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  • Contains 1 Component(s) Recorded On: 09/27/2016

    FREE - sponsored by SKYGEN USA

    If there's one way to make a complex, difficult, and time-consuming task worse, it's to ask someone to repeat that task multiple times. Yet that's exactly what happens to dentists when individual payers request credentialing information to build their dental networks. Dentists or their office managers invest days or even weeks of their time answering all the questions and providing information rather than focusing on patients. Then when it's finally done, here comes another request for the exact same information. It's no wonder payers often have to chase providers repeatedly to complete the application. This presentation will discuss the need for the dental industry to replace the current, repetitive, one-off model with a “one-and-done" centralized credentialing solution that will save time, save money and improve accuracy on both sides. Dentists will only have to provide their credentialing information once; the information will then be available instantly and on-demand to all payers, eliminating repetitive data entry. They will also receive email reminders when certain credentials are set to expire, such as dental licenses, insurance and DEA certificates, to ensure the information remains current.Payers will no longer have to send credentialing applications to each dentist and follow-up multiple times to get the information back; they will simply access the database and request information on the dentists they want for their networks. It's a streamlined, 21st century solution that benefits everyone involved.

    Mike Lessila

    Director of Credentialing Services

    As Director of Credentialing Services, Mike Lessila is responsible for all of SKYGEN USA's credentialing operations. This includes leading the internal credentialing function, working on growth strategies to increase the Credentialing Services provided to clients and managing SKYGEN USA's strategic relationship with the American Dental Association, supporting the ADA Credentialing Portal and its rapid growth in the industry.

    Mr. Lessila formerly was the Director of Business Development for SKYGEN USA, working with senior leadership to develop and execute strategies creating significant growth for the SKYGEN USA family of companies.Mike brings more than 20 years of experience in selecting, selling, designing and implementing new management systems, primarily in the insurance industry, to his role. He holds a Bachelor's Degree in Accounting and Business from Concordia University Wisconsin. He is a Certified Public Accountant.

    Mr. Lessila is on the Board of Directors for Grace Lutheran Church & School in Menomonee Falls, WI and is a volunteer coach for middle school boys and girls basketball.

    John Schaak

    Chief Innovation & Growth Officer

    SKYGEN USA

    As Chief Innovation & Growth Officer, John Schaak is responsible for driving profitable growth through the acquisition of new customers and sales of new products and services. John leads company efforts to solve industry problems by identifying new opportunities and markets, as well as innovative new products and services. With his strong commitment to exemplary client service and collaborative approach to both internal and external relationships, he has a demonstrated ability to help players in the healthcare continuum grow their businesses while reducing costs, improving operations, and serving their members more effectively.

    John brings extensive leadership experience to his position. He was previously the president of Scion Dental and SKYGEN USA’s chief operating officer. Before that, John was a partner with the national law firm Quarles & Brady.

    John has been listed on the Wisconsin Super Lawyers, Rising Stars list multiple times. He holds a Juris Doctorate from Marquette University Law School. He earned a Bachelor of Science Degree in Political Science and Criminal Justice with a minor in Sociology from the University of Wisconsin Oshkosh.

    Annie Driscoll

    Manager, Administrative & Credentialing Services, American Dental Association

    Annie Driscoll has been with the ADA for five years and is currently heading up the business development of the new ADA Credentialing Service. She has led this project since its inception in late 2014 and has brought together a cross-divisional team of ADA staff dedicated to its success.

  • Contains 1 Component(s) Recorded On: 10/18/2016

    Member - Free | Non member - $99

    Julie Bluhm will be presenting on how Hennepin Health, an Accountable Care Organization, has incorporated dental into their integrated health care delivery program for adults in Hennepin County, Minnesota. The program takes a holistic view of health, focusing on each member's medical, dental, mental health, and social needs. Services include housing and social services navigation, employment counseling, intensive case management, and access to clinics designed to meet members' complex needs.

    Gretchen Hageman will discuss how The Iowa Dental Wellness Plan (DWP) is an innovative, earned-benefits program that provides dental benefits for Iowa's Medicaid expansion plan. DWP is a public- private relationship designed to process and better understand health outcomes using dental science to assess the oral health of DWP members. Additionally, members will receive targeted education to improve their dental and overall health based on their personal dental risk assessment.

    Julie Bluhm

    Hennepin Health Clinical Program Manager at Hennepin County

    Julie is the Clinical Manager for Hennepin Health, Hennepin county's health care reform project. She manages the care model, ensuring consistent implementation across sites and work to better integrate social services into the medical home. Julie is always seeking new collaborative opportunities and ways to improve the delivery of services.

