Dental DialogFall 2019

Highlighting news, programs, policies and tips for Aetna® participating dentists

Aetna.com43.22.802.1-FA D (11/19)

2Aetna Dental Dialog Fall 2019

Dental DialogFall 2019

Inside this issue

Third molar extractions and opioid use .............................................................................................

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Opioid infographic 4

Announcements 5Aetna Dental® Medicare Advantage 5Timely and accurate customer service results 5

Reconciling solutions 6

Advantages of using DentalXChange 8

Don’t let your Medicare network status change 9

Power up your practice 10

Monthly roster compensation 11

Verify your demographics 12

Notices 13

Working with Aetna 14

Important numbers and addresses 15Dentist Hotline 15Addresses 15Aetna PPO grievances and appeals 15CA Language Assistance Program 15

Dental Dialog is published biannually. Dental benefits and dental insurance plans are offered, underwritten and/or administered by Aetna Life Insurance Company, Aetna Dental Inc., Aetna Dental of California Inc., Aetna Health Inc. and Aetna Health of California Inc.

3Aetna Dental Dialog Fall 2019

In the past, we’ve mentioned being the first dental carrier to cover liposomal bupivacaine (EXPAREL) in conjunction with impacted third molar extractions. We decided to cover EXPAREL to help empower dentists as they strive to prescribe fewer opioids. A recent study confirms that patients who received EXPAREL were prescribed significantly fewer opioids compared to those who did not.

In this study, researchers reviewed data from 600 patients who underwent impacted third molar extractions between 2012 and 2018 in two dental clinics; one in Connecticut and one in North Carolina. Data from 300 patients who received EXPAREL were compared to data from 300 patients who did not receive EXPAREL.

Patients in the EXPAREL treatment group received:

• Fewer total prescribed opioid tablets including refills, compared to patients in the non-EXPAREL group (6.4 tablets vs. 15.5 tablets, respectively; P<0.0001)

• Fewer additional opioid prescriptions compared to the non-EXPAREL group (3.3% of patients required a refill vs. 7.7% of patients, respectively)

The research was presented at the June 2019 International Association for Dental Research meeting in Vancouver, Canada.

A growing number of doctors who perform extractions of impacted third molars are making EXPAREL a part of their treatment protocol, largely as a result of Aetna coverage. Dr. Curt Hayes of Lafayette, CO, was an early adopter of EXPAREL, telling his patients: “Being that the majority of swelling or discomfort usually occurs within the first several hours, using EXPAREL can significantly improve your overall experience and comfort level. Plus, you’ll enjoy added financial benefits now that EXPAREL is covered by Aetna. Aetna enrollees can take advantage of this coverage, without the concern of a rejected claim.”

Watch this video to hear directly from Dr. Hayes about how he is doing his part to address the opioid crisis in America.

Adding to our ongoing efforts to combat the opioid epidemic by encouraging non-opioid pain management options, we are educating our members about non-opioid options to manage their dental pain. One way that we are communicating with members about this is on our Simple Steps website, designed to put the power of oral health information in the hands of our members to help them on their wellness journey.

Aetna Dental continues battle against opioids with groundbreaking program Aetna is combating the massive opioid crisis in our country through coverage of holistic and alternative treatments. We’re leading change in the dental space by offering a pain-management alternative for impacted wisdom teeth removal.

Here’s the problem

12%Dentists prescribe 12 percent of all immediate-release opioids in the United States.1

Dentists are the main opioid prescribers for patients 10 to 19 years old.2

20%of patients with an initial 10-day opioid prescription are still using opioids after a year.3

Here’s our solutionWe’re covering an alternative option to opioids after impacted wisdom teeth removal.

Aetna Dental coverage for EXPAREL® — an opioid alternative

1st

We were the first dental

carrier to cover EXPAREL.

EXPAREL is a non-addictive, one-time injection at the surgical site that relieves pain for the first few days after impacted wisdom teeth removal. We created a program to help increase EXPAREL awareness and use among oral surgeons in our network.

•

EXPAREL may reduce the need to take opioid medicine.

• We cover EXPAREL under all fully insured Aetna dental plans.

Our goal by 2022

50%Reduce opioid prescribing for our members by 50 percent.

To reach our goal:• We’re continuing to expand our EXPAREL program

to any providers who extract impacted third molars.

• We created a helpful resource on our provider search tool to show providers who offer EXPAREL.

1Denisco RC, Kenna GA, O’Neil MG, et al. Prevention of prescription opioid abuse: the role of the dentist. JADA. July 2011; 142 (7): 800 – 810. Available at: NCBI.NLM.NIH.gov/PubMed/21719802. Accessed March 1, 2018.

