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  • 2015 NADP Dental Benefits Report: Financial Operations

    Contains 1 Component(s)

    Full Voting Member: FREE | Non-Voting Member: $200.00 | Non Member: $400.00

    To provide current information about the financial condition of the dental benefits industry, the National Association of Dental Plans conducts an annual survey of its membership and other dental benefit providers to assess the financial condition of dental benefit providers.

  • *FREE* Paper Dental Claim Processing: Best Practices in Action (2016)

    Contains 1 Component(s) Recorded On: 08/25/2016

    FREE

    In the last educational webinar, Information Capture Solutions (ICS) discussed the best practices associated with the labor-intensive task of processing paper dental claims. From the mail room, OCR technology, scanning equipment, to finding the right outsource partner there are many avenues you can pursue to improve your paper to EDI process. ICS continues the series by putting these best practices into action and taking a look at the real-world results and benefits that these new implementations can bring to your organization. By taking a look at your internal paper process and understanding where improvements can be made, you can save you and your employees countless hours of time, as well as saving your organization valuable dollars that are not wasted by an outdated and labor dependent process.

    Brant Poore

    President, CEO & Co-Owner

    Brant Poore, Co-Owner and Chief Executive Officer of ICS has been in the Content Management, Data Capture, and Document Imaging business for two decades, since beginning his career in 1994 with a document scanning service bureau that was later acquired by a national BPO organization. During that time Brant served in all aspects of software application development, including:

    • Project Analysis
    • Technical Design
    • Application Development
    • Staff Management
    • System Support

    Today Brant oversees all aspects of technical design, future planning, and customer support for ICS. Brant has served as a founding member of the EMC Captiva Users Advisory Council to help provide ICS customers with the best product on the market. Brant is a certified EMC Proven Professional using the Captiva line of products, helping some of the largest companies and state agencies in U.S. implement document imaging and workflow automation solutions.

    Ray Shears

    VP, Chief of Business Operations & Co-Owner

    Ray Shears, Co-Owner and Chief of Business Operations for ICS has been in the Content Management, Data Capture and Document Imaging business since 1997. Ray served as an Account Executive to state and local government as well as private organizations while working for a national BPO organization. During that time Ray was responsible for all aspects of Account Management duties including:

    • New Customer Relations
    • Business Needs Evaluation
    • System Configuration
    • Resource Analysis
    • Solution Pricing
    • Continued Customer Service

    Today Ray continues his responsibilities as Account Manager of ICS's existing customers but also adds the responsibilities of a business owner, leading ICS efforts in:

    • Future Growth Planning
    • Market Planning & Research
    • Contract Negotiations
    • Financial Management

    Brian Tuttle

    Senior Project Manager

    Brian Tuttle, Senior Project Manager for ICS has been in the Content Management, Data Capture and Document Imaging business since 1997. Brian has served as a project manager on multiple state and local government jobs focused around document and claims capture. Brian has also served as lead project manager on 6 dental claims processing accounts. Brian's duties and responsibilities consist of:

    • Specifications and requirements gathering
    • System design
    • System implementation
    • Project schedule creation

    Brian is certified EMC Proven Professional for content management. Brian's knowledge and skill set allow him to effectively manage and control the build out of a claims capture process all the way from specifications gathering, to testing, to implementation. Brian insures the client's needs are met and that the system performs as expected.

  • 2016 Dental Benefits Report: Enrollment

    Contains 1 Component(s)

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

    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

  • NADP/LIMRA 2015 U.S. Group Dental Claims Processing Metrics (published Sept 2016)

    Contains 1 Component(s)

    Full Voting Member: $0.00 | Non-Voting Member: $200.00 | Full Price: $400.00

    In 2005 LIMRA International and NADP conducted their first annual joint research study to survey group dental carriers' contact center and claims processing performance. This report, the ninth in the series, provides dental carriers with an industry-specific performance benchmark for customer contact center performance.

  • *FREE* One and Done: Bringing Dental Provider Credentialing Into the 21st Century (2016)

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

    FREE

    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 Operating Officer, SKYGEN USA; Webinar Moderator

    John Schaak and his team are responsible for driving growth, operational performance, and customer satisfaction across SKYGEN USA’s suite of solutions. He leads efforts to improve effectiveness and efficiencies in the company’s benefits administration solutions, advance business services including client implementations, and increase customer responsiveness, making it easier for clients to do business with SKYGEN USA as their strategic solutions partner. 

    John is an experienced speaker who, among other things, takes every opportunity to speak about the need to protect children from pediatric dental abuse. He has been listed on the Wisconsin Super Lawyers, Rising Stars list multiple times, and 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.

  • 2015 NADP/LIMRA Customer Contact Center Metrics Report (Published October 2016)

    Contains 1 Component(s)

    Full Voting Member: $0.00 | Non-Voting Member: $200.00 | Full Price: $400.00

    In 2005 LIMRA International and NADP conducted their first annual joint research study to survey group dental carriers' contact center and claims processing performance. This report, the ninth in the series, provides dental carriers with an industry-specific performance benchmark for customer contact center performance.

  • Dental in ACO's (2016)

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

    Member- $100 Non Member- $195

    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.

  • NADP/LIMRA 2015 U.S. Group Dental Administrative Metrics (published October 2016)

    Contains 1 Component(s)

    Full Voting Member: $0.00 | Non-Voting Member: $200.00 | Full Price: $400.00

    In 2005 LIMRA International and NADP conducted their first annual
    research study to survey group dental carriers' contact center performance.
    This report has evolved to cover an expanding set of issues related to benefit
    administration. It now focuses on carrier performance on such metrics as
    membership group maintenance, ID cards processing and network
    maintenance–administrative benchmarking metrics were added in 2009.
    The current business environment—high price sensitivity and health care
    reform requirements—highlights the importance of effective management of
    the administrative components of dental plans.
    It is increasingly important for carriers not only to meet the industry
    standards in high quality customer care, but also effectively differentiate
    themselves from competitors.

  • Competing on the Exchanges: Narrowing Your Dental Networks (2016)

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

    NADP Member - $100 - Non Member - $195

    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.

  • *FREE* Streamline Dental Provider Data Collection and Reduce Costs Annually with CAQH ProView® (2017)

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

    FREE

    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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