ContentsCompany Updates page1-PremeraReceivesJ.D.PowerAward-New&RenewingGroups

Claims Update page2-3-CorrectedClaimSubmissions-NewMemberIDCards-ClaimsSubmittingTips

Health Plan Resources page3-4-QualityCustomerService-RepresentativesandtheContractingManager-AdministrativeUpdates

Online Services Update page5

Consultant’s Corner page6

Community Connections page7-InlandNorthwestDentalConference-EasternWADentalAdvisoryBoardMeets-WesternWADentalManagerAdvisoryBoard

AnIndependentLicenseeoftheBlueCrossBlueShieldAssociation

J.D.Powerand

Associateshas

namedPremerathe

top-rankinghealthplan

intheU.S.West

August2007

newsNewsfromPremeraBlueCross

Network

August2007WashingtonDentalNetworkNews1

D E N T A L

In its inaugural study of health plan

consumers, J.D. Power and Associates

has named Premera Blue Cross the top-

ranking health plan in the U.S. Western census

region. The Western region includes Alaska,

Arizona, California, Colorado, Hawaii, Idaho,

Montana, Nevada, New Mexico, Oregon, Utah,

Washington and Wyoming.

The 2007 National Health Insurance Plan

Satisfaction Study measures the member’s

experience with their health insurance plan by

evaluating core factors, key attributes, and other

issues that are important to members’ overall

experience with their plans. These factors

include:w Coverage and Benefitsw Network Choicew Information and Communication

Premera receives J.D. Power award for top-ranking health plan in the U.S. West

w Approval Processw Claims and Other Statementsw Customer Service

w Claims Processing

This study reports on the satisfaction of

over 10,000 commercial members of large U.S.

health plans. Health plan performance is ranked

within the four major U.S. census regions. For

more information, visit www.premera.com or

www.jdpower.com/healthcare.

New & Renewing Groups

Following is a small sampling of some of the new and renewing groups enjoying the

benefits of a Premera Blue Cross dental plan:

CompaNy Updates

w ACC Financial, LLC

w Ben Bridge Jeweler

w BluWater Consulting, Inc.

w Celebrate Express

w Confederated Tribes of the Chehalis

Reservation

w Green Diamond Resource Company

w Home Care of Washington, Inc.

w Intrepid Learning Solutions

w NSPT, Inc.

w Oxarc, Inc.

w Silver Cloud Inns & Hotels

w Simpson Investment Company

w Sunset Chevrolet

w T & A Supply Company, Inc.

w Trident Seafoods Corporation

Corrected Claim Submissions

At times it is necessary to submit

corrected claims to Premera.

You can submit corrected claims

electronically using the HIPAA 837

transaction or in a paper format. It is

best to use a Corrected Claim Standard

Cover Sheet when submitting a paper

correction. Use of this form expedites

claim processing and reduces the risk

that a corrected claim may be denied as a

duplicate.

A ‘corrected claim’ is necessary in

limited circumstances for previously

processed claims. The specific reasons are

for the correction of the diagnosis, date

of service, charges, patient information,

provider information, procedure code, and

the addition or correction of a modifier

on a previously processed claim that is

referenced on an Explanation of Payment.

When submitting paper corrections,

complete each section of the cover sheet

including the reason and any specific

clarification or comments regarding the

line item or claim information that was

corrected. Always attach the corrected

claim that will replace the original claim

submission to the completed Corrected

Claim Standard Cover Sheet. Please

do not write on the actual claim form.

All comments should be noted on the

cover sheet. Following this process and

including relevant information on the

cover sheet expedites our handling of the

correction.

The cover sheet is the standard

form developed by the Administration

Simplification Steering Committee of the

Washington Healthcare Forum. The form

is available online and may be accessed

at www.wahealthcareforum.org, or you

may access through the Premera Provider

portal, Library, Forms, Miscellaneous

Forms at www.premera.com.

Claims Update

2August2007WashingtonDentalNetworkNews

Please note: If you have the ability,

please submit a corrected claim

electronically using the HIPAA 837

standard claims transaction. Indicate it

is a corrected claim by placing the value

of ‘7’ in the Claim Frequency Type Code

data field.

