SUMMER 2024 DETAILS NEWSLETTER - DELTA DENTAL OF RHODE ISLAND
Celebrating 10 years of Rhode Island
Mission of Mercy
2024 marks the tenth year that the Rhode Island Mission of Mercy (RIMOM) has provided free oral health services to Rhode Islanders in need. Presented by the Rhode Island Oral Health Foundation, in partnership with Delta Dental of Rhode Island, Providence Community Health Centers and volunteer oral health providers, the annual two-day dental clinic has provided more than $3.2 million in no-charge oral health services to thousands of Rhode Islanders living and working across the state.
Improving the oral health of Rhode Islanders in need
The Rhode Island Oral Health Foundation (RIOHF) was founded in 2011 with the mission of providing funding and resources to improve oral health in the state of Rhode Island and to convene a yearly signature event (the RIMOM free dental clinic) that provides the opportunity for oral health professionals to address unmet oral health needs in Rhode Island.
Leadership transition
Dr. Jeffrey Dodge, founder and past president of the RIOHF/RIMOM, was presented with a Providence Business News 2024 Health Care Heroes award for his leadership and work with the annual free clinic. After serving over 10 years at the helm, Dr. Dodge transitioned leadership to Dr. John Kiang, who has assumed the role of president of the RIOHF and will lead the charge of the 2024 RIMOM free dental clinic this fall.
A mission-driven event
RIMOM is a testament to the collective commitment within the oral health community to assist Rhode Islanders in need in accessing vital dental care.
In 2023, a team of more than 275 volunteer oral health providers completed a total of 1,905 oral health procedures, including routine cleanings, X-rays, fillings, root canal treatments and tooth extractions, to more than 440 individual patients. An additional 185 community volunteers also supported the annual two-day dental clinic, providing instructions, translation services and more.
Delta Dental of Rhode Island has been a premier sponsor of RIMOM since its inception, providing financial support and annually sending a team of employee volunteers to support each event.
Scan to watch 2023 recap video
The 2024 RIMOM two-day dental clinic will take place October 5-6 at Providence Community Health Center’s Dental Clinic. Learn more: https://www.rimom.org/
A message from Delta Dental of Rhode Island Dental Director
A. Thomas Correia, DDS
I want to express our deep appreciation for our partnership with you and our shared mission of advancing the oral health of Rhode Island residents. I extend special thanks to the many dentists and dental office staff who attended meetings at Delta Dental of Rhode Island over the past few years, as well as those who hosted our professional relations team. Together, we have discussed the challenges presented by today’s economic climate and our shared dedication to our members. We are committed to continuing our investment in this partnership to enhance the health of all Rhode Islanders and shape the future of oral healthcare.
Our mission at Delta Dental of Rhode Island is to provide impeccable service, quality, and innovation that exceeds expectations. We are dedicated to offering accessible and affordable care that drives improved health outcomes and are committed to ensuring all Rhode Islanders have access to the care they need and deserve. With that mission in mind, we see much to celebrate in the oral health care sector in Rhode Island, along with areas where we can improve.
We recognize the challenges caused by rising operating costs for dental offices, and we share in your concerns about the national shortages of dental hygienists, assistants, and some specialists. Delta Dental of Rhode Island is taking the following actions to address these issues in our state:
• We financially support the Rhode Island Department of Health’s Health Professional Loan Repayment Program (HPLRP), a statewide program that has helped incentivize dozens of young professionals to launch and grow their careers in Rhode Island.
• We partner with the Community College of Rhode Island (CCRI) and Tufts University to provide funding for scholarships for dental hygienists and oral surgeons and the development and expansion of training opportunities.
• We collaborate with the Samuels Sinclair Dental Center at Rhode Island Hospital to launch the state’s first Oral Surgery Residency Program, which will accept two residents per year and support multiple newly created, full-time clinical, administrative, and programmatic positions at Rhode Island Hospital.
• We plan to create dental assistant programs through our partnership with the Rhode Island Department of Education (RIDE) that will help fill the gaps in our workforce.
• Additionally, we recently announced another round of fee schedule adjustments will take place this fall to ease the burden of inflation for dental practices.
