A Presentation for the Old Dominion Dental Society

1

A New Day For Oral Health In Virginia
Fall 2007 Provider Training Seminars October 2
8, 2007

2
Agenda

• Welcome and Introductions
• Review the Training Objective for the Session
• Discuss National Provider Identifier (NPI)
• Present News and Updates Regarding
• Recredentialing and Recontracting
• Interpreter Services
• Tamper Resistant Rx Pad
• Review Prior Authorization Procedures
• Discuss Enrollee Outreach Initiatives
• Review Details for Completing the ADA Claim Form
• Highlight key components of the Office Reference
  Manual
• Review the Provider Web Portal
• Q A

3
Training Objectives

• Provide information about NPI including the
  requirements for conducting business with the SFC
  program and how to share the NPI with Doral.
• Gain a greater understanding of compliance and
  regulatory issues that govern the delivery of
  care in the SFC Program.
• Increase knowledge and understanding of the
  procedures for requesting prior authorization
  including the procedures for operating room
  authorizations and emergencies.
• Provide information about initiatives aimed at
  identifying and developing strategies to reduce
  enrollee broken appointments.
• Develop knowledge and learn the procedures
  necessary for submitting accurately completed ADA
  Claims Forms.
• Provide instructions for reading and
  understanding Exhibits A and B in the Office
  Reference Manual
• Increase knowledge and learn to successfully
  navigate the features of Dorals Provider Web
  Portal.

4
NATIONAL PROVIDER IDENTIFIER(NPI)
5
National Provider Identifier (NPI)

• Previous communications from DMAS and Doral
  required a mandatory effective date of May 23,
  2007, for the initial submission of your NPI
  number however, a recent CMS communication
  allowed a twelve month contingency plan to allow
  payers additional time to obtain their necessary
  NPI numbers.
• The regulation for NPI submission will be
  enforced by CMS on May 23, 2008. However, Doral
  may require the use of NPI numbers prior to the
  May 23, 2008 CMS date.
• DMAS and Doral are currently reviewing
  contingency plans. Testing of NPI via the dual
  use period is extended during this contingency
  period.
• Over the next several months, DMAS and Doral will
  forward communications to providers regarding
  mandatory use of NPI and use of NPI with
  electronic and paper claims submission.
  Providers will also receive communication
  requesting verification of the NPI currently in
  Dorals system.
• Providers should continue to prepare for
  transition to use of the NPI and full NPI
  Compliance.

6
How to Report Your NPI to Doral

• Submit your individual, organization and/or
  sub-part NPIs to Doral via electronic bulk
  exchange format, such as Excel, Access, Word or
  text format to the following e-mail address
  NPISubmissions_at_DoralUSA.com or provide the
  information to Doral supplying the necessary
  information identified in the chart below.
  Electronic submissions must include the following
  data elements
• Maintain copies of NPI confirmation at your
  office location, issued to your organization and
  its sub-parts by the National Provider Identifier
  Enumerator.
• Return your completed form and NPPES Confirmation
  Form to Doral via fax to 262-241-4077 or by mail
  to

7
NEWS AND UPDATES
8
Recredentialing and Recontracting

• During program implementation, providers who were
  contracted with Doral Dental Services of
  Virginia, LLC and providers who were contracted
  with DMAS were automatically enrolled into the
  SFC program.
• Documentation of a completed application and a
  signed DMAS/Doral Provider Agreement is now
  required for all SFC participating providers.
• Recredentialing allows Doral to assure that
  participating providers continue to meet the
  standards for participation in the SFC Program.
• Participation in the SFC Program may be
  interrupted for Providers failing to comply with
  the request for a completed application and
  signed DMAS/Doral Provider Agreement.
• Subsequent recredentialing cycles will occur
  every three years.

