News for Participating Dental Providers Spring 2010 • Vol. 7, Issue 1 BLUE Impressions INSIDE thIS ISSuE Claims and Billing 5 Dental Radiographs 5 What’s Happening 2-3, 6-8 Did You Know? 2 Attention Dental Providers! Register for CareFirst Direct by March 31, 2010 and Receive a FREE Gift* 5 Continuing Education Registration Form 3 Changes in Provider Information - What Do I Need to Do? 6-8 Note: All references to “CareFirst” in this publication refer to CareFirst BlueCross BlueShield. All references to “CareFirst BlueChoice” refer to CareFirst BlueChoice, Inc. CareFirst was recently approved by the Maryland Academy of General Dentistry to offer continuing education courses. Presentations on Cone-Beam CT Imaging and Caries Prevention and Management will be held on Wednesday, May 12, 2010, at the CareFirst conference center located at 1501 S. Clinton St. The Cone-Beam CT Imaging course begins at 8 a.m. and ends at 10 a.m.; the Caries Prevention and Management course begins at 10:30 a.m. and ends at 12:30 p.m. The Cone-Beam CT Imaging course will provide an overview on how to read Cone Beam CT images and the different clinical applications for dental practitioners. Teaching the class will be Domenick Coletti, DDS, MD, FACS. Dr. Coletti is a former associate professor and division chief of oral and maxillofacial surgery at the University of Maryland. The Caries Prevention and Management class will offer a discussion of classic surgical approach to caries management and an evidence-based medical model to caries prevention and management and review of the relevant literature. Course instructors will be Allan Dworkin, DDS, board certified in pediatric dentistry and a member of the dean’s faculty at the University of Maryland School of Dentistry, and Robert S. Laurenzano, DMD, FAGD, CareFirst’s Dental Director and a past president of the American Association of Dental Consultants. The free courses are an effort by CareFirst to help network providers meet their Continuing Education Units requirements with relevant clinical topics. All attendees are eligible to receive four Academy of General Dentistry-PACE credits. Each course may satisfy two credits towards Continuing Education (CE) requirements. Space is limited to 100 attendees and pre-registration is required. To attend either event, please complete the attached Registration Form and mail or fax to Rosa Nagle (see form on foldout, page 3 for details). If you have questions, please contact Rosa Nagle at [email protected] or 410-605-2697. Registrations should be received by April 30, 2010. Parking is available on adjacent parking lot. CareFirst to Offer Continuing Education Courses CareFirst BlueCross BlueShield is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorse- ment. The current term of approval extends from 1/1/2010 to 12/31/2011.
Transcript
1Vol 7, Issue 1 • Spring 2010 BLUEImpressions
News for Participating Dental Providers Spring 2010 • Vol. 7, Issue 1
BLUEImpressions
INSIDE thIS ISSuE
Claims and Billing 5
Dental Radiographs 5
What’s Happening 2-3, 6-8
Did You Know? 2
Attention Dental Providers! Register for CareFirst Direct by March 31, 2010 and Receive a FREE Gift* 5
Continuing Education Registration Form 3
Changes in Provider Information - What Do I Need to Do? 6-8
Note: All references to “CareFirst” in this publication refer to CareFirst BlueCross BlueShield. All references to “CareFirst BlueChoice” refer to CareFirst BlueChoice, Inc.
CareFirst was recently approved by the Maryland Academy of General Dentistry to offer continuing education courses.
Presentations on Cone-Beam CT Imaging and Caries Prevention and Management will be held on Wednesday, May 12, 2010, at the CareFirst conference center located at 1501 S. Clinton St. The Cone-Beam CT Imaging course begins at 8 a.m. and ends at 10 a.m.; the Caries Prevention and Management course begins at 10:30 a.m. and ends at 12:30 p.m.
The Cone-Beam CT Imaging course will provide an overview on how to read Cone Beam CT images and the different clinical applications for dental practitioners. Teaching the class will be Domenick Coletti, DDS, MD, FACS. Dr. Coletti is a former associate professor and division chief of oral and maxillofacial surgery at the University of Maryland.
The Caries Prevention and Management class will offer a discussion of classic surgical approach to caries management and an evidence-based medical model to caries prevention and management and review of the relevant literature.
Course instructors will be Allan Dworkin, DDS, board certified in pediatric dentistry and a member of the dean’s faculty at the University of Maryland School of Dentistry, and Robert S. Laurenzano, DMD, FAGD, CareFirst’s Dental Director and a past president of the American Association of Dental Consultants.
