 Provider News DentalOctober 1, 2024 October 2024 Dental Provider NewsletterNew Orleans
October 17 - 19, 2024 Don’t miss the fun at the upcoming dental convention. Get ready for some fun and learning. We are going to be at the upcoming dental convention, and we’d love to see you there. It’s a chance for you and your team to meet our team. Remember to drop by our booth # 1623 and say, “Hi.” We’re looking forward to meeting you all. Mark your calendars. Anthem Blue Cross is the trade name of: In California: Blue Cross of California and Blue Cross of California Partnership Plan, Inc. Anthem BC Health Insurance Company is the trade name of Anthem Insurance Companies, Inc. Blue Cross of California, Blue Cross of California Partnership Plan, Inc., Anthem Blue Cross Life and Health Insurance Company, and Anthem BC Health Insurance Company are independent licensees of the Blue Cross Association. In 11 northeastern counties of New York: Anthem HealthChoice Assurance, Inc. and Anthem HealthChoice HMO, Inc. In these same counties, Anthem Blue Cross Retiree Solutions is the trade name of Anthem Insurance Companies, Inc. Independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. CABC-DEN-068791-24-SRS67582 Tobacco use, smoking, smokeless tobacco, compressed dissolvable tobacco, cigars, pipes and water pipes, and electronic cigarettes, is a leading cause of preventable illness and death. The adverse oral effects of tobacco use include gingival recession, impaired healing, oral cancer, mucosal lesions, periodontal disease, and tooth staining. The most effective clinical modalities for treating tobacco use and dependence are counseling, medication, and both in combination. We know that dental practices can provide an effective setting for recognition (finding patients who smoke and offering information about quitting), recommending that patients quit, assessing their willingness to quit, helping with counseling and pharmacotherapy, and arranging for follow-up contact. Cognitive behavioral therapy has been found to improve rates of cessation as do other nonpharmacological strategies (hypnosis and acupuncture). Pharmacological interventions, nicotine replacement therapy, as well as other medications (bupropion, varenicline, inhalers) have been found to be effective. To get started with a program, dental offices will want to include a question about tobacco use as part of their medical/dental history to allow identification of tobacco users and to assess a willingness to quit. Anthem can help through the Quitting Tobacco Roadmap program available to medical members. Other resources can be found on the websites of the American Dental Association and the Centers for Disease Control and Prevention. For enrollees/patients who identify their tobacco use, it is important that your office perform tobacco counseling (D1320) and submit the procedure as encounter data. Link from CDC for reference: https://tinyurl.com/5n7epb8k Anthem Blue Cross is the trade name of: In California: Blue Cross of California and Blue Cross of California Partnership Plan, Inc. Anthem BC Health Insurance Company is the trade name of Anthem Insurance Companies, Inc. Blue Cross of California, Blue Cross of California Partnership Plan, Inc., Anthem Blue Cross Life and Health Insurance Company, and Anthem BC Health Insurance Company are independent licensees of the Blue Cross Association. In 11 northeastern counties of New York: Anthem HealthChoice Assurance, Inc. and Anthem HealthChoice HMO, Inc. In these same counties, Anthem Blue Cross Retiree Solutions is the trade name of Anthem Insurance Companies, Inc. Independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. CABC-DEN-068784-24-SRS67582 We are committed to keeping you, our network partners, updated on our activities related to our compliance with the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI) Timely Access to Non-Emergency Health Care Services Regulations (the Timely Access Regulations). We maintain policies, procedures, and systems necessary to ensure compliance with the Timely Access Regulations, including access to non-emergency healthcare services within prescribed timeframes (also referred to as the time elapsed standards or appointment wait times). We can only achieve this compliance with the help of you, our provider network partners. The following chart includes the access standards that providers are required to meet. Access standards for dental professionalsAccess to | Standard | Non-urgent appointments for primary dental care (PCP) | Must offer the appointment within 36 business days of the request | Urgent care appointments (defined as severe pain, loss of life, limb, or major bodily function) | Must offer the appointment within 72 hours of request | Initial visits of dental examinations and X-rays for primary dental care (PCP) | Must offer the appointment within 36 business days of the request | Hygiene visits for primary dental care (PCP) | Must offer the appointment within 40 business days of the request | In-office waiting room time | Usually, members do not wait longer than 45 minutes to see a dentist or their designee. | After-hours care (when dental office is closed) | Member to reach a recorded answering machine message or live answering service voice response providing instructions on how to obtain urgent or emergency care including, when applicable, how to contact another dentist who has agreed to be on call to triage or screen by phone, or if needed, deliver urgent or emergency care | Emergency appointments (defined as a dental condition that exhibits unresolved pain, excessive bleeding, or swelling below the jaw) | Emergency appointments need to be available as necessitated by the patient’s condition, requiring the dentist to be on call to assess the patient’s needs and determine appropriate appointment scheduling. By contract, participating providers are required to be available 24 hours a day, seven days a week for emergencies and are required to provide an after-hours answering system, which could consist of an answering service, a recording device, a pager system and to return of a call to the member within two hours to assess the nature of the emergency. Must offer the appointment within 24 hours of request |
The Timely Access Regulations have provided exceptions to the time-elapsed standards to address these situations: - Extending appointment wait time: The applicable waiting time for a particular appointment may be extended if the referring or treating licensed healthcare provider, or the health professional providing triage or screening services, as applicable, acting within the scope of their practice and consistent with professionally recognized standards of practice, has determined and noted in the relevant record that a longer waiting time will not have a detrimental impact on the health of the patient.
