A Presentation for the Old Dominion Dental Society

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A New Day For Oral Health In Virginia
Presentation to Dental Advisory Committee April
14, 2006

2
Dental Network Overview
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159 Additional Dentists Have Signed Up
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Total Individual Providers By Specialty

• General Dentists 582
• Pediatric Dentists 77
• Orthodontists 50
• Periodontists - 6
• Oral Surgeons 50
• Endodontists 9
• Prosthodontists 3
• Dental Anesthesiologists - 2

5
Enrolled v. Actively Billing Providers

• Based on claims paid, the percentage of network
  providers actively participating in Smiles For
  Children has increased from 58 to 78.

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Provider Recruitment
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Recruitment Activities Implemented

• Application Assistance Activities
• Doral and DMAS are assisting providers with the
  application process by dropping off and picking
  up applications
• Attendance/Presentation at VDA Component
  Meetings
• Southwest Dental Society March 10, 2006
• Attendance/Presentation at ODDS Component
  Meeting
• Peter B. Ramsey Dental Society (Richmond Area) -
  February 21, 2005
• VCU School of Dentistry Clinic Day April 5,
  2006
• Interacted with approximately 100 visitors
• 4 recruitment packets distributed Commitment
  received from 1 provider
• Follow-up with E-Medicaid Providers
• Follow up currently underway with providers that
  participated in the E-Medicaid program but are
  not participating in SFC
• Provider Meetings and Office Visits
• Doral and DMAS are continuing to conduct
  recruitment visits to provider offices
• January 27
• February 14
• March - 21

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SW VA Recruitment Activities

• Added 6 new providers between January 1 and March
  31, 2006
• 4 General Dentists
• 2 Endodontists
• PATH members, led by Rhonda Seltz, visited 14
  providers in the area to distribute materials
  about Smiles for Children as well as contracts
  and applications.
• Conducted a presentation at the Southwest Dental
  Society on March 10, 2006. There were 63
  providers in attendance. Commitment received
  from one provider.
• Received a list of attendees from the Southwest
  Dental Society Meeting. Follow up with providers
  in attendance at the meeting currently underway
• Identified 2 potential orthodontists in the area.
  Efforts to recruit these orthodontists have been
  initiated.
• FORBA (Small Smiles) will be opening a new
  clinic in Roanoke in June 2006.

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Provider Education Training
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Training Objectives Accomplished

• Presented updates regarding progress towards
  program goals and the latest changes to the
  program
• Clarified and addressed issues related to
  eligibility
• Provided clarification regarding the prior
  authorization process for hospital cases
• Outlined the process for requesting authorization
  for orthodontic treatment
• Reviewed claims processes and procedures and
  provided helpful hints for timely reimbursement
• Discussed issues related to enrollee access and
  introduced new enrollee outreach activities
• Provided a brief overview of provider resources
• Encouraged greater utilization of the Doral
  provider website

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Attendance Survey Results
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Upcoming Recruitment Activities

• Continued provider office visits and application
  assistance
• Development of provider to enrollee ratios and
  needs assessment to determine adequacy of network
  and areas requiring more focused recruitment
• Attendance/Presentation at VDA and Old Dominion
  Dental Society Component Meetings
• Non-Participating Provider Informational
  Sessions
• Conduct at least one Informational Meeting per
  region Northern, Northwest, Southwest, Eastern,
  Central

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Claims
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Time Frame for Claims Adjudication
Average Number of Claims Processed Per Month
28,292 Average Turnaround Time (July 2005
February 2006) 19.70 Days
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Prior Authorization Activity
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Summary of Prior Authorization Activity
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Prior Authorization Orthodontic Denials
First Level Review Criteria Implemented
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Call Center
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Member Calls
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Provider Calls
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Grievances and Appeals
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Grievances Appeals
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Appointment Standards
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Appointment Standards

• Standards
• Emergency 95 of offices will see member
  within 24 hours
• Urgent 95 of offices will see member within
  48 hours
• Routine 95 of offices will see member within
  6 weeks

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Enrollee Outreach
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Broken Appointments

• Broken appointments are
• A major concern for DMAS, VDA, ODDS, and Doral
• Recognized as expensive for dentists
• Lead to dentists unwillingness to participate in
  the program
• Information is needed to better track, trend, and
  understand the issue
• Doral will use the information to
• Educate families regarding the importance of
  appointments and compliance with treatment plans
• Dentists can assist by completing the Broken
  Appointments Log and faxing to Dorals Outreach
  Coordinator
• Medicaid Transportation is available for dental
  appointments (contracted through the health
  plans)

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Appointment Reminder

• Mailed to enrollees who have not accessed care
• Postcard mailing campaign
• Richmond May 2006
• Norfolk May 2006
• Alexandria June 2006
• Roanoke June 2006

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Coming Soon! Beginning Summer 2006, Doral will
enhance its on-line services!
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Electronic Funds Transfer (EFT)

• EFT permits the direct electronic deposit of
  Smiles For Children claim reimbursements into a
  bank account designated by the provider whether
  claims are filed electronically or on paper
• Advantages of EFT include
• No lost checks or Post Office delay.
• Savings of administrative and overhead costs.
• No standing in line at the bank.
• Faster access to funds many banks credit direct
  deposits faster than paper checks
• Easier reconciliation of payments with bank
  statements

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Provider Web-Site Enhancements
Enhanced services will include

• Ability for providers to view status of claims
  and prior authorizations
• Provider information component, including
• On-line newsletter
• Program Information

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Thank You!