The free courses are an effort by CareFirst to help network providers meet their Continuing Education Units requirements with relevant clinical topics. All attendees are eligible to receive four Academy of General Dentistry-PACE credits. Each course may satisfy two credits towards Continuing Education (CE) requirements.
Space is limited to 100 attendees and pre-registration is required. To attend either event, please complete the attached Registration Form and mail or fax to Rosa Nagle (see form on foldout, page 3 for details). If you have questions, please contact Rosa Nagle at [email protected] or 410-605-2697. Registrations should be received by April 30, 2010.
Parking is available on adjacent parking lot.
CareFirst to Offer Continuing Education Courses
CareFirst BlueCross BlueShield is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship,Mastership and membership maintenance credit. Approval does not imply acceptanceby a state or provincial board of dentistry or AGD endorse-ment. The current term ofapproval extends from 1/1/2010 to 12/31/2011.
2 BLUEImpressions Spring 2010 • Vol 7, Issue 1
What’s Happening
Effective 12/8/09, The Dental Network and BlueChoice DHMO claims payment
will be made on a weekly basis. This means you will receive payments for DHMO
claims each week versus bi-monthly. This new schedule does not affect capitation
payments as the capitation schedule will remain the same.
For more information, contact the Provider Service area at 410-847-9060 or 888-833-8464.
Did You Know?Pregnant women with untreated gum disease may be risking the lives of their babies as well as the health of their teeth, according to researchers at Case Western University and a study published recently in Obstetrics and Gynecology.
Researchers have linked bacteria from a mother’s gums to an infection in a baby that was full-term but stillborn, according to the study. Expectant mothers have long been warned that gum disease can cause their child to be born prematurely or with low birth weight.
The issue was brought to light when a 35-year-old woman enlisted researchers’ assistance after the stillbirth of her baby. Earlier studies showed that an oral bacterium called Fusobacterium nucleatum could spread from the bloodstream to the placenta in mice, and the woman wanted to know if it was possible in humans.
Bacteria from the mouth can easily get into the bloodstream once a woman’s gums are bleeding. This type of bacteria generally can be easily combated by the immune system of the mom-to-be, whether mouse or human. But because of special conditions that exist in the womb, the fetus can be more susceptible, researchers said.
The woman had experienced heavy bleeding from her gums – a sign of pregnancy gingivitis – during her pregnancy. Bleeding gums aren’t unusual in pregnant women, with about 75 percent developing the condition due to normal hormonal changes. Mild gum disease can be treated simply by brushing and flossing more often. Pregnant women with more serious cases may need gingival surgery.
Uterine infections, which can harm a fetus, are usually caused by bacteria that work their way up from the vaginal canal. But the researchers detected a bacteria in the baby not typically found in the vaginal region. Plaque samples from the woman’s teeth were found to be positive for the exact same strain of the oral bacteria found in the dead baby’s stomach and lungs as confirmed by DNA analysis.
Women shouldn’t be overly alarmed by the new study, researchers said. However, it should serve as a reminder that pregnant women with bleeding gums should see a dentist to treat their gingivitis. Gingivitis can increase the risk of preterm birth anywhere from two to seven times.
The new study underscores the importance of oral hygiene not only for pregnant women, but also for those contemplating pregnancy.
3Vol 7, Issue 1 • Spring 2010 BLUEImpressions
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CareFirst BlueCross BlueShield10455 Mill Run CircleOwings Mills, MD 21117-5559www.carefirst.com
No. of Credit hours 2 credits per course Date of Course May 12, 2010
Provider’s CareFirst Participating Status – List all that apply
o Participating (traditional) o Preferred (PPO) o the Dental Network (DhMO) o Non-Participating
AGD Member? o Yes o No AGD Member #_____________________ (AGD Members only)
Mail or Fax Registration Form by April 30, 2010:
CareFirst BlueCross BlueShield1501 S. Clinton StreetBaltimore, Maryland 21224Attn: Rosa NagleMail Stop: Ct09-09Fax: 410-505-6749e-mail: [email protected]
For additional information contact Rosa Nagle at 410-605-2697.
Space is limited – In the event we exceed full capacity, participants will be notified prior to course date.
5Vol 7, Issue 1 • Spring 2010 BLUEImpressions
What’s Happening
When submitting radiographs to CareFirst for dental services, please submit only radiographs for the procedure codes listed on the List of Required Attachments and ensure the radiographs are labeled properly with the patient’s name and membership number and the provider’s name and address. Radiographs may also be submitted electronically via National Electronic Attachment (NEA). For more information, please contact NEA at 800-782-5150 and select Option #2.