9
Interpreter Services

• Virginia is home to more than half a million
  foreign born persons, some of whom have limited
  English proficiency and, therefore, face
  substantial challenges communicating with their
  health care professionals.
• Title XIX of the Social Security Act requires
  Medicaid providers to provide non-discriminatory
  services to its clients.
• In order to help providers meet this requirement,
  DMAS has implemented a provision for interpreter
  services for limited English proficient
  populations.
• To receive reimbursement for the interpreter
  services performed at the provider's office, the
  SFC dental provider must submit documentation
  (invoice) of the services provided and paid to a
  professional interpreter service. The following
  elements must be included in the documentation
• Date(s) of Service
• Patient name and ID number
• Copy of the invoice showing the name, address and
  telephone number of the professional interpreter
  service, the type and length of service, and the
  amount paid
• Mail the SFC Professional Interpreter Service
  Invoice Form (located in your training packet)
  along with the above documentation to
• Doral Dental
• ATTN Lori Howley
• 12121 N. Corporate Parkway
• Mequon, WI 53092
• An interpreter services resource listing is
  located on the DMAS website, http//www.dmas.virgi
  nia.gov

10
Tamper Resistant RX Pad

• Effective October 1, 2007 prescriptions for SFC
  patients cannot be filled at the pharmacy unless
  written on a tamper resistant prescription pad or
  unless the prescription is subject to one of the
  limited exceptions.
• Exceptions - The following will not be subject to
  the tamper resistant requirement
• Refills of written prescriptions presented at a
  pharmacy before October 1, 2007
• Prescriptions sent to the pharmacy electronically
  (either by e-prescribe or by fax)
• Prescriptions communicated to the pharmacy by
  telephone
• Drugs administered in nursing facilities, ICFMRs,
  and other institutional and clinical settings
• What is a tamper resistant prescription pad? -
  According to the federal government, to be
  considered tamper resistant on October 1, 2007 a
  prescription pad must have at least one of the
  following three characteristics
• Industry-recognized feature(s) designed to
  prevent unauthorized copying
• Industry-recognized feature(s) designed to
  prevent erasure or modification of information
  written by the prescriber
• Industry-recognized feature(s) designed to
  prevent use of counterfeit prescription forms
• Beginning next year, on October 1, 2008, to be
  considered tamper resistant, the federal
  government will require that a prescription pad
  contain all three of the tamper resistant
  characteristics noted above.

11
Prior Authorization
12
Prior Authorization Guidelines

• Prior-Authorization
• A request for authorization and all required
  documentation must be submitted before treatment
  begins.
• Authorization decisions are provided within 4
  business days from the date all required
  documentation is received.
• For Operating Room services, authorization must
  be provided by Doral and the MCO, if applicable.
  
• Authorization determination letters for
  non-emergent care are mailed to the providers.
• Authorization determination letters for emergent
  care are faxed to the provider.
• Emergency services that are performed in the
  Providers Office (i.e. outside of the hospital
  or ambulatory care center) do not require prior
  authorization.
• If authorization is not required, the option of
  requesting prior authorization is available by
  sending a request to the senior dental director
  for review and approval.

13
Operating Room (OR) Authorizations

• Process to obtain an OR/SPU authorization
• To ensure timely processing, requests should be
  submitted on an ADA claim form and mailed to
  Doral at least 10 days prior to the date of
  service.
• Clinically emergent requests should be marked as
  such and faxed to 262-834-3575.
• Emergent care is defined as A dental or oral
  condition that requires immediate services for
  relief of symptoms and stabilization of the
  condition such conditions include severe pain
  hemorrhage acute infection traumatic injury to
  the teeth and surrounding tissues or unusual
  swelling of the face and gums.
• Medical necessity should be clearly stated.
• Authorization of any services applicable to D9999
  should be submitted along with the request for
  SPU preauthorization.
• Doral is responsible for the coordination of the
  authorization process with the Managed Care
  Organizations.
• Dentist/Dental Offices are responsible for
  communicating to the hospital all relevant
  authorization information received from Doral.

14
OR Date Of Service (DOS) Changes

• Most MCOs authorize the requested procedure for
  the specific DOS.
• If the DOS changes, the provider must contact
  Doral with the necessary information as soon as
  the enrollees OR procedure is rescheduled, but
  no later than 72 hours prior to the DOS
• Fax the DOS change to 262-834-3575.
• Doral will contact the MCO to provide the updated
  information and obtain approval for the extension
  or new auth number.
• Doral will forward the updated authorization
  information to the provider.

