Dental BulletinPacificSource logo

Winter 2019

In this issue:

Recap of 2018: A Banner Year for PacificSource’s Dental Product >

Dental Product News for 2019 >

New Year, New Branding for Our Dental Network >

CDT 2019 Dental Code Changes >

Evidence-based Clinical Practice Guidelines: Nonrestorative Treatments for Carious Lesions >  

Quick Reminders for Coding and Claims >

Questions? We’re Happy to Help >


 

Recap of 2018: A Banner Year for PacificSource’s Dental Product

By Dr. Jim Gimarelli, Director of Dental Business, Commercial Programs

The year 2018 may have been the best ever for the PacificSource dental product. Loss ratios were solid, growth was the highest in our history, retention was at an all-time high, and our customer service folks knocked it out of the park!

We grew 17% on the commercial dental side, from 62,500 to over 73,000 members, bringing our total dental membership (including Medicare and Medicaid) to almost 136,000 dental members.  

Our retention was almost 82% overall, with our large group clients coming in at 88% and small group coming in at just over 80%.

Our dental customer service representatives answered nearly 45,000 phone calls in an average of 23 seconds and answered over 85% within 30 seconds. With PacificSource dental coverage, provider offices and members get to talk to a live person quickly!

 


Dental Product News for 2019

Effective January 1, 2019, PacificSource made two major changes in our dental offerings:

  • We added a $1,500 individual dental maximum to go along with our $1,000 individual dental maximum plan.
  • We also moved endodontics, periodontal surgery, and complex oral surgery from class 3 (major services) to class 2 (basic services) for small groups.

We are excited about the potential growth we will see as a result of these important changes.   

 


New Year, New Branding for Our Dental Network

As you may know, the exclusive network for PacificSource is Advantage Dental, and in October 2016, Advantage partnered with DentaQuest. The partnership combines DentaQuest’s extensive experience as a leading dental benefits administrator with Advantage’s innovative approach to the delivery of oral health care.

As part of this relationship, Advantage rebranded in November 2018 with a new name and logo. Advantage Dental is now Advantage Dental From DentaQuest. The rebranding also includes a refreshed design for their website, which has the same web address: www.AdvantageDental.com. The changes are subtle, but underscore the connection between the two entities in the marketplace.

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CDT 2019 Dental Code Changes

The American Dental Association has published CDT 2019, which replaces CDT 2018 as the reference document for dental services provided January 1, 2019, through December 31, 2019. 

If you have not already, please begin using CDT 2019 codes on claim forms to report services to eligible PacificSource dental members. Our system is programmed to deny claims with 2018 CDT codes used for service dates on or after January 1, 2019.

Fifteen new codes have been added for 2019 and four were deleted. Codes that will be covered with limitations are listed below:

  • D1516: space maintainer – fixed – bilateral, maxillary
  • D1517: space maintainer – fixed – bilateral, mandibular
  • D1526: space maintainer – removable – bilateral, maxillary
  • D1527: space maintainer – removable – bilateral, mandibular
  • D5282: removable unilateral partial denture – one piece cast metal (including clasps and teeth), maxillary
  • D5283: removable unilateral partial denture – one piece cast metal (including clasps and teeth), mandibular
  • D5876: add metal substructure to acrylic full denture (per arch)
  • D9944: occlusal guard – hard appliance, full arch
  • D9945: occlusal guard – soft appliance, full arch
  • D9946: occlusal guard – hard appliance, partial arch

 


Evidence-based Clinical Practice Guidelines: Nonrestorative Treatments for Carious Lesions

The American Dental Association (ADA) recently convened a team of experts to conduct a systematic review of nonrestorative treatments for carious lesions. They subsequently developed recommendations for the arrest or reversal of cavitated and noncavitated carious lesions in both primary and permanent dentition. The expert panel formulated 11 clinical recommendations, each specific to lesion type, tooth surface, and dentition.

Of the most effective interventions, the panel provided recommendations for the use of 38% silver diamine fluoride, sealants, 5% sodium fluoride varnish, 1.23% acidulated phosphate fluoride gel, and 5,000-parts-per-million fluoride (1.1% sodium fluoride) toothpaste or gel, among others. These approaches have shown to be effective in arresting or reversing carious lesions. Clinicians are encouraged to prioritize use of these interventions based on effectiveness, safety, and feasibility.

The panel’s recommendations are summarized in a handy chairside guide from EBD.ADA.org. ( See the guide.)

 


Quick Reminders for Coding and Claims

We want your experience working with us to be smooth and easy. Here are a few simple things to keep in mind when billing or contacting us. 

  • Claims for crowns or any services associated with lab work are only processed on the seat date, not the prep date.
  • Codes D1351, D1352, D1353, and D1354 are per tooth, not per tooth surface. Noting surfaces on your claim form is not needed and may cause delays in processing.
  • With procedure codes, please include the tooth number, arch, or quadrant that corresponds with the service.
  • If you have dental coverage questions, please call our Dental Customer Service team at (866) 373-7053. A friendly representative will be happy to help. PacificSource does not provide dental coverage information by fax.
  • If you need fee schedule information, Advantage Dental can assist you. Please contact them at (866) 268-9616, or visit Secure.AdvantageDental.com/credentialing. (PacificSource does not have access to Advantage fee schedules.)

Thank you for your assistance!  


Questions? We’re Happy to Help

Contact PacificSource Dental Customer Service for questions concerning:

  • Member benefits or eligibility
  • Status of a specific claim or EOP

Email: dental@pacificsource.com

Phone: Eugene: (541) 225-1981. All other areas: (866) 373-7053

Fax: (541) 225-3655

Contact Advantage Provider Relations for questions concerning:

  • Becoming a contracted provider
  • Provider contracts
  • Advantage fee schedules

Email: providerrelations@advantagedental.com

Phone: (866) 268-9616

Website: www.AdvantageDental.com

Fax: (866) 268-9318

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