GHI Family Dental Practice Embraces CAMBRA Model

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1 Embraces CAMBRA Model As of February 1, 2011, EmblemHealth s (GHIFDP) in Albany now offers the caries prevention program CAMBRA to all interested patients. The program goal is to prevent oral disease by helping patients reduce related risk factors. Short for Caries Management by Risk Assessment, CAMBRA is an assessment tool used to identify patients oral health behaviors and pinpoint their oral health risks. While all GHIFDP patients receive an initial CAMBRA assessment, their participation in the full program is voluntary. Patients may choose to join once they have received their results and their individualized risk-reducing recommendations and treatment protocols. For patients who join our pilot CAMBRA program, GHIFDP dentists and hygienists provide the following services: Private consultations about the patient s medical status, diet, medications, and history of fluoride use and tooth decay Treatment recommendations, including frequency of exams, cleanings and radiographs Personalized recommendations for lowering the patient s oral disease risk factors. These often focus on behavioral measures, such as changes to diet, brushing and flossing habits, or use of prescription or over-thecounter drugs. In conjunction with this program, EmblemHealth and the New York State Office for People With Developmental Disabilities hosted a statewide continuing education course on CAMBRA in late November GHIFDP is currently in discussions with the New York State Department of Health about assessing program results. For more information on the CAMBRA program, please contact Gary Goldstein, DDS, MBA, Dental Director of GHIFDP, at

2 Dental Setting: EmblemHealth On December 8, 2010, the EmblemHealth Dental Management department offered our network dentists a free continuing education course "Screening Tests: A New Era in Dentistry and HIV Care" in collaboration with the New York State Department of Health s NY/NJ AIDS Education and Training Center. This marks the first presentation of the course by a health insurance company and the first in a series of planned outreach efforts to our dental community. Because early symptoms of HIV often appear in the mouth first, dental professionals are in a unique position to detect HIV and combat its spread. Now you can perform rapid HIV screening right from the dental chair, making the dental visit an additional avenue for reaching patients. This screening can be administered either by oral swab or fingerstick. It produces results* in 20 minutes. With the greater availability of treatments, and the success of treatment depending largely on timely diagnosis, early detection is increasingly important. Rapid HIV screening can help connect HIV positive patients with immediate care. EmblemHealth's HIV/AIDS Clinical Practice Guidelines are available on our Web site, emblemhealth.com. For information on HIV screening in the dental office, please contact Howard E. Lavigne by or at Howard E. Lavigne is Deputy Director of HIV Clinical Education at the New York State Department of Health AIDS Institute. *Positive, or reactive, results are considered preliminary positive results only. A confirmatory Western blot test is always required to verify a reactive test result. For patients with a reactive test result, a confirmatory test should be ordered immediately and administered as soon as possible.

3 Oral health is essential to overall health, and dentistry can partner with the medical community to help patients achieve positive health outcomes, including disease prevention. Now, in-office saliva testing for HIV, diabetes, heart disease, arthritis and various forms of cancer offers dental professionals a new way to integrate potentially life-saving preventive care into routine dental treatment.* Widely used to detect oral disease (including periodontal disease and caries risk), salivary diagnostics are now proving their potential to detect systemic disease and reveal new information about oral-systemic health. 1 Supporting this development are technological advances that break down barriers to widespread salivary testing such as low speed and poor sensitivity and functionality. For example, with some new technologies, the clinician can screen for disease using only a small amount of bodily fluid and measure in saliva many things one can measure in blood. As a research tool, saliva may tell us more about our health than we once believed. As a clinical tool, it is compelling because it meets a demand for: Noninvasive screening, reducing patient anxiety and discomfort and simplifying the process of repeat sampling. Quick, easy and inexpensive methods, creating opportunities for more widespread use and making it possible to diagnose disease even in remote or impoverished settings. Ease of collection, storage and shipping, representing some advantages of saliva over serum. Fewer procedural manipulations, made possible because saliva does not clot. In a January 2010 survey from the American Dental Association, 87.7 percent of 1,900 dentists surveyed said they would be willing to perform salivary diagnostics. 2 With this level of support and enthusiasm, the goal of Healthy People 2020 could be achievable that is, to bring preventive interventions in a dental setting to a greater number of adults, including screenings for oral and pharyngeal cancer and tests or referrals for glycemic control. The Oral-Systemic Connection: Salivary Testing for Systemic *Screening services may not be covered under EmblemHealth and GHI dental plans. Related ADA CDT codes are as follows: collection and preparation of saliva sample for laboratory diagnostic testing (D0417) and analysis of saliva sample (D0418). References 1. Wong, David T., DMD, DMSc Salivary diagnostics powered by nanotechnologies, proteomics and genomics. The Journal of the American Dental Association. Vol. 137, No. 3, Greenberg, Barbara L., MSc, PhD, Michael Glick, DMD, Julie Frantsve-Hawley, RDH, PhD and Mel L. Kantor, DDS, MPH, PhD Dentists attitudes toward chairside screening for medical conditions. The Journal of the American Dental Association. Vol. 141, No. 1,