15
Enrollee Outreach
16
Broken Appointment Initiative Update

• Broken Appointment Tracking Log Outcomes
• Over 10,000 broken appointments from SFC
  participating dentists have been received since
  last Fall.
• Please continue or begin to let us know about
  missed appointments for Doral to follow up with
  the patient.
• Enhancements to the Broken Appointment Tracking
  Form
• Missed appointment - a missed appointment where
  the member or member representative did not call
  to cancel
• Late Notice Cancellation (LNC) - a missed
  appointment with a cancellation less than 24
  hours prior to the appointment time
• Reason codes - 1) forgot about appointment., 2)
  conflict with schedule, 3) transportation 4)
  illness, 5) other.
• Next Steps
• Broken Appointment Best Practices Questionnaire
• Broken Appointment Focused Survey
• SFC Broken Appointment Pilot Program

17
SFC TRANSPORTATION COMPLAINT FORM

• Analyses of data related to broken appointments
  indicate problems with transportation as one
  reason for broken appointments.
• Providers are encouraged to report problems with
  transportation to DMAS. The SFC Transportation
  Complaint Form can now be used to report problems.

18
Completing the ADA Claim Form
19
Header Information

• The header provides information about the type
  of submission being made. This information
  applies to the entire transaction.
• There are 3 boxes that may apply to this
  submission
• If services have been performed, mark the
  Statement of Actual Services box.
• If you are submitting a request for prior
  authorization, mark the Request for
  Predetermination/Preauthorization box.
• If the claim is through the Early and Periodic
  Screening, Diagnosis and Treatment (EPSDT)
  Program, mark the EPSDT/Title XIX box. EPSDT
  authorization requests are based on medical
  necessity regardless of any benefit limitations.

20
Insurance Company/Dental Benefit Plan Information

• Enter Dorals Name, Address, City, State, Zip
  Code.
• This item is always completed.

21
Other Coverage

• The other coverage area of the claim form
  provides information on the existence of
  additional dental policies.
• This information is necessary to determine the
  possibility of coordination of benefits.

22
Coordination of Benefits

• The SFC program is always the payer of last
  resort therefore any other insurance coverage
  that can be billed for a patient must be billed
  prior to requesting payment from Doral.
• The timely filing limit for claims with
  coordination of benefits (COB) begins with the
  date the primary insurance carrier(s) makes a
  payment decision on a claim. Proof of this date
  is required if the SFC claim is submitted more
  than 180 days after the date of service.
• Providers are strongly encouraged to submit
  claims with copies of the explanation of benefits
  (EOB) from the primary insurance carrier(s) for
  accurate claims adjudication.
• If you have submitted a claim to the primary
  insurance carrier and have not received an EOB
  within the timely filing limit, you may submit a
  claim to Doral for payment consideration. If
  payment is made by the primary insurance carrier
  at a later date, the office is responsible for
  submitting a request for claim adjustment to
  recoup any overpayments made by the SFC program.
• When submitting primary insurance carrier
  information on the SFC claim, list only the
  insurance information that pertains to this
  claim
• For example, if the member has a medical
  insurance policy, but this carrier is not being
  billed for the dental services provided, the
  medical insurance carrier information should not
  be included on the claim form.
• If the treatment performed is a result of
  occupational injury/illness, auto accident, or
  other accident, the appropriate box must be
  checked in section 45 of the 2006 ADA claim form
  along with the additional information included in
  boxes 46 and 47.

23
Policy/Subscriber Information

• This section documents information about the
  insured person who may or may not be the patient.

24
Patient Information

• The information in this section of the claim form
  pertains to the patient.
• Use the patients name as shown on their ID
  Card/legal name no nicknames in Box 20.
• The enrollees Medicaid ID Number should be
  displayed in Box 23 Patient ID/Account .

25
Record of Services Provided

• The Record of Services Provided contains
  information regarding the treatment performed
  (actual services), or proposed treatment
  (predetermination/preauthorization).
• Box 24 Procedure Date
• Enter Procedure Date for actual services
  performed
• Leave the Procedure Date blank if the claim is
  for preauthorization/predetermination.
• The presence or absence of a Procedure Date
  should be consistent with the type of
  transaction(s) marked in Item 1, Header
  Information (e.g. actual services
  predetermination/preauthorization).

26
Authorizations

• This section provides consent for treatment as
  well as permission for Doral to send any patient
  benefit available for procedures performed
  directly to the dentist or the dental business
  entity.

27
Ancillary Claim/Treatment Location

• This section of the claim form provides
  additional information to Doral regarding the
  claim.
• Box 39 - Number of Enclosures
• This item is completed whether or not
  radiographs, oral images, or study models are
  submitted with the claim.
• If no enclosures are submitted, enter 00 in each
  of the boxes to verify that nothing has been sent
  and therefore no possible attachments are
  missing.
• Box 41 Date Appliance Placed
• Indicate the date an orthodontic appliance was
  placed.
• This information should also be reported in this
  section for subsequent orthodontic visits.