2Volkow ND, McLellan TA, Cotto JH, et al. Characteristics of opioid prescriptions in 2009. JAMA. 2011; 305 (13): 1299 – 1301. Available at: JAMANetwork.com/Journals/JAMA/FullArticle/896134. Accessed March 1, 2018.

3Shah A, Hayes CJ, Martin BC. Characteristics of initial prescription episodes and likelihood of long-term opioid use — United States, 2006 – 2015. Morbidity and Mortality Weekly Report. March 17, 2017; 66 (10): 265 – 269. Available at: CDC.gov/mmwr/Volumes/66/wr/mm6610a1.htm. Accessed April 27, 2018.

4Aetna Dental Dialog Fall 2019

5Aetna Dental Dialog Fall 2019

AnnouncementsAetna Dental® Medicare AdvantageAetna Dental Medicare Advantage members who are covered under a dental exclusive provider organization (EPO) or a preferred provider organization (PPO) plan are supported by the Aetna Dental PPO network.

Treating patients

As a participating dentist, you’ll be able to see all Aetna Dental Medicare Advantage members, with reimbursements paid according to your Aetna PPO fee schedule.

There are different payer IDs, claims mailing addresses and phone numbers for Aetna Dental Medicare Advantage plans. Always see member ID cards for claims and service information.

Timely and accurate customer service resultsWe strive to make it as easy as possible for you to do business with us. So we closely monitor our results. This helps ensure that your communication with us is timely and accurate.

Here are some results through September 2019:

Percentage of dental claims paid within 15 days:

97.3%

Percentage of financially accurate claims paid:

99.9%

Average time calls are answered within:

17 seconds

Percentage of calls answered within 30 seconds:

90.6%

Percentage of calls abandoned before answered:

0.7%

6Aetna Dental Dialog Fall 2019

Reconciling claims to an electronic remittance advice (ERA) and to electronic funds transfers (EFTs) can be a time-consuming, manual process that can lead to missed reimbursements. With Revenue Cycle Insights, providers can conduct complex analyses and matching processes to align filed claims with received ERAs and EFTs to clearly see what’s outstanding. This can lead to capture of otherwise lost revenue.

•

Save administrative time and costs.

• Identify gaps and opportunities in revenue capture.

• Reduce accounting errors.

• Recognize trends and generate reports.

The tool integrates seamlessly with the Dental Connect® portal. A great feature our customers love about Revenue Cycle Insights is that it allows you to manage claim rejections, denials and resubmittals inside the tool. It also summarizes the potential revenue of a provider or location and gives you the ability to track patient collection accordingly.

Signing up for Dental Connect

Go to ChangeHealthcare.com/Solutions/Dental-Connect, click “Get Started Online,” and follow the prompts. If you have questions, call 1-866-817-3813.

Aetna Dental wants to make you aware of tools that might help your practice. The article above is information about Change Healthcare and Dental Connect.

7Aetna Dental Dialog Fall 2019

How you benefit

•

Reduce the cost of paper, printing, envelopes and postage.

• Save time spent on paper processes, so staff can focus on more important tasks.

• Get paid faster.

Signing up for Dental Connect

It’s simple. Go to ChangeHealthcare.com/Solutions/Dental-Connect, go to “Get Started Online,” and follow the prompts. If you have questions, call 1-866-817-3813.

8Aetna Dental Dialog Fall 2019

We live in an online world, but many dental practices aren’t convinced that sending their claims attachments online is the right step for them. To help practices take the leap, here are the clear advantages to sending your claims attachments online with DentalXChange.

All-in-one design

The DentalXChange Attachment Service is fully integrated into the leading claims processing service, ClaimConnect. This all-in-one software is designed to save time and improve efficiency by providing customizable attachment rules by payer and even by provider, virtually eliminating the sending of unnecessary attachments. It also eliminates duplicate information entry since all of the information on a claim will be with the attachment when it is sent.

Save money

By using ClaimConnect, practices can cut the cost of using third-party software. More savings occur by eliminating the need for paper and postage. It is also much faster, so work hours are cut down.

To learn more, call 1-800-576-6412, ext. 455.

Save time

There is no need to open a third-party program, no need to print and mail; everything is done from the comfort of your computer through easy-to-use snip and paste tools.

DentalXChange Attachment Service

DentalXChange Attachment Service is only

$ 25a month

for unlimited attachments.

There are no registration fees, no contracts and if you sign up now, you’ll receive

$ 10off

through the end of June 2020.

Aetna Dental wants to make you aware of tools that might help your practice. The article above is information about DentalXChange Attachment Service.