Earlier this year, Delta Dental of Rhode Island conducted a detailed analysis of our claims and provider data, compiled into our first ever Rhode Island Dental Market Landscape Report. That analysis shows a steady and growing population of dentists in Rhode Island, with the number of younger dentists increasing by 43% over the last ten years. We are committed to building on this growth and ensuring that our state remains a wonderful place for both new and experienced dental professionals.
We are also pleased to see the passage of The Dental Loss Ratio Reporting and Study Act, which establishes a data-driven process for evaluating dental loss ratio in the Rhode Island health care marketplace. This is a measure Delta Dental of Rhode Island fully supports as it equips the Office of the Health Insurance Commissioner (OHIC) with the necessary time and resources to collect relevant data, conduct a thorough market analysis and eventually bring forth a recommendation that is in the best interest of all stakeholders, including dentists, patients and employers.
Thank you for your continued partnership and dedication to the oral health of our community. Together, we can navigate these challenges and continue to make a positive impact on the lives of Rhode Islanders.
Respectfully,
A. Thomas Correia, DDS
Delta Dental of Rhode Island is growing
We proudly cover more Rhode Island smiles than any other dental benefits company.
Since 2022, we have added over 200 new client groups, including:
• Collette Travel Service, Inc.
• HopeHealth
• Kelly & Picerne, Inc.
• Neighborhood Health Plan of Rhode Island’s INTEGRITY (Medicare-Medicaid Plan) members, Medicare dental benefits
• South County Health
• Taco Comfort Solutions
• Toray Plastics (America), Inc.
New business enrollment since 2022 grew nearly 45,000 members
Upcoming fee adjustments for fourth quarter 2024
Delta Dental of Rhode Island is pleased to announce a new round of fee schedule adjustments this fall
These adjustments build upon Delta Dental of Rhode Island’s fee increases from May 2022 and the adjustments to specific oral surgery codes in September 2023. The new fee schedules will be mailed to offices in advance of their implementation. As always, our professional relations team is available to answer any questions you might have.
Supporting the Rhode Island workforce: Health Professional Loan Repayment Program
In 2015, the Rhode Island Department of Health (RIDOH) launched the Health Professional Loan Repayment Program (HPLRP), a statewide program supported by both public and private funding that aims to improve access to care and address disparities in health through the recruitment and retention of qualified professionals providing healthcare services in traditionally underserved communities.
According to the RIDOH, the HPLRP has created 233 awards totaling more than $7.8 million since its inception. Recipients included 37 doctors, 41 dentists, 50 registered nurses, and 45 behavioral health clinicians. In 2023, the program provided loan repayment to 24 healthcare professionals. Delta Dental of Rhode Island has provided roughly $500,000 in financial support to this initiative since its inception.
Delta Dental of Rhode Island was recognized earlier this year by the RIDOH for our continued support of the HPLRP.
“We are strongly committed to workforce development in Rhode Island’s healthcare sector,” said Joseph R. Perroni, president & CEO, Delta Dental of Rhode Island. “The Health Professional Loan Repayment Program’s innovative approach is one of many reasons talented, young professionals are choosing to study, work, and stay right here in Rhode Island. We are proud to support it, and we look forward to continuing to work alongside our partners and colleagues to build on Rhode Island’s health care workforce development momentum.”
Learn more and apply
To learn more about the program, including eligibility requirements, and to sign up for notifications for the 2025 application cycle, visit Rhode Island Department of Health’s Health Professional Loan Repayment Program
Utilization review guidelines with individual considerations (IC)/exceptions: A reminder about the process
Our dedicated dental case management team, led by our Dental Director, routinely considers exceptions for procedures. Any procedure can be submitted for review.
Here is the process for requesting an individual consideration (IC):
• Submit a paper claim and indicate this is a request for an individual consideration (IC).
• Include supporting documentation like treatment notes, x-rays, photos and/or a narrative. This will help our case management team conduct the review.
• Provide a reason for the request for IC.
Our Utilization Review guidelines explain the criteria that we use to determine if a procedure is covered. We update this document regularly to keep your office informed about changes in materials, techniques, and procedure codes. Log in to your online account to learn more and review guidelines. If you have any questions or need additional information, contact our professional relations team at professionalrelations@deltadentalri.com
CareLink expands reach of its Mobile Dentistry unit
Continuing a partnership that dates back to 2020, Delta Dental of Rhode Island awarded grant funding to CareLink that will be used to expand its Mobile Dentistry unit to include at least three new locations across the state, with the potential to serve nearly 200 new patients.
