Your Partner For Dental Plan Success
Welcome to Denex Dental Dear Executive: I’d like to introduce you to Denex Dental, our newest division here at Group Dental Service (GDS). In 2003, after 40 years of providing full-service dental plans to large groups, GDS established the Denex division to offer a suite of dental products targeted for distrubution by the broker community. Our history of success at GDS — and now Denex — is a direct result of our unwavering commitment to exceptional service standards. Ours is an experienced and engaged team – one that consistently goes above and beyond to provide outstanding service to organizations like yours. In fact, I’m so proud of the Denex staff that I often refer to them as my Dream Team. At Denex, we understand that our performance directly affects your business and, indeed, we take our relationship with you very seriously. That’s why the needs of our brokers and customers remain front and center every day. This brochure will introduce you to Denex Dental and the long history of our parent company, GDS. It will also introduce you to our experienced team, our optimized processes, and our world-class administrative system. Certainly, these attributes are critically important as, without them, we wouldn’t have achieved such customer loyalty and member satisfaction. But, what’s much more difficult to capture in words is the energy and culture here at Denex. We are guided by a set of core values, including integrity, loyalty, responsiveness, and partnership, which foster exceptional service and long-lasting relationships. Hopefully, as you read through this brochure, our commitment to these values will become evident. We look forward to introducing you to our company. Warm regards, Dr. Ralph Foxman Founder and CEO Denex Dental
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A Rich History of Dental Expertise In 1965, Dr. Ralph Foxman, a pioneer of managed dental care, founded Group Dental Service (GDS), the parent company of Denex Dental. The company quickly established a reputation for effectively serving large groups in the mid-Atlantic region, most of which are still with us today. Since then, we’ve grown our portfolio of offerings to include: • Denex Dental for small and mid-size groups • A full-service dental third-party administrator specializing in private-label programs • A full suite of discount products Using our knowledge and experience, we deliver exceptional service with a flexible platform and product suite to exceed customers’ expectations. GDS Timeline
DBP Timeline
1965 – 1983 Dr. Ralph Foxman establishes GDS and pioneers managed dental care in mid-Atlantic region. GDS earns a strong reputation for effectively servicing large employer groups of Giant, Safeway, Marriott, and Sheraton. 1984 – 2001 GDS continues to thrive as regional provider of managed dental care products, never losing a client.
1984 – 2001 Dr. Foxman founds Dental Benefit Providers (DBP) to offer privatelabel dental products to national insurance companies. DBP grows to over 2 million lives and operates in 38 states. Clients include Kaiser Permanente, Blue Shield of CA, Regence and Premera Blues, Health Net, Anthem, and HealthAmerica. United Health Group acquires DBP in 2002.
2002 – Present GDS recruits industry leaders. Denex Dental is launched to offer broker-friendly products for the group market.
A Dedication to Performance At Denex, we’ll quickly earn your confidence and trust. Our talented staff includes industry leaders as well as managers and directors with 20+ years of experience – all of whom have deep subject-matter expertise. Every day – through their performance and results – our staff demonstrates an unwavering commitment to Denex’s core values of integrity, loyalty, responsiveness, and partnership. That’s why our customers rely on us as their long-term dental partner of choice.
A Proven Formula for Your Success
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We’ve also implemented best-in-class technology that enables our people and processes to meet the highest efficiency and service standards. With our powerful web-based administrative system, Denex consistently delivers accurate and complete real-time data and 24/7 service.
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We’ve taken great care to optimize our operational processes in order to maximize efficiencies. And, we diligently monitor those processes with transparent metrics in order to repeat best practices and maintain business performance.
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Denex seamlessly integrates the right people, technology, and processes to deliver the very best service. We carefully recruit the most qualified staff, who undergo sophisticated functional and dental training, testing, and certification before getting started in their roles. Furthermore, we ensure they continue learning through ongoing training, re-testing, and re-certification programs administered by our experienced in-house training professionals.