9Aetna Dental Dialog Fall 2019

Complete your FDR attestation today

If you are a provider or organization contracted for Medicare Advantage (MA), Medicare-Medicaid plan (MMP), prescription drug plan (PDP and MAPD) and/or Dual Eligible Special Need (DSNP) products, you must meet the Centers for Medicare & Medicaid Services (CMS) compliance program requirements for first tier, downstream and related (FDR) entities found in the Medicare FDR program guide. This is required annually by December 31 of each

year to avoid losing your ability to participate in these products. In addition, once you review and ensure you’ve met the requirements, you’re ready to complete your attestation. Simply click the 2019 Medicare Compliance FDR Attestation link on the page and follow the instructions. A single annual attestation meets all your Medicare and/or MMP compliance obligations. If you have further questions on the program, please review our FDR frequently asked questions or email us at Medicare FDRAttestation@Aetna.com.

How to complete your attestation

You can find the attestation on our Medicare Information and Resources page on Aetna.com. You’ll find information you need to ensure your compliance. Once on the page, click Medicare compliance FDR program guide or FDR frequently asked questions or See our office manual under “Need more information on the Medicare FDR program?”

Where to get more information

If you have compliance-related questions not addressed in our resources, email us at FDRAttestation@Aetna.com or review the FAQs. If you’re an MMP-only provider, you can email us at MedicaidMMPFDR@Aetna.com.

10Aetna Dental Dialog Fall 2019

Power up your practiceSaving your patients’ day means you need tools that work for you, not against you. That’s why Renaissance has built straightforward and cost-effective claims processing software, called Remote Lite powered by RPractice, so you can focus on what’s important. Here is how you can save time and money:

Talk to a specialist

RPractice works with your current practice management software to help you save money, work faster and focus on your patients.

Master your claims

Our software works alongside your practice management system to send claims, upload attachments and resolve rejected claims. And we are here for backup when you need it.

Be a dental heroTo set up a time to install the latest version of Remote Lite powered by

RPractice, schedule an appointment now. Call 1-866-712-9584, or email

Support@DentalHero.com.

Aetna Dental wants to make you aware of tools that might help your practice. The article above is information about the Remote Lite practice management system from Renaissance Electronic Services.

11Aetna Dental Dialog Fall 2019

Monthly roster compensation The Aetna DMO® network and health maintenance organization (HMO) dental rider monthly roster compensation payment schedule for 2019 and 2020 can be found at AetnaDental.com. Click on “Log In/Register” to access the “Welcome to the Aetna DMO Network” page through the “Working with Us” link. If you’re not already registered, click on “Log In/Register” to create your account.

Roster checks are sent within normal U.S. Postal Service mailing time for first class mail. EFT payments should be available in your account by the dates given in the compensation schedule. It is not guaranteed to be transferred on these days.

If you have questions, please call our National Dentist Line at 1-800-451-7715.

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The Aetna preferred provider organization (PPO)/participating dental network (PDN) currently supports members enrolled in a Medicare plan that provides dental coverage as an optional supplemental benefit. Unless you have contacted CMS to be excluded or contacted Aetna Dental directly and are a currently participating provider in the PPO/PDN plan, you agree to comply with all applicable Medicare laws, rules and regulations, including instructions issued by CMS.

CMS requires every Medicare Advantage organization to perform a quarterly outreach to every contracted provider, and to request validation of their demographic information listed in our directory. Aetna uses vendors

(currently the Council for Affordable Quality Healthcare [CAQH] and Availity) to make this outreach each quarter.

When you’re contacted, please comply with the request. We ask that you cooperate fully with the validation and attestation request from our vendors within the allotted time frame. All you do is sign in on their website and complete the attestation about your demographic information. Providers who do not comply with the validation request may result in further action, including directory suppression and ultimately the termination of participation in our Medicare Advantage plans.

Visit us at Aetna.com/staycurrent to help you keep this information updated.

It’s easy to let us know

Just log in at AetnaDental.com and go to the DMO or PPO welcome page. Select the appropriate form to send back to us.

13Aetna Dental Dialog Fall 2019

NoticesHandling information/record requests for domestic violence victims

New York law requires insurers to develop a confidential way to handle information/record requests for victims of domestic violence. We must follow the protocol that the Privacy Office created.

View the protocol document. Please print the notice and hang it in your office.

Dentists in California: Use the Language Assistance Program (LAP) for non-English-speaking members

As a reminder, participating dentists in California must use the LAP when they provide care to non-English-speaking Aetna members. There’s no charge for this service. Call 1-800-525-3148 (TTY: 711) to reach an interpreter. This number bypasses our Dental Service Center. It connects members directly to qualified interpreters.