Important note: If a claim is missing

critical information we are unable

to process it and will return it with

instructions. These are resubmitted as new

claims and are not considered ‘corrected

claims’. Examples of missing critical

information include illegible claims,

missing patient or provider information,

missing or invalid diagnosis or procedure

codes, or if the individual line item

charges do not equal the total billed

charges. Submitting these as a new claim

will also expedite handling.

August2007WashingtonDentalNetworkNews3

Claims Update

Claims Submitting TipsFollowing are tips to keep in mind when submitting dental claims. Inclusion of these tips supports faster claims

processing.

w Please include tooth number (including tooth surfaces if required), quadrant, or arch when submitting a claim. This

will help us process your claim efficiently and without unnecessary delay of payment.

w Remember to provide two common data elements when a claim is submitted for a crown, inlay, onlay, labial veneer,

bridge or denture: 1) ‘Replacement of Prosthesis?’ box and the 2) ‘Date of Prior Placement’ box when replacement is

indicated. Please take the time to complete these two boxes when it is appropriate.

w Please submit all CDT procedure codes starting with the letter D as indicated in the 2007-2008 CDT published by

the American Dental Association. Premera no longer accepts CDT procedure codes that start with the number 0.

New Member ID Cards

The Blue Cross Blue Shield Association provides

guidelines that 40 affiliated Blue plans across the

United States follow. Most recently it outlined updated

guidelines to ensure that member ID cards achieve consistency

and updated features to support readability across all regions.

The initiative outlines member health plan ID card updates

that organize data into “fixed” and “flexible” fields. Only

placement of information on the cards is changing, not the type

of information in the new layout. Here are a few additional

changes you will see in the new layout:

w If the member has dental coverage with Premera, the

information is still included on the front, right hand side of

the ID card

w The Medcologo will no longer appear on the front of member

cards. Instead, a generic “Rx” symbol will appear. The back

of the cards will display the Medco logo along with the

corresponding disclaimer.

w The Issueddate has changed to DatePrinted.

HereisanexampleofamemberIDcardwiththenewdesign:

Premera Blue Cross associates will receive the new cards

first, so you may see them as early as July 1, 2007. The majority

of members will begin receiving the new card at their renewal

period in 2008.

For more information call Provider Relations at

1-877-342-5258, option 4.

Working Together to Provide Quality Customer Service

Most dental offices call customer

service on behalf of our

members for general dental

benefits; however, an increasing number

of general dentist offices as well as

specialty dental offices (i.e., Endodontist,

Periodontist, and Oral Surgeon offices)

are calling for dental benefits regarding a

specific dental service or procedure.

In response, Premera Blue Cross

brought several teams together and

developed a new resource tool. This tool

allows a customer service representative

to type in a dental procedure code or

procedure code description and display

benefit class and limitations if any, as

well as any documentation that may be

required. We recently implemented this

tool for large employers that we cover with

great success.

We will continue to roll out this tool

for additional groups throughout the

remainder of this year.

HealtH plaN Resources

4August2007WashingtonDentalNetworkNews

Every contracted dental provider

in the state of Washington has a

representative at Premera.

A Provider Network Executive

(PNE) or Provider Network Associate

(PNA) is assigned to your office and acts

as the liaison between your office and

Premera. They assist you in doing business

with Premera, learning our policies

and procedures and facilitating your

interactions with us.

They can support you in all aspects

of provider contracting. If you have a

dentist joining or leaving your office,

they will help you complete the necessary

paperwork.

Continue to use the telephone

number on the back of the member’s

ID card to contact Customer Service for

member eligibility, benefits, claims status,

and claims payment questions.

Teresa Triggs is the new

representative for Eastern Washington

providers and works from our Spokane

office. Her counties include Asotin,

Benton, Chelan, Columbia, Douglas,

Premera Representatives and the Contracting Manager

Paula Van Hoy

“Iamfortunatetoworkwithsuchagreatdental

networkandPremerateam.Idonotgettowork

theday-to-daymattersasmuchasIusedto,but

alwaysenjoyworkingwithyou.Ifyouneedto

contactme,Iamavailablebyphoneorbyemailat

paula.vanhoy@premera.com,”saidPaula.