CareLink’s Mobile Dentistry unit brings licensed dentists, public health dental hygienists and dental assistants to underserved areas across the state to provide free, on-site services to older adults who – due to decreased physical mobility, lack of reliable transportation, or other contributing factors – lack access to the oral health care they need.
Did you know?
98%
of Delta Dental of Rhode Island members stay in-network for their dental services.
71%
Clinics supported by Delta Dental of Rhode Island’s grant funding include:
• Saint Elizabeth Apartments for Seniors and Mobility Impaired
• East Providence Senior Center
• Amos House
• The DaVinci Center
Founded in 1997, CareLink is a non-profit network of mission-driven post-acute and community-based providers serving older adults and adults with disabilities. CareLink is also a direct care provider of rehabilitation, dental, audiology, podiatry, psychiatry and wellness services. Since launching its Mobile Dentistry unit in 2008, CareLink has provided care to over 72,000 Rhode Islanders.
Learn more and get involved at CareLink Mobile Dentistry
of Delta Dental of Rhode Island members have dental plans with benefit enhancements like Preventive Rewards and Maximum Carry Over, making it easy to stretch their annual maximums. For more information about these programs, reach out to our professional relations team.
Welcome to the Delta Dental of Rhode Island network
Delta Dental of Rhode Island is pleased to welcome the following recently credentialed dentists to our network:
Nicole Balthazar, DMD Dutchman Dental LLC
Christine Barry, DMD Comprehensive Community Action Program
Jessica Berman, DDS
Children’s Dentistry of East Greenwich and Children’s Dentistry of Coventry
Vlad Botezatu, DMD Reservoir Dental LLC
Paola Buckley, DMD Dental Associates of Cumberland
John Fitzsimons, DMD
WellOne Primary Medical and Dental Care
Behind the smiles
Nominate a colleague
Is there someone in your office who deserves recognition? Nominate a dental professional that we can feature in a future publication. Send your submission, highlighting the nominee’s name, position, accomplishments/ impact on your office and picture to our professional relations team at professionalrelations@deltadentalri.com with the subject: Behind the Smiles.
Aly Gamee, DMD Thundermist Health Center
Adrianna Gyorfi, DMD Comprehensive Community Action Program
Jacquelyn Hadi, DMD Frenchtown Dental Associates
Vasseur Kamseu Noukeu, DMD Thundermist Health Center
Erica Kleinbaum, DMD Periodontics Inc.
Mili Koirala, DMD Rhode Island Dental LTD
Guilbert Maria, DMD Bright Dents LLC
Irma Nalic, DMD Thundermist Health Center
Hannah Namgung, DDS Thundermist Health Center
Olga Raptis, DMD
Children’s Dentistry of East Greenwich
Barry Rosenberg, DMD
Children’s Dentistry of Westerly and Children’s Dentistry of Wakefield
Mir Ayesha Siddiqua, DDS Dental Associates of North Smithfield, P.C.
Lisa Vu, DMD Coastal Dental Associates II LLC
Did you know?
Save the date: Rhode Island Dental Hygiene Association annual meeting of all claims submitted to Delta Dental of Rhode Island are processed accurately the first time.
99.9%
The annual meeting of the RI Dental Hygiene Association (RIDHA) will take place on Saturday, September 14, from 8 AM – 4 PM at the Rhode Island Nursing Education Center. This in-person event will feature Continuing Education Units (CEUs) and is an excellent opportunity to inspire and engage with dental hygienists from across the state. Highlight your practice, products or services by reserving a vendor space. To learn more, email admin@ri-dha.org
95% of pretreatment estimates are processed by Delta Dental of Rhode Island within 10 days.
Complete claim standard
For your claims to be processed quickly and accurately, it’s important to include all the necessary information. We can only start processing once your claim meets our Complete Claim Standard.
Please ensure that your claim meets the following criteria:
• Paper claims must be submitted using a current ADA form. All information must be legible.
• Electronic claims must be in a HIPAA-compliant format.
• Submitted subscriber/patient information (name, date of birth, and Delta Dental ID number) must be accurate and must match Delta Dental’s records for that subscriber/patient.