Rhode Island complaints and appeals process Rhode Island requires we remind you annually of the complaint, grievance and appeal process available to members and providers. Please visit Aetna.com for the Rhode Island Complaints and Appeals process available to all members and providers, both participating and nonparticipating. You can find the appeal process under Aetna.com/health-care-professionals/insurance-regulations-state.html and select the Rhode Island drop-down menu. As always, you can contact Provider Services with any questions.

Grievances and appeals process We have a formal process that allows dentists to file an appeal when they:

•

Do not agree with a payment decision.

• Do not agree with a clinical decision.

• Do not agree with the Usual and Customary Reimbursement (UCR) allowance.

You can find complete details for the grievance and appeal process on our Dispute and Appeal Process page on AetnaDental.com.

Get quick claims tips.

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Working with AetnaThe Aetna Dental Access® network and Aetna Dental® Administrators plans continue to grow. Here’s a quick reference guide to help you easily welcome these participating patients to your office.

Aetna Dental Access

Discount programs supported by theAetna Dental Access network

Yes No

PCD selection required

PCD referral required

Submit claims to Aetna

Collect payment from patient at the time of visit

Program overview:

•

Discount programs are not insurance.

• ID cards: Program names and brands will vary. Look for the Aetna Dental Access logo; it will appear on all ID cards.

• You don’t need to file a claim.

• Patient is responsible for entire payment at time of service. The payment is based on PPO fee schedule.

• Call with questions. You’ll find the number on the patient’s ID card.

• Visit AetnaDental.com for a list of current plans that the Aetna Dental Access network supports.

Aetna Dental Administrators

Benefits plans supported by the Aetna Dental Access network

Yes No

PCD selection required

PCD referral required

Submit claims to address on ID card (may not be Aetna)

Program overview:

•

Third-party administrators and other payers may administer these programs. Program designs may vary.

• ID cards: Program names and brands will vary. Look for the Aetna Dental Administrators logo; you’ll find it on all ID cards.

• Submit claims to the address on the ID card only.

• Call number on patient’s ID card to verify eligibility.

• Visit AetnaDental.com for a list of current plans that Aetna Dental Administrators supports.

Aetna Dental Access will appear on different ID cards

in different places.

The Aetna® Vital Savings discount program is supported by the Aetna Dental Access network.

Aetna Dental Administrators will appear on different

ID cards in different places.

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Important numbers and addressesDentist Hotline

National Dentist LineHave a question about the network, claim status, member eligibility, contact information or DMO supplies? Call the National Dentist Hotline at 1-800-451-7715 (TTY: 711).

Dentist Contracting HotlineFor PPO contract information, call the Dentist Contracting Hotline at 1-800-776-0537 (TTY: 711).

Addresses

All claims and specialist referralsAetna Dental PO Box 14094 Lexington, KY 40512-4094

Encounters and encounter listingsAetna Dental PO Box 14530 Lexington, KY 40512-4530

Aetna PPO grievances and appealsCall the Dentist Contracting Hotline at 1-800-776-0537 (TTY: 711) for the correct mailing address.

Dentist web addressGo to AetnaDental.com to:

•

Update your personal information, including your NPI and email address.

• View Dental Office Guides.

• Get continuing education courses, and more.

Aetna DMO grievances and appeals

Northeast region

(CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VA, VT, WV)

Aetna Dental PO Box 14080 Lexington, KY 40512-4080

South region

(AL, AR, FL, GA, LA, MS, NC, OK, SC, TN, TX)

Aetna Dental PO Box 14597 Lexington, KY 40512-4597

West region

(AZ, CA, CO, HI, IA, ID, IL, IN, KS, KY, MI, MN, MO, NE, NM, NV, OH, OR, UT, WA, WI)

Aetna Dental PO Box 10462 Van Nuys, CA 91410

Please note: The PO box number and the last four digits of the ZIP code vary with each address.

CA Language Assistance ProgramFor free interpretation services, call 1-800-525-3148 (TTY: 711).

Aetna Dental Dialog Spring 2019

The opinions expressed or articles in this publication are not intended to provide dental/medical nor legal advice nor any endorsement by Aetna of any specific product, vendor, drug or pharmaceutical.

Articles or opinions written by individual contributors do not necessarily reflect the views of Aetna.

Aetna does not assume any liability in connection with the use or implementation of any techniques, policies or procedures discussed in this newsletter.

While this information is believed to be accurate as of the print date, it is subject to change. Refer to AetnaDental.com for more information about Aetna networks. aetnadental.com.

Comments and suggestions are welcome. Please email: DentalDialogNewsletter@aetna.com

©2019 Aetna Inc. 43.22.802.1-FA D (11/19)