    Gretchen Hageman

    Delta Dental of Iowa

    Gretchen Hageman is the Government Programs Director at Delta Dental of Iowa (DDIA).She has been with DDIA for 18 months. Gretchen serves as the director for Iowa's Medicaid Expansion adult benefit and Iowa's State Health Insurance Plan- hawk-i benefit plan.Prior to DDIA, Gretchen worked as a Bureau Chief and Title V Director at the Iowa Department of Public Health for 15 years.Gretchen served for three years on the Association of Maternal and Child Health Programs as a board member and other various child health board and advisory councils in Iowa.

  • Contains 1 Component(s) Recorded On: 11/09/2016

    Member - Free | Non member - $99

    Nearly 2 million people enrolled in standalone dental plans during the 2016 ACA Open Enrollment period. This growing market is different from the traditional group insurance market: consumers are spending their own money and, as a result, they value lower premiums over large networks. Narrowing your network by focusing on the providers with the best fee and utilization profiles can help attract and retain price-sensitive members.

    During this webinar, we will discuss:

    1. An overview of narrow networks on exchanges
    2. Using a targeted approach to select dentists that best fit your profile
    3. Designing plans that will improve your prospects of attracting new exchange members

    Aaron Groffman

    President of The Ignition Group

    Aaron Groffman started the Ignition Group, the healthcare consulting company that powers NetMinder, in 2004. Aaron is an industry veteran, educated at Wharton and the University of Miami, who ran marketing and competitive intelligence functions and built networks for divisions of Cigna and UnitedHealthGroup. He understands the needs of health plans, sales professionals, and network recruiters for accurate, accessible and cost-effective competitive knowledge. Aaron built NetMinder to meet these needs, and continues to improve it each year based on industry insights from users.

    Herschel Reich

    Vice President in the Payer Consulting practice of OptumInsight

    Herschel Reich is a Vice President in the Payer Consulting practice of OptumInsight. He joined the company in 2005 and has helped significantly grow the New York and Northeastern markets as the Office Manager. He has worked in the actuarial health care and managed care arena for more than 25 years with experience in specialization in commercial and Medicare strategy assessments, performance improvement, pricing, underwriting, reserving, product development, alliance development and vendor management for health and ancillary products.

  • Contains 1 Component(s) Recorded On: 01/17/2017

    FREE - sponsored by CAQH

    Efficient and trusted are a few of the reasons why dental health plans are migrating to CAQH ProView.

    Regarded as the industry standard by more than 30,000 dental and 1.4 million healthcare providers for capturing and sharing self-reported healthcare data, CAQH ProView dramatically reduces the time and cost associated with administrative data collection and dissemination.

    CAQH ProView offers enhanced usability and functionality over traditional methods for provider data collection. Developed by the non-profit alliance CAQH® in collaboration with dental and health plans, the solutions enable dental and healthcare providers to use a single, secure, online process to share their professional and practice information with one or multiple plans.

    Join the experts at CAQH to learn how CAQH ProView improves the business processes for dental health plans while:

    • Annually saving on re-credentialing costs.
    • Substantially reducing the processing time for initial credentialing applications.
    • Improving data quality and reducing returned mail

    Ann Brisk

    Director of Business Development, CAQH

    Ann Brisk is a Director at CAQH where she leads the sales and business development strategy and team that offers solutions to payers and other organizations focused on reducing administrative costs in the healthcare industry. Ann previously worked at Optum, part of UnitedHealth Group, in a number of roles in their financial services business focused on claims payments and healthcare accounts. Prior to joining Optum, she held a number of product management and business development roles at several established and start up organizations in the commercial payments business including Bank of America, Visa USA, Bank One and GE Capital. Ann has deep subject matter expertise in payments and healthcare related financial services. She graduated from the University of Colorado at Boulder and currently lives in Salt Lake City, UT.

    Scott Everline

    Sales Manager, CAQH

    At CAQH, Scott identifies target clients and markets for CAQH solutions. He provides consultative sales to prospective health plans, hospitals and other healthcare organizations while developing in-depth understanding of an organization's current business activities as they relate to provider credentialing and network management. Scott also manages implementation and training for all new clients and works internally to align industry needs with CAQH solutions.

    Live Audience Questions from 1/17/17:

    Does the system have API's?

    • Yes, CAQH ProView offers both API feeds and extracts are available through a sFTP server.

    What is the cost per provider to access provider data files? Does the cost scale to the level of use?

    • Annual Fee $3,000, Implementation Fee (one-time) $2,000, Annual Provider Fee $4.50/3.50 per Standard/Allied provider per year. DMD and DDS are considered “Standard” providers.

    One of the most difficult problems in looking up providers is name matching. How much detail is needed in roster files to assure a match to the right dentist?

    • CAQH ProView uses unique identifiers, NPI, SSN, DOB, TIN, etc. in combination with other information for matches.

    Is breakdown of dentists per state available that use CAQH?

    • Yes, Will send updated list shortly to NADP to distribute.