28
Billing Dentist or Dental Entity

• The Billing Dentist or Dental Entity section
  provides information on the individual dentists
  name or the names of the group practice/corporatio
  n that is responsible for billing and other
  pertinent information.
• Box 49 NPI
• Enter the appropriate NPI type for the billing
  entity.
• A Type 2 NPI is entered when the claim is being
  submitted by an incorporated individual, group or
  similar legally recognized entity.
• Unincorporated practices may enter the individual
  practitioners Type 1 NPI.

29
Treating Dentist and Treatment Location
Information

• The Treating Dentist and Treatment Location
  Information section provides information
  specific to the dentist who has provided
  treatment. This section must be completed for
  all claims.
• Box 53 Certification
• Signature of the treating or rendering dentist
  and the date the form is signed.
• If the claim form is being used to obtain a
  predetermination or preauthorization, it is not
  necessary for the dentist to sign the form.
• Claim forms prepared by the dentists practice
  management software may insert the treating
  dentists printed name in this Item.
• Box 54 NPI
• Enter the treating dentists Type 1 Individual
  Provider NPI.

30
Use of NPI on ADA Claim Forms

• 2006 ADA Claim Form
• Providers are encouraged to use the 2006 ADA
  form. Fields 49 and 54 on the 2006 form have
  been allocated for NPI.
• NPI is not required on electronic claims
  transactions on May 23, 2007, and the Doral
  Dental legacy identifiers remains the primary
  means of assessing claims. Therefore, legacy
  identifiers must be included at this time.
• Older ADA forms
• For older ADA forms, providers should continue to
  provide the same information as they are
  presently providing, using their legacy Doral
  Provider ID number in the appropriate field on
  the form.

If you now have your NPI number and have any
questions regarding the placement of your NPI
number on any claim form, please contact Doral
for assistance.
31
Claims Processing
Required Information

• Most pertinent sections of the ADA form that must
  be completed in full in order to process your
  claims
• Members information
• Name
• Address
• Date of Birth
• Subscriber ID Number
• Record of services provided
• Date of service
• Fee
• Valid procedure code and a tooth number
• Tooth surface or quadrant if the procedure code
  requires it
• Treating address
• Treating provider
• Billing entitys information

32
Helpful Hints to Ensure Timely Payment

• Submit claims electronically (57 of providers
  are submitting electronically)
• Submit legible and correctly completed ADA claim
  forms
• Alert Doral of any changes (i.e TIN, location,
  etc.)
• Staple multiple claim forms and supporting
  information together.
• Submit claims as soon after date of service as
  possible
• Ensure that claim forms are filled out completely
• When requested, be sure to use the treating
  location not a P.O. Box
• Use the patients name as shown on their ID
  Card/legal name no nicknames
• Claims must be submitted within 180 Days from the
  date of service or the provider will face timely
  filing denials.

33
OFFICE REFERENCE MANUAL
34
Benefits For Enrollees Under Age 21

• SFC provides comprehensive dental benefits for
  enrollees under the age of 21
• Diagnostic
• Preventive
• Restorative
• Endodontics
• Periodontics
• Prosthodontics Removable
• Maxillofacial Prosthetics
• Prosthodontics Fixed
• Oral Surgery
• Orthodontics
• Adjunctive General
• A listing of services covered by code is
  available in Exhibit A.

35
Benefits For Enrollees Age 21 and Older

• Coverage for adults, age 21 or older is limited
  to medically necessary oral surgery and
  associated diagnostic services.
• Oral surgery procedures not listed in Exhibit B
  may be covered under the members medical
  benefits through the Medicaid, FAMIS, or FAMIS
  Plus fee-for-service or managed care organization
  (MCO) program.

36
How to Read the Benefit Exhibits

• Code Exhibits A and B are organized into
  categories of service, each with specific
  five-digit alphanumeric codes.
• Exhibit A (for Enrollees under age 20) includes
  11 categories of service.
• Exhibit B (for Enrollees Age 21 and older)
  includes 2 categories of service.

37
How to Read the Benefit Exhibits cont.

• Description Provides a written definition of the
  Dental Procedure Code as listed in the current
  CDT (Current Dental Terminology) book.

