new large-group client: Chipotle Mexican Grill. With 900 locations across the US, Canada and Europe, Chipotle has more than 1,900 members worldwide. This new group adds to DDCO’s growing list of restaurant industry clients. Chipotle became effective with Delta Dental of Colorado on January 1, 2012.

We Value Your Opinion This newsletter is meant to be an informative and useful

publication for providers and office staff. E-mail your ideas, suggestions and comments to the

Delta Dental of Colorado editorial team at updatenewsletter@ddpco.com.

Minty Fresh Changes Coming Soon

Isn’t it refreshing when a company listens? We’re making improvements to please our customers, including:

• going green with Electronic EOB statements

• streamlining group administration

• adding new implant coverage

• enabling real time eligibility updates

• adding online billing

• making Maximum Plan Allowances more transparent and more!

Keep your eyes open for more information on the minty fresh changes we will be introducing throughout 2012!

delta dental of colorado update page 3

It’s springtime in Colorado. A time of rejuvenation and life. Shades of green paint the landscape, signaling a time of growth and new beginnings.

The same rings true in Durango, Colorado – the small, western slope ranching town where Dr. Vaughn Johnson practices orthodontics. As the frigid winter landscape gives way to the first warm breaths of spring, the cycle of life on the ranch starts once again.

The oldest of seven siblings, Dr. Johnson’s family’s ranching history is rich, dating back to the original 200-acre family farm in La Jara, Colorado. “I’ve been around livestock all my life - since I was a little kid,” he recounted. “My family took care of 100 head of cattle on that first ranch, and in eighth grade we moved to a 200-acre ranch in Durango, Colorado. So obviously,

Dr. Vaughn Johnson

Provider Spotlight

ranching is something I was born into. I chose to become an orthodontist.”

And speaking of, how does one make the transition from rancher, to a highly educated doctor of dental surgery with a master’s of science in oral biology and a certificate of specialization in orthodontics? “Actually, the two professions are actually quite similar,” he surmised.

“In either profession, teamwork and planning are paramount,” he explained. “There’s just too much work, too much to be aware of, for any one person to handle the responsibility.” He refers to his staff as the glue that holds the practice together. His extended family plays a similar role on the ranch.

Ranching, the doctor explained, is a cyclical business based on teamwork. “In ranching, things have to happen in a certain order. What you do in the spring might not be relevant until you reap the crop in the fall, but you can’t get a crop without planting the seed.”

He said the same rings true for orthodontics. “We see a patient who needs treatment, and we develop a plan. It may take years of baby steps, but one day that patient’s smile will be completely transformed. That really feels good – it gives everyone involved a sense of accomplishment.”

No different he reassures, from the sense of teamwork and accomplishment he feels as his family pulls together to help with each season’s ranching chores.

“Haying and calving are two seasons that require all hands on deck. It simply can’t be done without teamwork. It’s an excellent chance for generations of my family to work side-by-side,” he said. “And of course there’s a bond – When we finally complete one of these major chores, there’s a unique family pride and sense of accomplishment that seems to radiate out of everyone on the ranch.”

The fall round-up is a particularly special time for Dr. Johnson. His brother, Dr. Rex Johnson, is also an orthodontist. During the round-up, the doctors take advantage of the hours riding the open plains to share orthodontic tips and hints. “We have fun. We’ve started referring to our fall round-up as the Orthodontic Study Club. Rex and I get some great ideas from one another – I suppose cattle herding stimulates interpersonal communication for us,” he laughed.

“Things I learned from my family about team work have definitely translated to my orthodontic practice – and vice versa,” he concluded.

Life on the Open Range (as an orthodontist)

We’ve started referring to our fall round-up as the Orthodontic Study Club. – Dr. Vaughn Johnson

From left to right Dr. Johnson’s nephew, Jacob; son, Derek; daughter, Delanie; and brother, Rex

Dr. Johnson and his family enjoying Colorado's natural landscape

Dr. Johnson (far right) with his brothers, Rex (left) and Jay (middle)

delta dental of colorado update page 4

It’s simple to convert a pre-determination into a claim – just follow these steps:

1. Note that you must use the Delta Dental of Colorado website, not your practice management software.

2. Visit www.deltadentalco.com, go to the Provider area and log in.

a. Log in as a provider by typing your username and password in the Provider Login box

b. Type the patient’s information into the Find a Patient search feature

c. Once the patient’s information is displayed, click on the Treatment Plans tab

d. The pre-determination previously submitted will pop up. If one wasn’t submitted, the box will read ‘No treatment found’

e. Enter the date of service, then submit the claim for payment

HINT: On the pre-determination, you can subtract any treatments not performed, but you cannot add any new treatments.