    If a provider directs a plan to CAQH but the plan does it credentialing elsewhere; can the plan get a single file without fully signing up with CAQH for the $3000 annual fee plus $2000 integration fee, etc?

    • The Annual and Implementation Fees are required to access provider data through CAQH ProView. However, a single provider can generate their individual provider application and save as a PDF or print to share with plans. With over 35,000 dental providers in ProView, the value is in more than accessing just single providers.

    Do you have any plans to offer primary verification of the information supplied by the dentists?

    • Yes. CAQH became a NCQA Certified Credentials Verification Organization (CVO) and will be offering primary source verification on all provider types in the Spring of 2017.

    What "sanctions" are checked? BODE, NPDB etc.

    • CAQH continually monitors all state licensing boards, Office of the Inspector General (OIG), Office of Personnel Management (OPM), Systems Award Management (SAM), Medicare and Medicaid Exclusions. A complete list of sources is available upon request.

    How receptive have dental providers been in participating with ProView?

    • Providers have been receptive to CAQH's targeted dental outreach efforts but plan engagement is a must for providers to see value in using ProView.

    How can I see a list of participating plans to see if this would be a worthwhile time investment for my providers?

    In what states are providers currently participating? We are based only in MI.

    • CAQH ProView covers all US states and territories.

    Are the fees separate for ProView, DirectAssure and SanctionTrack?

    • Yes. SanctionsTrack is $2,500 per state a plan operates in, with a maximum of $30,000 annually.

    DirectAssure is an additional $1.68 per provider per year.

    How will primary source verification effect the price?

    • Primary Source Verification will increase the per provider cost over the three-year credentialing cycle and will include all primary source fees and CAQH ProView Provider Fees.

    The presentation referred to File Based exchanges of data, are APIs available at this time?

    • Yes, API is available as well as Extracts available through the ProView portal or sFTP server.

    Is the primary source verification included in the pricing?

    • No PSV is not included in the ProView provider fees. PSV pricing will be bundled to include all primary source fees and CAQH ProView provider fees for the three (3) year credentialing cycle.

    For additional questions, please contact us!

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  • Contains 1 Component(s) Recorded On: 01/24/2017

    Free - Sponsored by Netminder

    Accessibility reporting is part of every sales opportunity and drives many network development decisions. Yet, there are limits to current software solutions. Join us to see how NetMinder can expand and support your existing accessibility reporting. Our discussion will focus on helping your network stand out for small and medium-sized opportunities, with specific emphasis on

    • evaluating network access compared to multiple competitors
    • comparing and contrasting choice and access
    • assessing compliance with network adequacy requirements

    NetMinder is the industry standard for dental and vision network data: 90% of the dental market and 50% of the vision plans trust NetMinder as their credible source. More than 3,000 users run 100,000 reports annually comparing 450 dental, vision, behavioral, and medical networks.

    Aaron Groffman

    President of The Ignition Group

    Aaron Groffman started the Ignition Group, the healthcare consulting company that powers NetMinder, in 2004. Aaron is an industry veteran, educated at Wharton and the University of Miami, who ran marketing and competitive intelligence functions and built networks for divisions of Cigna and UnitedHealthGroup. He understands the needs of health plans, sales professionals, and network recruiters for accurate, accessible and cost-effective competitive knowledge. Aaron built NetMinder to meet these needs, and continues to improve it each year based on industry insights from users.

  • Contains 1 Component(s) Recorded On: 03/14/2017

    Member - Free | Non member - $99

    During the presentation, we will review the current state of the
    legislative environment and how the healthcare discussions will evolve
    in 2017. We will also discuss some trends in the market and how they
    affect exchanges including the health and dental products they offer.
    The future of private exchanges will be addressed including innovate
    approaches exchanges are taking and should take to reach and retain
    members.

    Ryan Howells

    Principal

    Ryan Howells is a principal based out of the Chicago office. His work with clients is focused on health insurance market reforms, disruptive distribution channels that have occurred through the emergence of public and private exchanges, and how the implementation of technology can improve the triple aim of reducing costs, increasing quality, and improving outcomes. He is also currently the executive director of the Private Exchange Coalition (PEC).

  • Contains 1 Component(s)

    Full Voting Member: FREE | Non-Voting Member: $395.00 | Full Price: $895.00

    Revised enrollment report as of 10/16/17:

    Changes to the enrollment report include:

    • A minor data reporting issue has been corrected.
    • Additional clarification on the methodology, additional exhibit footnotes have been added.
    • A handful of typographical errors were corrected



    To provide current information about the prevalence of dental benefits in the population of the United States, the National Association of Dental Plans conducts an annual survey of its membership and other dental benefit providers. The NADP has been collecting this information since 1994 and the findings in this report draw on this history. This report contains specific information on Dental HMO, Dental PPO, dental Indemnity, and Discount Dental enrollment at the national and state level and Direct Reimbursement and publicly funded benefits at the national level.