38
How to Read the Benefit Exhibits cont.

• Age Limitation Indicates the minimum and maximum
  age limits for enrollees eligible for the covered
  service(s).

39
How to Read the Benefit Exhibits cont.

• Teeth Covered Lists the teeth numbers, arches
  and quadrants that are covered for the listed
  service.

40
How to Read the Benefit Exhibits cont.

• Authorization Required Indicates that either
  prior authorization or prepayment review is
  required for the specific code
• Prior Authorization Oral Surgery and Orthodontic
  services are the only services that require Prior
  Authorization. If Yes is indicated, see the
  Documentation Required column for a description
  of the materials/items that must accompany the
  Request for Predetermination/Preauthorization.
• Services that require Prior Authorization should
  not be started prior to the determination of
  coverage.
• Prepayment Review If Yes is indicated, see the
  Documentation Required column. If the written
  description of documentation required references
  prepayment review, proper documentation must be
  submitted prior to consideration of payment.

41
How to Read the Benefit Exhibits cont.

• Benefit Limitations Provides a description of
  any limitations on benefit(s) associated with the
  specific code. Benefits may be restricted by
  frequency, occurrence and rendering providers.

42
How to Read the Benefit Exhibits cont.

• Documentation Required Provides a description of
  the information that is necessary for review and
  whether it must be submitted on a prior
  authorization basis or with a claim following
  treatment for prepayment review.

43
Revised Office Reference Manual

• The Office Reference Manual (ORM) has been
  revised. An updated copy is available on line
• Go to www.doralusa.com. Log in to the website
  and click on Documents in the navigation bar on
  the top of the screen.
• or
• Download a copy from the DMAS website at
  http//www.dmas.virginia.gov/dental-home.htm

44
PROVIDER WEB PORTAL
45
Provider Web Portal (PWP)

• Meets accessibility standards put forth by the
  ADA (Americans with Disabilities).
• Users can use any browser no longer limited to
  Internet Explorer.
• New improved look for ease of use.
• Easy to read menu.
• Email form for streamlined communication.
• Payment release dates so Providers can easily
  track payment dates.
• Location information displayed for the office
  staff to check accuracy and update the
  information via a contact form.
• Claims and authorization entry still available
  with accurate reporting and tracking information.

46
Doral Dental USA Website

• Open Microsoft Internet Explorer and access
  www.doralusa.com.
• Click on the Providers button to continue.

47
Access to PWP

• To access Provider Web Portal (PWP), click
  Provider Web Portal (PWP).

48

• If you are not a registered user, click on the
  link Not a registered user

49
New User Registration

• Complete the following information in the User
  Registration window
• Location ID Enter your unique location
  identifier. This can be found on your remittance
  statements, or by contacting customer support.
• Location Name Enter your location name. A
  partial location name may be entered. The name
  should match any documentation, such as,
  remittance advice statements.
• City Enter the city for your location.
• State Enter the 2 character state abbreviation
  for your location.
• Zip Enter the 5 digit zip code for your
  location.
• Email Address Enter an email address for the
  new user (optional).
• Click Continue after completing the required
  fields.

50
New User Registration cont.

• Complete the following information in the User
  Registration window
• User Name Any name that the user would like to
  select. The username must be at least 4
  characters, it can be numbers, letters or a
  combination of both.
• Password Any name that the user would like to
  select. The password must be at least 8
  characters and contain a minimum of 2 non-alpha
  characters. Passwords are case sensitive.
• Retype Password Retype your password to verify
  what you entered in password field.
• Click Continue after completing the User
  Registration information.
• If registration is successful, you will receive a
  message that states Successfully Registered New
  User.
• Close message to go to login required fields.

51
Log In

• Type your User Name and Password and click on the
  Log In button.

52
Main Menu

• This page gives you the ability to navigate to
  any page within the Provider Portal. See the
  Online Help option if you have questions
  regarding the features.

53
.
Provider Menu

• You can click on the Provider Menu from any area
  to return to the Main Menu.

54
How to Check Member Eligibility

• Click on Check member eligibility to check if a
  member is eligible.

55
How to Check Member Eligibility, cont.

• Basic Information Entry Fields
• Location Displays the logged in user's
  location.
• Provider Select a provider. All providers for
  the logged in user's location are listed. When
  only one provider exists for the location, it
  will be selected and displayed (required).
• Service Date Enter an estimated service date.
  You may select a date from an interactive
  calendar by clicking on the calendar icon next to
  the field (required).

