Kansas Dental Program. Kansas Health Policy Authority. Dental Program History. Quasi Independent Agency
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1 Kansas Dental Program Janelle Garrison, RN, BSN Kansas Health Policy Authority Dental Program Manager Kansas Health Policy Authority Quasi Independent Agency Reports to a Board of Directors Nine Voting Members Eight Non Voting Members Secretaries of State Insurance Commissioner Education Commissioner KHPA Executive Director Dental Program History 999 thru Three Fiscal Agents administer dental program Two Managed Care Organizations (MCO) One Fee For Service (FFS) Title 9 rates increased thru Two Fiscal Agents administer dental program One MCO One FFS Title (SCHIP) rates increased Dental MCO & ASO awarded to one Fiscal Agent Processed Title Received Title 9 claims and prior authorizations Different Fiscal Agent processed Title 9 claims thru MMIS system Review of all dental policies into master policy per benefit plan 6
2 Title 9 $, annual limitation discontinued Periodicity schedule adopted (ADA, AAPD, AAP) Fluoride treatments approved for Medical Providers Prior Authorization removed for several CDT codes 6 One Fiscal Agent awarded dental contract for Title 9 and Title Providers begin accessing real time claims adjudication via KHPA Web site Prior Authorization removed for more CDT codes Title 9 and Title children benefit plans aligned 7 7 Governor s office sent letters to dental providers that had participated in KHPA dental program for more then years Comprehensive dental benefits added for some waiver adults Home and Community Based Services» Developmentally Disabled» Head Injury» Physically Disabled» Frail Elderly Dental: The KHPA Way 9 Dental: The KHPA Way Dedicated Dental Services Team Dental Program Education Coordinator Dental Services Call Center Unique phone option for dental providers Provide customer service to only dental providers Recruitment Dental Resolution Specialist Consistency Provider Toolkit Dental Services Team Local Dental Consultant Automatic Voice Response System Electronic Data Interchange (EDI) Electronic claims
3 KHPA web site Publications Global Messages Bulletins Provider Manuals» Re written in a provider friendly format Eligibility Inquiry Dental Services Profile» Five year history Dental Claim Header Level» Provider ID and NPI auto populate» Enter beneficiary ID number; beneficiary name and date of birth auto populate» Free form text box» Third party liability payment field Detail Level» Pop up boxes prevent user from entering invalid information» Drop down box enabled when certain CDT codes are entered» Correct number of surface fields are enabled when a restoration code is entered Dental Claim Inquiry Research past dental claims» Resolve account receivable Adjustments» Complete claim corrections on the web site Re submit denied claims Provider Survey In November 6 a satisfaction survey was sent to KHPA dental providers that filed claims in 6. One hundred seventy nine providers returned the survey, a % response rate. Overall performance of the new dental fiscal agent N/A or no opinion Fair or Poor Satisfied Superior or Good % 6% % 7% % % % 6% % 6 Recruitment Mailings Recruitment brochure was developed in June 7. Kansas Dental Board provided KHPA with a list of all dentists currently licensed in Kansas 9 dental offices were identified as non participating Recruitment brochure was mailed to these offices % of all the offices were contacted successfully. They sited the following reasons for non participation:» % said the fees were well below their cost of seeing the patient» % sited the high no show rate for Title 9/Title beneficiaries» % sited the amount of paperwork and staff time» % said they would like more information and would consider participation Recruitment Spring 9 workshops Post cards will be sent to non participating dental providers to encourage their attendance in the dental specific portion held in their local area across the state. 7
4 Claim Outcomes Electronic Submission 6 7% 7 77% 79% Claim Processing (receipt to adjudication) 6 6.9% < days % < days.% < days Average for all dental claims in. days Claim form mandate or later ADA dental claim form 9 6 Report Medicaid Percentage of children receiving any dental services Age Group Title Total < FY FY Dental Provider Participation Analysis - Title 9 January 9 SAME MONTH SIX MONTH FISCAL YEAR-TO-DATE LAST YEAR AVERAGE THIS YEAR LAST YEAR THIS MONTH Providers Enrolled 9 Providers Participating 67 6 Percent Provider Participating 7% % 7% 7% 6% Total Claims Paid 7,,7 7,7,,66 Claims Paid Per Participating Provider 6 Total Participants Served,,66,9,9 9,69 Total Payments $,769,9.7 $,9,69. $,7,.69 $9,,.76 $7,7,7.67 Average Payment Per Participating Provider $7,.7 $7,66.9 $,7. $,6.7 $,76.9 Age Group Title 9 Total < FY FY Average Payment Per Participant $9.7 $9.7 $9. $9.9 $9.6 Services Rendered 6, 7,76 6, 67,,9 Average Number of Services Per Participating Provider ,7.,.6 Average Number of Services Per Participant Average Payment Per Service $.9 $. $.9 $.6 $9. 7 providers are enrolled in Title 9 only KHPA TXIX Dental Provider Participation th Quarter, Beneficiaries Served by Provider County 7 6 Border State Providers: Missouri - Oklahoma - Nebraska - Colorado - Out of State -
5 Beneficiaries Served by Provider County Beneficiaries Served by Provider County Beneficiaries Served by Provider County 6 Dental Summary Dental Summary 7 Summary Simplified children s benefit plans into one plan Reduced provider paperwork Increased provider confidence in receipt of payment Streamlined claim submission Decreased claim processing time Easy access of information and assistance Dental Services Team AVRS KHPA Web Site Dental: The Results Increased Provider participation January thru June 6 69 Providers Participated January thru June 7 Providers Participated Beneficiary access January thru June 6 7,9 Beneficiaries Served January thru June 7,7 Beneficiaries Served Dental services performed January thru June 6, Services Performed January thru June 9, Services Performed 6: Figures reflect data with multiple fiscal agents. : Increased data is a direct reflection of the changes made to the dental program and administration by one fiscal agent. These increases were achieved by KHPA in conjunction with a significant reduction in 9 administrative costs. Janelle Garrison, RN, BSN Kansas Health Policy Authority Dental Program Manager Janelle.Garrison@khpa.ks.gov
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