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GDS Enterprise Solution for Maximum Efficiency and Accuracy The GDS Enterprise Solution is a best-in-class, web-based dental system that enables us to manage administrative costs and deliver service with maximum efficiency and accuracy. Built around industry best practices and deep market intelligence, this system’s 33 integrated modules effectively centralize all data as well as automate and support core business processes. Developed using state-of-the-art router, SQL server, web, and firewall technologies, our administrative system optimizes performance and security with a scalable server and database infrastructure to support growth. Furthermore, Denex protects your data with proven backup and restore technology, long-term off-site data retention, and comprehensive disaster recover plans. The GDS Enterprise Solution empowers Denex to consistently exceed customer service standards. But, equally important, it’s also a powerful tool for clients, members, and providers, enabling centralized web access to accurate real-time information. The SAS 70-compliant system has been tested to maximize user satisfaction, visual layout, navigational capabilities, and speed of data presentation. And, we periodically release updated versions to leverage new market trends and user feedback. In addition to providing fast centralized access to accurate data anytime and anywhere – our administrative system also offers large-group clients the E-BIS module, which allows for ad hoc intelligence reports for effective decision making and plan management. In short, the GDS Enterprise Solution enables any organization to run a more efficient and competitive dental program as well as boost member satisfaction.
GDS Enterprise Solution Overview of Key Modules System Functionality Eligibility
Provider Management
Claims
• Manages initial enrollment via paper, web, or EDI
• Developed as a dental-only claims processing system
• Easily interfaces with third-party systems
• Supports 90%+ drop to pay
• Generates invoices
• Enables customized adjudication rules and edits • Fully integrates robust cost management functionality
Call Center
Web Services
• Provides real-time visibility into claims and adjudication status
• Secure logins for members, providers, and group administrators
• Enables utilization optimization
• Allows same-screen look ups for claim and call history
• Easy access to centralized real-time data and services
• Facilitates multiple network tracking
• Integrates with 24/7 IVR system
• 24/7 access to standard administrative functionality
• Allows for customized fee schedules for every doctor and for every product/ location sold
• Ad hoc customer reports available
Business Intelligence Reports Facilitates effective operational controls throughout the group’s life cycle, including enrollment, set-up, eligibility maintenance, and renewals.
Supports completely paperless environment with 99% processing and financial accuracy, exceeding industry standards for turnaround times.
Facilitates effective decision making around cost management and plan design.
Enables our staff to exceed industry standards for call center, speed, and quality metrics, including 90% first-call issue resolution.
Enables complete visibility for effective plan management.
Best Practice Processes
Web Services for Clients, Members, and Providers Clients
Members
Providers
• Submit enrollment
• Check claims
• Enter claims for services rendered
• Access E-BIS
• Review EOBs
• Generate reports
• Print and order ID cards
• Check claim and pre-authorization status
• Review/change eligibility
• Find providers
• Contact Client Services
• Nominate providers
• Contact general management
• Contact CSRs
• Review invoices
• Change personal information • Submit enrollment
• Verify patient eligibility • Submit service authorization requests • Submit electronic attachments (x-rays, EOBs, etc.) • Check patient treatment history for specific services 5
Responsive and Accurate – Guaranteed At Denex, we take performance metrics seriously, ensuring exceptionally high levels of responsiveness and accuracy. For large groups, we offer customized guarantees on any metric that’s important to you. We provide all small groups (3– 99 lives) our standard guarantees on: • Fast Plan Implementation and Fulfillment: We send fulfillment materials within 10 business days of enrollment.
• Fast Claims Processing: We accurately process 95% of claims within seven business days of submission.
• Fast Issue Resolution: We respond within one business day with resolution or status update.