56
How to Check Member Eligibility, cont.

• Member Information Entry Fields
• Member DOB Enter the members date of birth
  (required).
• Subscriber ID Enter the members complete
  recipient ID.
• -OR-
• Member DOB Enter the members date of birth
  (required).
• Last Name Enter the members complete last
  name.
• A partial last name will result in the member not
  being found.
• First Name Enter the members first name. A
  partial first name may be entered

.
57
How to Check Member Eligibility, cont.

• Member Information Entry Fields
• Once required information is entered, click the
  Verify Eligibility option. This identifies the
  member and checks eligibility based on the
  member, provider and service date information.
• The Add To List button feature allows you to view
  member history (limited codes) for eligible
  members.
• The Print List button, once all chosen members
  have been added to the list, you have the option
  to print results for your records. (See
  Eligibility Report)

58
Eligibility Report

• Eligible Members The information will
  include subscriber number, name, address,
  insurer and product. Eligible members gives the
  option of limited member history. See next page
  for example.
• Non-Eligible Members Member is not eligible for
  selected date of service.
• Non-Members Verify that you typed the
  information correctly based on the what you have
  or contact customer service.

59
Member Claim History

• To view claims history from the eligibility page,
  click on Hist displayed end the end of each
  eligible member.

60
Member Claim History

• This page is displayed when viewing of claims
  history is requested during claims or
  authorization entry or when checking a member's
  eligibility. Please note that claims history
  information is only available for eligible
  members.
• The report includes partial claims history
  information for the member
• Procedure code, description, tooth number, place
  of service and service date are displayed.
• Only valid, paid claims are displayed.
• Only the latest service date for the procedure
  code, tooth and place of service combination is
  displayed.

61
Member Claim History
Only the following procedure codes are displayed

• Please note this information includes only valid
  paid services, but does not guarantee or imply
  payment and is contingent upon other factors,
  including but not limited to eligibility changes,
  covered services and benefit limitations.
• For history on other codes, please Doral Customer
  Service.
• This list can also be found under the Online Help
  option.

62
How to Request Dental Authorizations

• To request a dental authorization from the main
  menu, click on Request Dental Authorization.

63
Authorization Entry and Submission

• Basic Information Entry Fields
• Location Displays the logged in user's
  location.
• Provider Select a provider. All providers for
  the logged in user's location are listed.
• When only one provider exists for the location,
  it will be selected and displayed (required).
• POS Select a place of service (required).
• Submission Date Date defaulted to current date.

64
Authorization Entry and Submission cont.

• Member Information Entry Fields
• Member DOB Enter the members date of birth
  (required).
• Recipient ID Enter the members complete
  recipient ID.
• -OR-
• Last Name Enter the members complete last
  name. A partial last name will result in the
  member not being found.
• First Name Enter the members first name. A
  partial first name may be entered.

65
Authorization Entry and Submission cont.

• Optional Fields
• Referral Enter a referral number.
• Notes Please enter your NEA Attachment ID in the
  notes field.
• When all required fields are complete, click the
  Enter Service Lines button to continue claims
  submission.

66
Authorization Entry and Submission cont.

• After entering the service code, use the tab key
  to advance the cursor to the next required field
  for that particular code. Once complete, click
  on the Add Service Line button. The information
  will then populate under the blue Service Line
  bar.
• When all codes for authorization are entered,
  click on the Submit Auth button

• .

67
How to Check the Status of Authorizations
Submitted

• To check the status of a submitted authorization,
  from the main menu, click on Check submitted
  authorization status.

68
Provider Authorization Status Report
This feature allows you to check the status of
submitted authorizations (regardless of method of
submission). By choosing the filter criteria,
you determine the report generated.
69
(No Transcript)
70
View Authorization Entry Report

• To view a report of authorizations entered, from
  the main menu, click on View authorization entry
  report.

71
Authorization Entry Confirmation Report
This feature allows you to review authorizations
that were submitted using the Provider Portal for
todays date. (See Authorization Entry
Confirmation Page)
72
This report is for your records and should be
reviewed for submission accuracy.
73
How to Enter Dental Claims

• To enter dental claims, from the main menu,
  click on Dental Claims.