The following chart includes the access standards we are required to meet. Access to | Standard | Contacting Member Services by telephone to obtain information about how to access clinical care and how to address and/or resolve problems (this is a plan responsibility and not a provider network partner responsibility) | Within 10 minutes to reach a live person by phone during normal business hours |
If you have further questions, please contact us at 866-947-9398. For patients with Department of Managed Health Care regulated health plans:
If you or your patients are unable to obtain a timely referral to an appropriate provider or for additional information about the regulations, visit the Department of Managed Health Care’s website or call 888-466-2219 for assistance. For patients with California Department of Insurance regulated health plans:
If you or your patients are unable to obtain a timely referral to an appropriate provider or for additional information about the regulations, visit the Department of Insurance’s website at insurance.ca.gov or call 800-927-4357 for assistance. Language Assistance programWe offer members free language assistance services using interpreters for both verbal and written communications. If you or the member are interested in these services, please call the Member Services number on the member’s ID card for help (TTY/TDD: 711). For more information, refer to Anthem’s Dental Language Assistance Program for your office article in this newsletter. We hope this clarifies our expectations and your obligations regarding compliance with the Timely Access Regulations. Our goal is to work with our providers to successfully meet the expectations for the requirements with the least amount of difficulty and member abrasion. Anthem Blue Cross is the trade name of: In California: Blue Cross of California and Blue Cross of California Partnership Plan, Inc. Anthem BC Health Insurance Company is the trade name of Anthem Insurance Companies, Inc. Blue Cross of California, Blue Cross of California Partnership Plan, Inc., Anthem Blue Cross Life and Health Insurance Company, and Anthem BC Health Insurance Company are independent licensees of the Blue Cross Association. In 11 northeastern counties of New York: Anthem HealthChoice Assurance, Inc. and Anthem HealthChoice HMO, Inc. In these same counties, Anthem Blue Cross Retiree Solutions is the trade name of Anthem Insurance Companies, Inc. Independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. CABC-DEN-068785-24-SRS67582 We are actively preparing to meet the requirements of California's mandate AB1048. This mandate necessitates the removal of the missing tooth clause from our small group dental plans as well as the elimination of both the missing tooth clause and mandatory waiting periods from our large group dental plans. Please be aware that these changes will come into effect January 1, 2025. This is part of our continuous endeavor to align with state mandates and provide better services to our clients. Anthem Blue Cross is the trade name of: In California: Blue Cross of California and Blue Cross of California Partnership Plan, Inc. Anthem BC Health Insurance Company is the trade name of Anthem Insurance Companies, Inc. Blue Cross of California, Blue Cross of California Partnership Plan, Inc., Anthem Blue Cross Life and Health Insurance Company, and Anthem BC Health Insurance Company are independent licensees of the Blue Cross Association. In 11 northeastern counties of New York: Anthem HealthChoice Assurance, Inc. and Anthem HealthChoice HMO, Inc. In these same counties, Anthem Blue Cross Retiree Solutions is the trade name of Anthem Insurance Companies, Inc. Independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. CABC-DEN-068786-24-SRS67582
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Prime and complete
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All other dental products
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Paper claims address
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Please review the back of the member’s ID card to determine the appropriate dental claims mailing address (address varies by group). In the absence of an address, call the number on the back of the ID card for instructions on where to submit the claim.
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Please review the back of the member’s ID card to determine the appropriate dental claims mailing address (address varies by group). In the absence of an address, call the number on the back of the ID card for instructions on where to submit the claim.
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Electronic claims
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Follow current process or contact your clearinghouse.
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Follow current process or contact your clearinghouse.
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Customer service numbers
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See back of patient’s ID card or call 877-567-1804.
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See back of patient’s ID card
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Grievance/appeals
Note: Sending to a PO Box different than the following, may result in a delay in your appeal.
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Attn: Dental Claims
Appeals & Grievances
P.O. Box 1122
Minneapolis, MN 55440
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Anthem Blue Cross
Attn: Corporate Appeals Dept.
P.O. Box 659471
San Antonio, TX 78265
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Professional services
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866-947-9398
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866-947-9398
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Provider Reference Manual
(PPO only)
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anthem.com/ca/provider/dental
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anthem.com/ca/provider/dental
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Language Assistance Program
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See back of patient's ID card.
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800-627-0004
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Anthem Blue Cross is the trade name of: In California: Blue Cross of California and Blue Cross of California Partnership Plan, Inc. Anthem BC Health Insurance Company is the trade name of Anthem Insurance Companies, Inc. Blue Cross of California, Blue Cross of California Partnership Plan, Inc., Anthem Blue Cross Life and Health Insurance Company, and Anthem BC Health Insurance Company are independent licensees of the Blue Cross Association. In 11 northeastern counties of New York: Anthem HealthChoice Assurance, Inc. and Anthem HealthChoice HMO, Inc. In these same counties, Anthem Blue Cross Retiree Solutions is the trade name of Anthem Insurance Companies, Inc. Independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. CABC-DEN-068793-24-SRS67582 |