A Presentation for the Old Dominion Dental Society

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A New Day For Oral Health In Virginia
Presentation to Dental Advisory
Committee January 5, 2007

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Distribution of Paid Claims SFY 2005 vs. SFY 2006
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Distribution of Services SFY 2005 vs. SFY 2006
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Distribution of Paid Claims SFY 2007 QTR 1

• Of the 24,250,458 paid claims, 8,512,409 (35)
  was paid on Preventive and Diagnostic Services.
• The balance, 15,738,049 (65), was paid on
  Treatment Services.

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Distribution of Dental Services SFY 2007 QTR 1

• Of the 444,751 services performed, 306,340 (69)
  of services rendered were for Preventive and
  Diagnostic Services.
• The balance, 138,411(31), of services rendered
  was for Treatment Services.

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Time Frame for Claims Adjudication

• Average Turnaround Time (July 2006 September
  2006) 19.93 Days
• 99.8 of all clean claims adjudicated within 30
  days of receipt of claim
• Performance Standard 90 of clean claims are
  processed within 30 calendar days of receipt of
  claim.
• 100 of all claims processed within 60 days
• Performance Standard 99.5 of all provider
  claims for services are processed within 60
  calendar days.

Performance Goal lt30 Calendar Days
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Member Calls Response Times

• 98 of all member calls received by the Call
  Center for the quarter were answered
• Total Calls Received for the quarter 14,634
• Total Calls Answered for the quarter 14,292
• The average abandonment rate for the quarter is
  2.
• The average hold time in queue prior to
  abandonment for the quarter is 213.

Performance Goal lt5
Performance Goal lt3 Minutes
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Provider Calls Response Times

• 96 of all provider calls received by the Call
  Center for the quarter were answered
• Total Calls Received for the quarter 8,452
• Total Calls Answered for the quarter 8,139
• The average abandonment rate for the quarter is
  4.
• The average hold time in queue prior to
  abandonment for the quarter is 711.

Performance Goal lt5
Performance Goal lt3 Minutes
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Broken Appointments

• During the period between December 1, 2005 and
  November 30, 2006, an average of 31 providers per
  month (3) reported broken appointments.
• Next Steps
• Analyze data collected during the 12 month period
  (December 2005 December 2006)
• Identify regional trends and patterns
• Identify repeat offenders
• Identify variations between provider types
• Evaluate feasibility of potential case management
  initiatives.
• Identify actions to encourage greater provider
  participation in reporting non-compliant
  enrollees.

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Total Individual Providers Locations

• Between July 1, 2006 and November 30, 2006, 76
  additional dentists enrolled in the program.
• The total number of additional dentists that have
  signed up since July 1, 2005 is
• This represents a 45 increase in the network
  from 620 to 897.

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Increase in Specialty Providers

• Between January 1, 2006 and November 30, 2006,
  the number of Orthodontists, Oral Surgeons and
  Endodontists increased as follows
• Orthodontists increased from 50 to 57.
• Oral Surgeons increased from 50 to 56.
• Endodontists increased from 6 to 14.

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Distribution of Providers By Specialty
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Network Recruitment Retention Strategies

• Strategic Provider Recruitment Planning Session
• Provider claims specific reporting per planning
  district
• Identification of providers rendering specialty
  services (oral surgery, endo)
• Recipient utilization data per planning district
• Non-Participating Provider Informational
  Sessions
• Conduct at least one Informational Meeting per
  region Northern, Northwest, Southwest, Eastern,
  Central
• Provider Training Sessions
• Six provider training sessions held in October
  2006. The total number of attendees was 149.
  The majority of attendees rated the overall
  effectiveness of the training as excellent.
• Increase recruitment of dental school students
• VCU School of Dentistry Clinic Day
• Senior Dental Student Seminars

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National Provider Identifier (NPI)

• Currently, 37 (330) of SFC providers have
  submitted their NPI number to Doral. Some
  providers have reported their NPI number directly
  to DMAS. The actual number of providers
  submitting their NPI number may be higher.
• Actions Doral is taking to ensure compliance with
  program requirements

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Thank You!