• Treatment must be billed using the appropriate CDT codes.
• Date of service must be noted for each procedure.
• The providers’ charge for each procedure must be noted.
• The treating dentist and complete address of the treatment location must be indicated and must match the information that Delta Dental has in its records.
• The provider’s TIN and individual NPI must match the information that Delta Dental has in its records.
• Appropriate documentation from the other carrier must be included for claims that require Coordination of Benefits.
• Appropriate documentation must accompany claims for any procedures that are eligible for clinical review, in accordance with our Utilization Review Guidelines listed in the Dentist Section of the Delta Dental of Rhode Island website.
• Submitted x-rays must be less than two years old and of diagnostic quality showing the entire treatment site. X-rays must be mounted, labeled with the patient’s name, the date they were taken and if applicable, right or left must be indicated.
• Treatment notes, narratives or charting submitted with claims must be legible and may not contain abbreviations.
• Payer must have no reason to believe that the claim was submitted fraudulently and that there is no material misrepresentation.
If the above conditions are not met, the claim is not considered to be a complete claim and is therefore not subject to applicable statutory/regulatory prompt pay provisions.
To learn more about the requirements and timelines for claims documentation, visit www.deltadentalri.com, click on the Dentists tab, and then select the link for Utilization Review Guidelines.
2024 credentialing meeting schedule
Please ensure that your completed application is submitted at least 7 days before the scheduled meeting date. Only fully completed applications will be reviewed at the meeting. If your application is incomplete, it will be reviewed at the next available meeting date once all required documents have been received. Check the graphic below for specific meeting and application due dates.
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Remaining 2024 holiday schedule
Please make note of the following Delta Dental of Rhode Island corporate office closures.
August 12 (Monday) Victory Day*
September 2 (Monday) Labor Day
October 14 (Monday) Columbus Day/ Indigenous Peoples’ Day*
November 11 (Monday) Veterans Day*
November 28 (Thursday) Thanksgiving Day
November 29 (Friday) Thanksgiving Friday
December 25 (Wednesday) Christmas Day (observed)
*Delta Dental of RI Customer Service office is open
National dental holidays
Every year, it’s important to take time to celebrate the hard work of your practice. These occasions also offer great opportunities to educate your patients about oral health issues. Be sure to add the dates below to your calendar.
Reminders
Help keep our records accurate Accurate information helps us process your claims quickly and efficiently. When changes happen in your office, contact Debra Fernandes in our Professional Relations Department at 401-752-6206, email dfernandes@deltadentalri.com
Electronic attachments
Delta Dental accepts electronic attachments like x-rays, periodontal charting, narratives, and COB information using National Electronic Attachment, Inc. (NEA) services, Dental Xchange and Change Healthcare.
ADA Dental Claim Form
To ensure your claim is processed without delay, please use the current ADA Dental Claim Form.
2024 dental awards
RIDA awards
Congratulations to the following award recipients:
• Dr. David Ward, Dr. Joseph Box Everyday Leadership Award
• Dr. Gregory Stepka, Dr. A. James Kershaw Award
• Dr. John DeMello, Good Citizen Award
• Dr. Christina DiComes, Humanitarian Award
International College of Dentists (ICD) District 1 awards and honors
Congratulations to the following award recipients:
• Dr. Francis Connor, Jr., Inaugural Dr. Vangel Zissi Distinguished Service Award
• Dr. Bob Kubaska, Dr. Brian Gaudette, Dr. Gregory Stepka, Rhode Island dentists inducted into the ICD.
Re-credentialing policy
When re-credentialing, please return the following documents:
• Your completed re-credentialing profile.
• A copy of the first page of your current professional liability insurance.
• An updated W-9 form if changes have been made.
Appeals and complaints
To learn more about our appeals and complaints processes, please visit the FAQs page at https:// deltadentalri.com/Provider/PublicFAQ
Value-Based Care reimbursement
Mid-year Practice Profile Scorecards used for our Value-Based Care reimbursement program were mailed to eligible offices on July 17. For questions about the program or your practice scorecard, please contact our Professional Relations Department. Contact Professional Relations professionalrelations@deltadentalri.com
10 Charles Street, Providence, RI 02904-2208 Telephone: 401-752-6206 Fax: 401-752-6060