Tips and Hints: Converting a pre-determination to a claim

Direct Deposit iPAD Winners

In 2011, we touted the benefits of direct deposit. It’s such a great, convenient service and we thought everyone should know about it! Near the end of the year, we held a promotional period, during which offices enrolling in direct deposit or referring another office to direct deposit were entered in a drawing for four iPADs. Congratulations to the promotion’s winners:

• Dr. Jeff Spiegel-Comfort Dental-Littleton

• Dr. Justin Bley-Greeley

• Dr. David Jacobson-Grand Junction

• Dr. Chad Watts-Colorado Springs

Thank you to everyone who has enrolled in direct deposit so far!

Important Information About Dental Benefits

Your patients’ Delta Dental benefits are determined by their employer. Dental treatment performed should be based on dentist/patient mutual agreement and be completed with the best interests of the patient in mind. Your claims will be processed in accordance with the employer group contract and the Delta Dental National Processing Policies that you have contractually agreed to follow.

delta dental of colorado update page 5

Classes & Seminars

Delta Dental offers free educational seminars and CPR classes to participating dentists and their office staff. Space is limited and registration is required.

Dental office staff seminars provide timely and relevant information on “what’s new” at Delta Dental of Colorado.

Allseminars/classestakeplaceonFridaysatDeltaDentalofColorado,unlessalocationotherthanDenverislisted.For other locations, a Provider Relations representative will contact you with location information.

Denver Classes & Seminars

Delta Dental of Colorado 4582 S. Ulster Street, 12th Floor Denver, CO 80237

Please RSVP for classes and seminars at least 10 days prior by calling (303) 889-8677 or by downloading a registration form from the Provider section of www.deltadentalco.com.

Dental Seminars – What’s New at Delta Dental

Colorado Springs April 20th 9 AM to Noon Hyatt Place at Garden of the Gods

Loveland May 4th 9 AM to Noon Fairfield Inn & Suites

Boulder July 27th 9 AM to Noon Boulder Inn - 28th Street

Denver August 24th 9 AM to Noon Delta Dental – 12th Floor

Grand Junction September 7th 9 AM to Noon Residence Inn Marriott

Colorado Springs September 7th 9 AM to Noon TBD

Denver/ TBD in October 1PM to 4PM Delta Dental – 12th FloorOrtho Seminar

CPR Classes

Denver April 13th 1 PM to 4 PM Delta Dental – 12th Floor

Colorado Springs April 20th 1 PM to 4 PM Hyatt Place at Garden of the Gods

Loveland May 4th 1 PM to $ PM Same location as Seminar

Boulder July 27th 1 PM to 4 PM Same location as Seminar

Grand Junction September 7th 1 PM to 4 PM Same location as Seminar

Colorado Springs September 7th 1 PM to 4 PM Same location as Seminar

Denver October 19th 1 PM to 4 PM Delta Dental – 12th Floor

Denver November 30th 1 PM to 4 PM Delta Dental – 12th Floor

delta dental of colorado update page 6

Having trouble finding what you need on our site? Make sure you’re not going to the national portal – www.deltadental.com. Delta Dental of Colorado’s website is www.deltadentalCO.com.

Update Newsletter E-bites Coming SoonAre you a techie? Addicted to your iPhone or Blackberry? If so, you’ll be happy to hear that Delta Dental is taking the Update newsletter electronic! Sent quarterly, the Update e-bites will provide timely, relevant, dental benefits-related information, delivered to your in-box in electronic format.

Not a techie? Not even close? No worries! Many people still prefer a paper copy, so we will also continue to mail hard copies of the Update newsletter to you on a quarterly basis.

Want to make sure you receive these important updates? Send an e-mail to profservices677@ddpco.com and ask to be added to our e-mail distribution list.

Implant Coverage to Benefit Subscribers and ProvidersDelta Dental of Colorado is always searching for ways to add value to dental benefits – for our providers and our subscribers.

We’re excited to announce that in July 2012, all small groups (1-100 enrolled employees) will benefit from implant coverage, which will automatically be added upon their next renewal.

For Delta Dental’s larger groups (100+), implants have always been an option that can be added at the group’s request.

Please check the Patient Benefit Report for each of your patients to determine how their group covers implant services. The Patient Benefit Report can be accessed in one of two ways – click the Full Benefit Report link on the member’s Dental Benefits tab in our website, or request a faxback document through our Automated Call Center at 1-800-610-0201.