    While national and state information is provided in this report, no company specific data is reported. Company specific information along with states of operation can be found in NADP's Member Directory.

    NADP's mission is to promote and advance the dental benefits industry to improve consumer access to affordable, quality dental care. For more information regarding this report please contact Jerry Berggren, Director of Research and Information, by calling 972.458.6998 x 113

  • Contains 2 Component(s)

    Full Voting Member: $0.00 | Non-Voting Member: $240.00 | Full Price: $500.00

    This is a new report for NADP in 2017.  In addition to the number of providers participating on a network (DHMO and DPPO) by specialty and by state and MSA, this report includes results from our survey on the operational aspects of managing and maintaining a provider network. Among the topics to be covered in the survey are Narrow Networks, Credentialing, Contracting, Directory Management, Staffing, and Provider Payments and Discount levels. Includes two files: a report of survey results and network statistics and a spreadsheet that includes the counts of dentists participating on networks.

  • Contains 1 Component(s) Recorded On: 03/01/2018

    Member - Free | Non member - $99

    Dental benefits can boost the overall health of America’s workforce whether by integrating dental benefits into medical policies or coordinating the goals of dental benefit design with the goals of employers in offering medical benefits. Some employers are considering the elimination of ancillary benefits, such as dental, vision, disability and life insurance to help manage costs. But, by thinking strategically about how to integrate and coordinate ancillary coverage options – and specifically dental coverage – with medical benefits, dental benefits companies can help build a healthier workforce, generate medical cost savings and ultimately expand dental benefits. Heather Kane, CEO of Dental at UnitedHealthcare, and David DePorter, DDS, Dental Director of Pacific Resources, discuss the links of dental health to overall health and how changes in dental benefit design can boost the overall health of America’s workforce. Learn more about the inner workings of UnitedHealthcare’s Bridge2Health integration platform, and how it’s benefitting businesses by better aligning employees’ whole health needs and enabling proactive medical interventions. Also learn Pacific Resources views on needed changes to the dental benefits landscape to meet employer’s needs. With recent statistics and benefit design insights to validate trends in the industry, this presentation is a value to your company’s development of dental benefit products.

    Dr. David DePorter

    Consulting Dental Director, Pacific Resources

    David is Pacific Resources’ consulting dental director and dental benefits expert.  He has over 25 years of experience in the dental benefits industry including numerous roles in senior and executive level positions with large national payers. Those roles include dental product manager, business lead in utilization management, dental sales lead, and dental director.   

    David’s recent experiences also include a range of dental benefits-related consulting projects, as well as building and directing advanced education in general dentistry residency programs at the Florida Institute for Advanced Dental Education and Mattia College, where he developed a forward-thinking curricula focused on the latest knowledge and industry best practices in dental care.  His dental industry experiences also include active duty in the U.S. Navy as a general dentist, private practice in general dentistry, assistant professor of operative dentistry and assistant director of comprehensive care at the University of Illinois College of Dentistry.  

    David is a graduate of the University of Illinois College of Dentistry.  He later earned a masters degree in health professions education from the University of Illinois at Chicago and a masters degree in public health with a major in health services administration from the University of California at Los Angeles.  In addition, he was a Robert Wood Johnson Dental Services Research Scholar at UCLA, a member of the Woods Hole Group (a Kellogg Foundation-sponsored think tank that studied and made recommendations concerning the future of dentistry) and a past board member on the National Association of Dental Plans Foundation.

    Heather Kane

    CEO of Dental, UnitedHealthcare

    Heather Kane is the CEO of Dental at UnitedHealthcare, based in the company’s Chicago office. Her organization is responsible for the development and management of all dental products and services across the company’s Commercial, Medicare and Medicaid business segments. 

    Heather has a passion for identifying and developing innovative solutions to continuously improve the health care segment, growing start-up businesses, and mentoring new leaders across the organization.

    She is active in non-profit and healthcare-related organizations. She is currently a board member and committee chair of the Gateway for Cancer Research, a non-profit organization dedicated to funding innovative, patient-centered advancements in cancer treatment. Heather earned a Bachelor of Arts degree from Hillsdale College and an MBA from the University of Michigan.  

  • Contains 1 Component(s) Recorded On: 03/02/2018

    FREE

    Last November, NADP issued a press release on the impact of preventive dental care on the cost for care of Medicaid patients with certain chronic conditions. That press release can be found here. On March 2, 2018, Jerry Berggren, Director of Research and Information, presented the findings from that research to an Oral Health 2020 workgroup seeking to expand Medicaid dental benefits to adult populations.

    That presentation was made via conference call and with the workgroup’s permission we are able to make the audio of that presentation available to members and nonmembers.