74
How to Enter Dental Claims cont.

• Basic Information Entry Fields
• Location Displays the logged in user's
  location.
• Provider Select a provider. All providers for
  the logged in user's location are listed. When
  only one provider exists for the location, it
  will be selected and displayed (required).
• Service Date Enter service date. You may select
  a date from an interactive calendar by clicking
  on the calendar icon next to the field
  (required).
• POS Select a place of service (POS).

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How to Enter Dental Claims cont.

• Member Information Entry Fields
• Member DOB Enter the members date of birth
  (Required).
• Recipient ID Enter the members complete
  recipient ID.
• -OR-
• Member DOB Enter the members date of birth
  (Required).
• Last Name Enter the members complete last
  name. A partial last name will result in the
  member not being found.
• First Name Enter the members first name. A
  partial first name may be entered.

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How to Enter Dental Claims cont.

• Optional Fields
• Office Ref Enter an office reference number.
• Referral Enter a referral number.
• EOB Present Select checkbox if there was other
  coverage for the claim. If selected, enter the
  NEA EOB Attachment ID in the Notes field.
• Notes Enter any notes. If there was other
  coverage for the claim, enter the NEA EOB
  Attachment ID.
• When all required fields are complete, click the
  Enter Service Lines button to continue claims
  submission.

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How to Enter Dental Claims cont

• After entering the service code, use the tab key
  to advance the cursor to the next required field
  for that particular code. Once complete, click
  on the Add Service Line button. The information
  will then populate under the blue Service Line
  bar.
• When all services are entered, click on the
  Submit Claim button.

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How to Check the Status of Authorizations
Submitted

• To check the status of a submitted claims, from
  the main menu, click on Check submitted claims
  status.

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Provider Claim Status Report
This feature allows you to check the status of
submitted claims (regardless of method of
submission). By choosing the filter criteria,
you determine the report generated.
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Claim Entry Report

• To view a report of claims entered, from the
  main menu, from the main menu, click on View
  claim entry report.

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Claim Entry Confirmation Report
This feature allows you to review claims that
were submitted using the Provider Portal for
todays date. (See Claim Entry Confirmation Page)
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View Location Information
To view information for a specific location,
from the main menu, click on View location
information.
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Location Information
These features shows all the current information
we have in our system for a specific location.
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View Payment Status
To view information regarding the status of a
payment, from the main menu, click on View
payment status.
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Provider Web Portal Payment Status
New Feature!

• Offices now have the ability to view the release
  date of their payment, or check to see what the
  anticipated release date may be.
• Offices will no longer have to call Doral
  Customer Service Representatives to ask when
  their payment will be mailed.

This features allows you to view any payment
statuses for the last 12 months.
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Provider Web Portal Support

• For questions regarding the Provider Web Portal
  and technical support, contact
• 800.341.8478, option 7 -OR-
• email at eclaims_at_doralusa.com

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Keep Doral Updated

• Accurate and up-to-date information is essential
  for appropriate referrals and claims payment.
  Inform Doral of
• Changes to your address, phone and fax numbers
• New practice locations
• Changes to Tax ID Number(s)
• Plans to retire or terminate
• Send an application for new providers joining
  your practice at least 30 days prior to the
  effective date and respond to Dorals
  credentialing requests in timely manner.
• Alert Doral of broken appointments occurring in
  your practice.
• Share your experiences (positive or negative)
  with us.
• Let us know which topics you would like presented
  in our next session.

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Contact Information

• Doral Smiles For Children Staff
• Cheryl Harris
• Project Director
• Direct Line [phone]
• Fax [phone]
• Email cpharris_at_doralusa.com
• Anna Perez
• Provider Relations Representative Direct Line
  [phone]
• Fax [phone]
• Email amperez_at_doralusa.com
• Kristen Gilliam
• Outreach Coordinator
• Direct Line [phone]
• Fax [phone]
• Email kfgilliam_at_doralusa.com

• DMAS Smiles For Children Staff
• Sandra Brown, MSW
• Dental Program Manager
• Direct Line [phone]
• Fax [phone]
• Email sandra.brown_at_dmas.virginia.gov
• Lisa Bilik
• Dental Contract Monitor
• Direct Line [phone]
• Fax [phone]
• Email lisa.Bilik_at_dmas.virginia.gov
• Lisa Ware
• Dental Program Analyst
• Direct Line [phone]
• Fax [phone]
• Email Lisa.Ware_at_dmas.virginia.gov

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Thank You!