In-House Expertise to Enhance Your Value Denex Dental’s full-service operations cover every aspect of delivering high-quality dental administration. Our in-house operations include: • Mail Room and Fulfillment Center • Claims Department • Professional Review • Call Center • Provider Relations and Network Recruiting • Actuarial/Underwriting • Sales and Account Management
• Project Management for Large-Group Custom Implementations • Billing and Eligibility • Financial Services • Contracts and Regulatory Compliance • Training and Quality Assurance
Our Full-Service Approach To meet and exceed your service expectations, Denex carefully combines highly experienced professionals with industry best practices and optimized business processes. This comprehensive approach ensures we can deliver the very best in every area of dental management, including: • Call Center: Denex enjoys very low turnover in our call center, where we offer staff incentives for exceeding industry standards in key metrics-based performance areas. And, with the advanced features of the GDS Enterprise Solution, we resolve 90% of issues on the first call as well as offer 24x7 IVR for member eligibility, provider search, and claims status. • Claims Adjudication and Document Control: Combining an experienced staff and the rich functionality of our claims system, Denex processes claims with 99.9% financial accuracy. In addition, we provide multiple audit layers along with licensed dentists to perform professional claims review. • Cost Management: Denex employs in-house licensed dentists to review claims. And, to meet clients’ unique needs, our administrative system allows for group-specific edits to adjust the stringency of cost management. • Eligibility and EDI: We employ a dedicated IT team to facilitate existing and new data feeds and meet customer conversion needs. Our eligibility services are enabled by EDI capabilities with proprietary and ANSI formats. We also accept both paper and web enrollment and eligibility changes.
• Fulfillment: Our administrative system offers a proprietary feature for generating ID cards on demand. Additionally, we include a provider directory sample and benefit schedule in every subscriber kit. • Plan Design: We provide consulting services to help large-group customers design customized dental plans that meet their specific benefit and budget requirements. • Private Label: Our flexible system and processes allow Denex to customize any aspect of a dental program, including plan design, enrollment, fulfillment, marketing materials, web site, cost management features, call-in features, and reporting functionality. • Program Support: With both standard and custom implementations, we adhere to proven quality assurance standards. • Regulatory Compliance: Our team of regulatory experts is comprised of attorneys who previously served at the National Association of Insurance Commissioners (NAIC). They develop certificates of coverage, summary plan descriptions, and contracts as well as ensure HIPAA and anti-fraud compliance.
Provider Networks Denex offers clients access to both a national PPO and a mid-Atlantic regional EPO network. The national PPO network delivers access to over 75,000 credentialed providers. Through this network, customers can select either a PPO or a discount dental program. We established our regional EPO network in 1965. Due to the exceptional care and service we provide to our dentists, this exclusive network offers deep discounts in the Washington D.C./Baltimore area. Our in-house network recruitment team performs custom recruits for both the national PPO and EPO networks when required. If you don’t have the network you need, we’ll get it for you. We also provide network utilization, geo-access, and disruption reports. 7
Flexible Funding to Meet Your Needs GDS, Denex Dental’s parent company, is structured to take risk. Additionally, we’re a licensed third-party administrator that can defer the risk if the customer so desires. This flexibility enables us to offer fully insured, self-funded, or risk-shared funding options.
Your Partner for Dental Plan Success Denex offers all groups full access to our people, processes, and technology. When necessary, we’ll create custom implementations for large-volume clients, ensuring they receive just the services and technology required to meet their unique needs. At Denex, we approach our client relationships as consultative partnerships in every way. With a compelling combination of experience, service, and flexibility, we deliver what you need – when you need it. We look forward to the opportunity to serve as your dental partner.
This brochure provides general information about the products and services offered by Denex Dental, a division of Group Dental Service. Product offerings may not be available in certain states and may vary depending on state laws. All plans are underwritten by Group Dental Service of Maryland, Inc., a wholly owned subsidiary of Group Dental Service, Inc.
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Denex Dental 111 Rockville Pike, Suite 950, Rockville, MD 20850 www.denexdental.com 1-866-433-6398