Insurance Connection
voluntary managed care program , and its withdrawal from 17 voluntary counties will impact approximately five percent of those consumers . ( Blair County will be excluded from the withdrawal and will remain in Gateway ’ s voluntary county service area ).
Recipients in 16 of the withdrawal counties will have the choice of at least one other voluntary managed care plan or ACCESS Plus , DPW ’ s Primary Care Case Management ( PCCM ) Program . One county , Northumberland , does not have another managed care plan as an option and these recipients will be transferred to the ACCESS Plus program .
Pennsylvania Begins Implementing Federal Recovery and Health Care Reforms On September 9 , PDA ’ s government relations staff attended a Health Care Summit sponsored by the Pennsylvania Business Council Education Foundation . The central theme was the federal recovery act and health care reform bill . Ann Torregrossa , director of the Governor ’ s Office of Health Care , spoke about Pennsylvania ’ s implementation of the electronic exchange of health records , called the Pennsylvania Health Information Exchange ( PHIX ). Medical and dental records could be part of this exchange and it remains optional for providers to participate .
Funded by the federal government , PHIX is an electronic superhighway that allows the secure exchange of health information to authorized users to improve the delivery of health care services to patients . The Governor ’ s Office has not yet determined who will operate PHIX and it is researching agencies in other states to determine which can implement PHIX most cost-effectively . The state also is determining who will have oversight of this agency and is considering creating a public authority with a board of directors or contracting with a non-profit group . The state ’ s deadline for implementing PHIX is January 1 , 2014 .
Federal funding to implement the technology for the electronic exchange of dental records may be available to eligible dental providers . For more information , please contact Dr . Frank Kyle , the American Dental Association ’ s manager of legislative and regulatory policy , at ( 202 ) 789-5175 . PDA will continue to monitor developments with PHIX and other health care reforms at the state level to determine their potential impact on the dental profession .
PDA ’ s Insurance Liaison Program Available to Members Beginning January 1 , PDA is launching a more comprehensive program that will partner government relations staff and members of the Dental Benefits Committee ( DBC ) with insurance carriers across the state . The purpose of the Insurance Liaison Program is to build stronger relationship with each dental insurance carrier , and for staff and DBC volunteers to work in tandem to solve members ’ insurance-related problems . Ideally , liaisons from the insurance company will work at the claims processing supervisor level , and will help provide tips on submitting claims correctly . This would relieve their processing backlog and speed up reimbursements to providers . We would also use this exchange with insurers to update members on the latest trends and new processing policies of each insurance carrier . In order to facilitate our communication with insurers and provide pertinent information to members on a timely basis , we plan on meeting with all of the major carriers on at least two occasions per year or as needed .
We would like feedback from members involved in cases of continual denial of claims . Although HIPAA privacy laws prohibit us from discussing individual patient claims , staff is available to provide some insight as to how claims should be processed . Please contact Ivan Orlovic with any questions or concerns at ( 800 ) 223- 0016 , ext . 105 , or iio @ padental . org .
14 November / December 2010 • Pennsylvania Dental Journal