Reminder: Please do not send x-rays with claims, unless requested. This will save you time and money!

delta dental of colorado update page 7welcome

ArvadaDr.JungsooByun Prem/PPODr.DavidZeitlin Prem/PPO

AuroraDr.DavidBird(Endo) Prem/PPODr.NataliyaDonskaya PremDr.YukiDykes PPODr.GeorgeHilal(Perio) Prem/PPODr.MichaelMcEwan(Ortho) Prem/PPODr.KimdungTran Prem/PPO

BoulderDr.KyleDaniel PPODr.BenjaminMcEvoy Prem/PPODr.RaymondRoper PPO

BroomfieldDr.RobertBerry Prem/PPO

Castle RockDr.ChadCarubia Prem/PPO

CentennialDr.MichaelHarmon PPODr.LarryHaws PremDr.PhillipJohnson PPODr.RyanReyes PremDr.MariaSong-Johnson PPO

Colorado Springs Dr.ScottBrinton PPODr.JoshuaCarter PPODr.PaulDodsworth PPODr.JamesHenry PremDr.GeorgeHilal(Perio) Prem/PPODr.JeremyHood PremDr.VanessaKaplan(Ortho) Prem/PPODr.TracieKeller PPODr.KjellRagnar Prem/PPODr.ChristopherRoot Prem/PPO

ConiferDr.GraceJeong Prem/PPO

CortezDr.JosephVreeken Prem

CraigDr.OwenAtkin Prem

Denver Dr.KateBrokaw Prem/PPODr.RichardDruckman(Prosth) Prem/PPODr.TimothyNichols(Pedo) Prem/PPODr.ChristopherRoot Prem/PPODr.BabakShahrokh Prem/PPODr.ErinSundt PPODr.SonyaVillarreal Prem/PPO

EdgewaterDr.LisaBennett Prem/PPO

Fort CollinsDr.AndreaMustian Prem/PPODr.BrandonNielson Prem/PPO

FountainDr.ScottBrinton PPO

Glenwood SpringsDr.MichaelMcEwan(Ortho) Prem/PPO

Grand JunctionDr.EricBenefield Prem/PPODr.BrandonBerguin PPODr.AaronBirch PPODr.StephenKelly(Oral) PPODr.MichaelMcEwan(Ortho) Prem/PPODr.DavidNock(Oral) PPODr.TrentonRoss PPODr.JohnWood PPO

GreeleyDr.JustinBley(Oral) PPODr.ChristopherRoot Prem/PPO

Highlands RanchDr.BrettLancaster Prem/PPO

LakewoodDr.RobertTeitelbaum(Endo) PPO

LittletonDr.PhillipJohnson PPODr.MichaelMcEwan(Ortho) Prem/PPODr.ChristopherMorris PremDr.MariaSong-Johnson PPO

LoneTreeDr.GinaSmith Prem/PPODr.EricWalker Prem/PPO

LongmontDr.ChristopherRoot Prem/PPO

LovelandDr.AaronTuchklaper Prem/PPO

MontroseDr.TimothyJessop PremDr.JoeStucky PPO

ParkerDr.NathanielSherman Prem/PPO

SilverthorneDr.ErinSain Prem/PPO

Steamboat SpringsDr.WilliamSchwartz Prem

WestminsterDr.MichaelMcEwan(Ortho) Prem/PPO

Winter ParkDr.DavidLurye Prem

Delta Dental’s Networks Keep Growing! }

DeltaDentalofColoradowelcomesthefollowingnewdentiststoitsnetwork(specialties are noted in parentheses when applicable):

PREM=DentistswhohaverecentlyjoinedtheDeltaDentalPremier®network.

PPO=DentistswhohaverecentlyjoinedtheDeltaDentalPPOSMnetwork.

PREM/PPO=DentistswhohaverecentlyjoinedtheDeltaDentalPremierandDeltaDentalPPOnetworks.

Update

PRSRT STDU.S. Postage

PAIDDenver, CO

Permit No. 336Delta Dental of Colorado

P.O. Box 5468

Denver, Colorado 802ı7-5468

Delta Dental of Colorado maintains an integrity program to ensure that participating dentists abide by the terms of their Participating Dentist Agreements. The integrity program also encompasses Delta Dental’s anti-fraud efforts.

A key component of the integrity program is compliance audits of dental offices. If your office is selected for an audit, you will receive prior notice. Audits are conducted in a manner that is minimally disruptive to your practice.

During compliance audits, the examiner reviews patient chart notes and account ledgers to verify:

• The dentist has collected the applicable copayment and/or deductible, ormade a reasonable attempt to collect the applicable amount.

• Delta Dental of Colorado patients have not been billed for any amountsindicated as not chargeable to the patient on the Explanation of Benefits statement.

• Informationsubmittedontheclaim,orinsupportofaclaim,isaccurate.

Participating dentists agree to cooperate with the compliance program under Section 9, item b, of the Participating Dentist Agreement.

Program Integrity