4 Submission for Dental Providers We are pleased to offer free electronic claims submission for our EmblemHealth and GHI dental providers. Electronic claims improve administrative efficiency, simplify recordkeeping, and reduce clerical time and money spent on producing, processing and mailing paper claims. We have identified two options from DentalXChange, our trading partner: Option 1, for data entry claims systems: Benefit from free software and no-cost transaction fees when you choose to submit electronic claims via the direct data entry (DDE) claims system. No-cost transaction fees are not limited just to EmblemHealth or GHI; ask about additional payer plans available with this offer. Submission for Dental Providers Option 2, for practice management systems: For a free 30-day trial period, a practice management system (PMS) can be set up for batch claims submission for EmblemHealth, GHI and other payers. After the trial period, you will have the option of continuing this solution for a fee. To switch to electronic claims, call , ext For more information on DentalXChange, visit their Web site at

5 An ounce of prevention is worth a pound of cure. Benjamin Franklin Preventive dentistry is a win-win situation for your younger patients. Teaching them good oral health habits in childhood prepares them to take responsibility for their own dental health over a lifetime. Because we recognize the critical importance of preventive dental care, our EmblemHealth and GHI Dental Preferred and Preferred Plus plans cover the following preventive services: D0145 Oral evaluation for a patient under three years of age and counseling with primary caregiver D1120 Prophylaxis child D1203 Topical application of fluoride child D1206 Topical fluoride varnish; therapeutic application for patients with moderate-to-high risk of caries For children, our dental plans also cover one fluoride treatment or fluoride varnish application per calendar year. Patients have a maximum allowance of four bitewing X-rays per calendar year, and a maximum allowance of 14 periapical X-rays or one panoramic film per three-year period.

6 Here are some helpful reminders for easier transactions and prompt payments: New periodontal policies. Effective December 2010, our periodontal service guidelines include new provisions to patient eligibility for annual treatments, scaling and root planing, periodontal maintenance and surgeries. To review the new guidelines, please see pages 19a and 19b of our Dental Office Manager s Handbook. Universal ADA 2006 form. As we no longer accept the green GHI Dental claim form, please submit a universal ADA 2006 form when submitting claims manually. To access the form, log on to the provider home page of emblemhealth.com and click ADA Dental Claim Form on the portal home page. X-rays and periodontal charting. Please note the following submission opportunities and policies: Electronic submissions. Submit your X-rays and periodontal charting online through the FastAttach system of National Electronic Attachment, Inc. (NEA). Our Electronic Payer ID is To learn more about FastAttach, call , ext. 2 or NEA directly. Please note that at this time, EmblemHealth and GHI do not review EOBs or narratives submitted to NEA. Original claim submission. X-rays and periodontal charting must be submitted with the original claim submission. With your submission, please include a list of the procedures that required these diagnostics. Member agreement for out-of-pocket expenses. When out-of-pocket expenses are anticipated for billable services, offices must enter into a written agreement with the EmblemHealth or GHI member (or the patient s parent or guardian). To request a waiver form, our Dental Management team.

7 Our Web Site Capabilities and For instant access to eligibility and benefits information, tooth history, exam records and much more, log on to the provider home page of emblemhealth.com. Following are just some of the online capabilities we provide to make it easier for you to work with us: us. For quick, efficient correspondence with the EmblemHealth Dental Management team, us at Use this address to let us know about changes to your contact information, TIN number and other practice specifications. Get updates. Send us your address to opt for automatic electronic delivery of Dental News and other ecommunications with important information for your practice. Or log on to the provider home page of emblemhealth.com and add your address to your profile. Submit your claims online. We accept electronic claims and claim attachments through the FastAttach system of National Electronic Attachment, Inc. (NEA). To learn more, call , ext. 2 or NEA directly. Our Electronic Payer ID is Submit your NPI number online. Just log on to the provider home page of emblemhealth.com and click "Submit NPI." Call our Electronic Data Interchange (EDI) help desk. Call for help registering for and submitting electronic claims.