Please submit full mouth x-rays or very clear panoramic radiograph with claims for implants and bridges. All submitted images must be diagnostic and dated.
As a reminder, the submission of any combination of seven or more periapical and/or bitewing procedures reported on the same date of service will be considered a full mouth series (D0210) and, therefore, will be processed as such. For additional information or to obtain a complete List of required Attachments, please visit the CareFirst Web site at www.carefirst.com >Providers and Physicians > Provider Manuals > CareFirst Dental Provider Manuals or contact the appropriate Provider Service area.
Dental Radiographs
CareFirst Direct is an on-line tool that allows registered users to quickly obtain information regarding claims status and patient eligibility and benefits, including limitations and co-insurance.
All information is provided in real-time and is the same information available when speaking to a service representative. CareFirst Direct is free, quick and easy, and provides a printable copy of the information for your records.
To find out more, visit www.carefirst.com > Providers & Physicians > Electronic Services > CareFirst Direct for Dental Providers.
* This promotion applies to new registrations only.
Attention Dental Providers! Register for CareFirst Direct by March 31, 2010 and Receive a FREE Gift*
Claims and Billing
5Vol 7, Issue 1 • Spring 2010 BLUEImpressions
6 BLUEImpressions Spring 2010 • Vol 7, Issue 1
Questions regarding new provider credentialing and changes to provider information are handled in various areas of CareFirst. To reduce the amount of time you spend on the phone and to properly direct you to the appropriate area, we have compiled a list of frequently asked questions. For your convenience, we have provided the answer, forms required and contact information in the chart below. Please note that all required forms can be found on our Web site at www.carefirst.com > Providers & Physicians > Credentialing > Dental (or Medical) Credentialing > Forms & Resources. We also ask that you contact us in advance of any changes to allow us time to make necessary adjustments prior to the effective date.
What’s Happening
Changes in Provider Information - What Do I Need to Do?
Issue What do I need? What forms does CareFirst need?
Who do I call with questions?
Contact information
1) I want to join the CareFirst Dental Provider Network. What do I do?
All providers wishing to join the CareFirst Dental Networks must be cre-dentialed with us. Please download the required forms from our Web site at www.carefirst.com > Provider & Physicians > Credentialing > Dental Credentialing > Forms & Resources and submit with the necessary attachments
* Maryland Uniform Dental Credentialing Form
* Dental Billing Authorization Form
* Current professional license and specialty certification (if applicable)
* DEA* CDS ( if applicable) * Professional liability
coverage certification
Contact Dental Provider Credentialing and Contracting at 443-921-0676 or via email at [email protected]
CareFirst BlueCross BlueShield Dental Provider Contracting and Credentialing
Mail Stop CT06-24Owings Mills, Md. 21117Phone: 443-921-0676Fax: 410-720-5080
2) I want to join the CareFirst Medical Provider Network (for oral surgery, accidental injury, temporomandib-ular joint disor-ders, etc). What do I do?
Providers wishing to submit claims to medi-cal insurance are eli-gible to join the Medical Provider Networks. You must be credentialed. Please download the required Medical Con-tracting forms from our Web site and submit them with the neces-sary attachments
* Maryland Uniform Credentialing Form or District of Columbia Cre-dentialing/Recredential-ing Provider Application
* Billing Authorization Form
* Practice Questionnaire* Current professional
license and specialty cer-tification (if applicable)
* DEA* CDS ( if applicable) * ECFMG ( if applicable)* Professional liability
coverage certification
Contact Provider Information and Credentialing at 410-872-3500 or 877-269-9593
CareFirst BlueCross BlueShield Dental Provider Contracting and Credentialing
Mailstop CG-4110455 Mill Run CircleOwings Mills, Md. 21117-0825Phone: 410-872-3500 or 1-877-269-9593You may also fax a completed form to 410-872-4107
3) I sent in my application to become a provider with the CareFirst Dental Network. What is the status?
Please allow 60 days before calling to check on the status
Contact Dental Provider Credentialing and Contracting at 443-921-0676 or via email at [email protected]
CareFirst BlueCross BlueShield Dental Provider Contracting and Credentialing
Mail Stop CT06-24Owings Mills, Md. 21117Phone: 443-921-0676Fax: 410-720-5080
7Vol 7, Issue 1 • Spring 2010 BLUEImpressions
What’s Happening
Issue What do I need? What forms does CareFirst need?
Who do I call with questions?