Ferry, Franklin, Garfield, Grant, Kittitas,

Klickitat, Lincoln, Okanogan, Pend

Oreille, Spokane, Stevens, Walla Walla,

Whitman and Yakima. You can reach

Teresa at 1-877-342-5258, option 1,

ext. 27239.

Sylvia Aksdal is your representative

if you are in Clark, Cowlitz, King, Lewis,

Skamania or Wahkiakum County. You can

reach Sylvia at 1-877-342-5258, option 1,

ext. 85232.

Debbe Hopper is your representative

if you are in Clallam, Grays Harbor,

Island, Jefferson, Kitsap, Mason, Pacific,

Pierce, San Juan, Skagit, Snohomish,

Thurston or Whatcom County. You can

reach Debbe at 1-877-342-5258, option 1,

ext. 85544.

Paula Van Hoy was promoted to

Dental Regional Contracting Manager. Her

team is responsible for Washington and

Alaska contracting. She also works closely

with our national vendor whose network

serves our members in the other 48 states.

You can reach Paula at 1-877-342-5258,

option 1, ext. 27235.

Teresa Triggs

“Iamproudtobeworkingwiththe

dentalcommunity.Iamhappytohave

hadtheopportunitytomeetandbuild

relationshipswithseveralEastern

Washingtonproviders.Ilookforwardto

meetingmoreprovidersinthecountiesI

service,”saidTeresa.

August2007WashingtonDentalNetworkNews5

HealtH plaN Resources

Administrative Updates

oNliNe serviCes Update

Provider Portal

Provider portal enhancements are effective today with some exciting changes including:

w Return of the claim receipt

w Addition of the payment reference number, check number and check cashed

date to the payment status on the Claim Detail page

w Addition of copay information to the Eligibility Summary screen

w If a member is not eligible for the date entered, the eligible period dates will

display

w Display of the Plan renewal month on the Eligibility & Benefit Summary page.

If you need an additional dentist

listed in the network, call Physician and

Provider Relations at 1-877-342-5258,

option 4, then 1. You may also call this

number for:

w contracting questions

w practice/dentist profile and updates

(e.g., address or tax identification

changes)

w fee schedule information

w notification of retiring and moving

dentists at your practice

w name of the Provider Network Associate

(PNA) or Provider Network Executive

(PNE) assigned to your office.

Credentialing and contracting

your new associate or employee

provides the following

advantages:

w increases your visibility in our online

and paper directories

w results in consistent billing and

payment for your group or partnership

at the office

w reduces enrollee confusion when all of

your dentists and specialty dentists are

listed

w preserves patient relationships.

When a new associate or employee

dentist joins your practice, please let us

know.

6August2007WashingtonDentalNetworkNews

Cosmetic Dentistry

By Dr. Ronald Cantu

In recent years there has been an understandable, and as a whole, beneficial focus

on cosmetic dentistry. Many of our members are having or planning to have,

cosmetic services performed and naturally will have questions regarding their

dental care plan benefits for cosmetic dentistry.

Premera Blue Cross dental care plans are designed to provide benefits for dentally

necessary services. These are defined as services provided to restore, repair, and recover

diseased and pathologically affected soft and hard structures of the oral cavity. For

example, there is an assumption of coverage for decayed or fractured teeth, but if a

tooth is simply worn or discolored and the service

is being rendered solely for cosmetic or aesthetic

purposes, the service is not covered.

I recently reviewed a proposed treatment plan

which included crown lengthening and porcelain

veneers on teeth #6 through #11. The diagnostic

x-ray that was submitted indicated the maxillary

anterior teeth in question were free of decay with

no significant fracturing. This is an example of

treatment that would be considered not dentally necessary and although aesthetically

pleasing, this treatment would be considered cosmetic and not covered by the dental

care plan.

Premera maintains a goal to provide dental care plans that promote oral health and

provide financial assistance through an employer-provided dental care plan. Providing

benefits for our member’s fundamental oral health, in turn allows our members to

choose elective cosmetic dentistry at their own cost. Cosmetic dentistry provides our

members with choices while increasing the sophistication of the practice of dentistry.

CoNsultaNt’s Corner

Many of our members are having or planning

to have, cosmetic services performed and

naturally will have questions regarding

their dental care plan benefits for cosmetic

dentistry.

Dr.RonaldCantu

Premera Blue Cross dental care plans are designed to provide benefits for dentally necessary services.

August2007WashingtonDentalNetworkNews7

CommuNity Connections

Eastern Washington Dental Advisory Board Meets

Office Managers and Insurance

Coordinators from seven local dental

offices, a Premera Provider Associate

Representative from Eastern Washington,

and the Regional Dental Manager all met

in Spokane on June 14 at the NorthPointe

Office Plaza to discuss ways to achieve

better health and sustainable costs through

mutually beneficial strategic objectives.

Attendees included:Alycia Massie – Cascade Dental Care

Tracy Assmus – Chaffin Dental Care

Tracy Anderson – Oral Surgery Plus

Kristin Humphrey – Collins Oral and Maxillofacial Surgery

Deborah Hollman – Dr. Dale Ruemping

CJ James – Dr. Edward Charbonneau

Lonna Serrin – Dr. Stephen Call

Paula Van Hoy – Dental Regional Contracting Manager (Premera)

Teresa Triggs – Provider Network Associate for Eastern Washington (Premera)

Sylvia Aksdal – Premera Provider Network Executive for Western Washington facilitated the meeting.

The Dental Advisory Board’s sole

purpose is to advise Premera on how we

might collaborate with our contracted

network to achieve strategic objectives

using vehicles such as education,

communication and recognition.

Laura Totten, Manager of Market

Research at Premera, was the guest

speaker. Laura presented the value and

effectiveness of surveys and questionnaires

as communication tools. She explained

how surveys help Premera leaders focus

on innovation, improvement, and specific

elements that appeal to employers, such

as a robust network and balance billing

flexibility.

The open forum portion of the agenda

allowed those present to cover all types

of ideas from topics discussed to wishes

and desires of the individual offices and

upcoming speakers.

Some of the suggestions raised

during the open forum portion of the

agenda were:

w Ensure concise surveys that are no

more than 1 - 1.5 pages in length

w Determine whether to email or send

survey by mail

Inland Northwest Dental Conference

Premera Blue Cross was pleased to

participate in the Inland Northwest

Dental Conference in Spokane

at the beautiful new convention center

in May.

This annual conference provides

a wonderful opportunity for Premera

representatives to meet members of the

dental community.

We appreciated you stopping by the

Premera booth so we could say hello and

put a name with a face. Every year we

have a drawing and out of almost 500 entries, our winner this year was a student

from Spokane. The winner received a soft cooler, blanket and picnic package.

Thank you to everyone who participated!

w Shorten the Benefit Advisory

turnaround time

Future topic suggestions included

creative plan designs, and Network News

content. Laura received some good take

away suggestions as to how we can get the

best from a survey. The next meeting will

take place in the fall.

Western Washington Dental Manager Advisory Board Meets

The Western Washington Dental

Manager Board Meeting met June 27 on

the Mountlake Terrace campus.

Karen Brandvick-Baker, Provider

Communications Manager was the

keynote speaker. Karen writes, edits, and

produces the provider newsletters for all

regions and develops communication

strategies. Having spent more than

18 years in the area of strategic

communications, Karen had a great

deal to share with this group about

“Communications & Collaborations.”

The topic was both timely

and fit nicely with our objectives

of communication, education and

recognition as setting the stage for better

health and sustainable costs.

Office managers from numerous

locations attended, providing

comprehensive geographic representation

at the meeting. The next meeting will

occur in November.

ProviderNetworkAssociatesGailScanlan(left)

&TerersaTriggs(right)attheInlandNorthwest

DentalConference

Pleasepostorcirculatethisnewsletterinyouroffice

001400 (08-2007)8August2007WashingtonDentalNetworkNews

Premera Blue Cross

P.O. Box 327

Seattle, WA 98111

PRESORTED STANDARD

U.S. POSTAGE PAIDSEATTLE, WA

PERMIT NO. 2944

Network NewsEditor: Karen Brandvick-Baker1-800-422-0032, ext. 4920 Fax: 425-918-5575karen.brandvick-baker@premera.com

Back issues of Network News are on our Web site at www.premera.com in the Library on the Provider page under “Communications.”