Contact information
4) A claim was returned stating that the treating dentist is not contracted. Why?
Most likely, the practitio-ner has not been creden-tialed with CareFirst. If you believe this has been done, then please contact Dental Provider Contract-ing to verify. If not, the required forms must be submitted and the prac-titioner must be creden-tialed with us in order for claims to be processed (see #1 above).
* Maryland Uniform Den-tal Credentialing Form
* Dental Billing Authori-zation Form
* Current professional license and specialty certification (if appli-cable)
* DEA* CDS (if applicable)* Professional liability
certification
Contact Dental Provider Credentialing and Contracting at 443-921-0676 or via email at [email protected]
CareFirst BlueCross BlueShield Dental Provider Contracting and Credentialing
Mail Stop CT06-2410455 Mill Run CircleOwings Mills, Md. 21117
Phone: 443-921-0676Fax: 410-720-5080
5) I am a participat-ing provider and am opening a new office. What do I need?
Please complete a Den-tal Billing Authorization form and submit it to us with a letter providing the new office informa-tion and effective date.
* Dental Billing Authori-zation Form
* Specific office informa-tion on letterhead
Contact Dental Pro-vider Credentialing and Contracting at 443-921-0676 or via email at [email protected]
CareFirst BlueCross BlueShield Dental Pro-vider Contracting and Credentialing
Mail Stop CT06-2410455 Mill Run CircleOwings Mills, Md. 21117Phone: 443-921-0676Fax: 410-720-5080
6) I need to change my tax identifi-cation number. What do you need?
Please complete a Den-tal Billing Authorization form and submit it to us with a letter requesting to change the tax iden-tification number and the effective date
* Dental Billing Authorization Form
* Specific request with current and new tax identification numbers and the effective date on practice letterhead
Contact Dental Provider Credentialing and Contracting at 443-921-0676 or via email at [email protected]
CareFirst BlueCross BlueShield Dental Provider Contracting and Credentialing
Mail Stop CT06-24Owings Mills, Md. 21117Phone: 443-921-0676Fax: 410-720-5080
7) I need a current fee schedule. Where can I obtain one?
Please contact the appropriate Dental Provider Relations Specialist for your area. The Special-ists can be found by visiting our Web site at www.carefirst.com > Provider & Physicians > Find My Provider Rep-resentative > Dental
N/A N/A N/A
8) I need to update my provider in-formation (tele-phone number, remit address, name change, etc.). What do you need?
Please submit a letter to us requesting the appropriate change you wish to make and the effective date.
Specific request and the effective date on practice letterhead
Contact Dental Provider Credentialing and Contracting at 443-921-0676 or via email at [email protected]
CareFirst BlueCross BlueShield Dental Provider Contracting and Credentialing
Mail Stop CT06-24Owings Mills, Md. 21117Phone: 443-921-0676Fax: 410-720-5080
Changes in Provider Information - What Do I Need to Do? (continued from page 6)
8 BLUEImpressions Spring 2010 • Vol 7, Issue 1
What’s Happening
10455 Mill Run Circle Mailstop CT06-24Owings Mills, Maryland 21117
DENTAL DIRECTOR EDITOR Robert Laurenzano, D.M.D Robert Hilson [email protected]
Blue Impressions is published quarterly by CareFirst BlueCross BlueShield’s Corporate Communications Department.
CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are independent licensees of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc.
Issue What do I need? What forms does CareFirst need?
Who do I call with questions?
Contact information
9) We want to add or drop a network with which we participate. What do we have to do?
Request to add or drop a dental network take 90 days to complete. Please submit a letter to us requesting the appropriate change you wish make
Specific request and the effective date on practice letterhead
Contact Dental Provider Credentialing and Contracting at 443-921-0676 or via email at [email protected].
CareFirst BlueCross BlueShield Dental Provider Contracting and Credentialing
Mail Stop CT06-24Owings Mills, Md. 21117Phone: 443-921-0676Fax: 410-720-5080
10) A practitioner in my office is leaving. What do I need to do?
Please submit a letter to us advising the prac-titioner will no longer be practicing in your office and the effective date
Letter advising us of the change on practice let-terhead
Contact Dental Provider Credentialing and Contracting at 443-921-0676 or via email at [email protected].
CareFirst BlueCross BlueShield Dental Provider Contracting and Credentialing
Mail Stop CT06-24Owings Mills, Md. 21117Phone: 443-921-0676Fax: 410-720-5080
Changes in Provider Information - What Do I Need to Do? (continued from page 7)
