Premier PIPELINE Fall / Winter 2013

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Premier Access Appoints New Dental Director Premier Access is pleased to introduce our new Dental Director; Cherag D. Sarkari, D.D.S. Dr. Sarkari holds both a B.D.S. and M.D.S. (Prosthodontics) from the College of Dental Surgery in Manipal, India. After receiving his D.D.S. from the California Dental Board in 2003, he began his career in California at Access Dental Centers, as an Associate Dentist. Over the next several years, he advanced to Managing Dentist and in 2011, was named Senior Regional Dentist, a position he held until he accepted the role of Dental Director in July 2013. He will continue to see patients on a limited basis during his tenure as Dental Director.

The Dental Director holds a critical position at Premier Access and oversees all aspects of our Quality Management Program (QMP). Dr. Sarkari will:

• ChairtheQualityManagementCommittee(QMC),thePeerReview,DentalPolicies,QualityManagementStudies and Performance Measure, and will participate in all Quality Management subcommittees.

• InvolvehimselfwithallactivitiesoftheQMPtoestablishglobalunderstandingofitsfunctions and its direction.

• Managetheday-to-dayclinicalactivitiesofqualitymanagement,utilizationmanagement(priorauthori-zationofspecialtyreferralsandcasemanagement),peerreview,grievances/appealsandclinicalpolicyfunctions of Premier Access and provides clinical oversight to the credentialing function.

• ChairPeerReviewSubcommitteeandcoordinatewithotherProviders,representedontheCommittee,presentspecificcasesinvolvingqualityofcareforfurtherinvestigationanddeliberation.

• InitiatediscussionsatQMCmeetingsrelatedtoQualityofCareStudiestoidentifyandassessthequalityand level of care delivered to members.

• OverseeallaspectsoftheQMPincludingstaffinvolvedwithQMPfunctions.

• OverseeStructuralandProcessofCareReviews.

• Ensureallfollow-upactionstoimprovecare,addressqualityissues,managethequalityandcost-effectivenessofcare,andreportanysignificantgovernmentregulatorycomplianceviolationstoExecutiveManagement.

• Consultwiththeorthodonticconsultantregardingorthodonticareas.

As the Chair of the Quality Management Committee (QMC), the Dental Director reports to the Senior Vice President of Regulatory and Operational Compliance.

Dr. Sarkari brings a great deal of expertise and enthusiasm to his new role and will be working with our contractedproviderstoensureopenandon-goingcommunication,whichincludesacolumninthispublication.Hisfirsteditorialcanbefoundadjacenttothisarticle.WebelieveDr.Sarkariwillbeanassettotheorganiza-tion and to our continuing efforts to facilitate a strong working relationship with the dentists who provide care to Premier Access members. We encourage you to get to know Dr. Sarkari.

PREMIER PIPELINEN E W S & I N F O R M AT I O N F O R P R O V I D E R S

YOUR COMMUNICATION CONNECT I ON

FALL / WINTER 2013

P.O. BOX 659010

Sacramento, CA 95865-9010

800.640.4466 (toll free)

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ProviderRelations@premierlife.com

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FALL / WINTER 2013

IN THIS ISSUE:

New Dental Director . . . . . . . . . . pg. 1

Dr. Sarkari Message . . . . . . . . . . pg. 2

Updated CDT codes . . . . . . . . . . pg. 2

ACA . . . . . . . . . . . . . . . . . . . . . . pg. 3

EHB . . . . . . . . . . . . . . . . . . . . . . pg. 4

Privacy Notices . . . . . . . . . . . . . . pg. 4

Social Media . . . . . . . . . . . . . . . pg. 5

SmartPhone Brushing App . . . . . pg. 5

Dental Home by Age 1 . . . . . . . . pg. 6

Prenatal Oral Health. . . . . . . . . . pg. 7

OnlineCEClasses . . . . . . . . . . . pg. 7

Peer Review . . . . . . . . . . . . . . . . pg. 8

Quality Management . . . . . . . . . pg. 8

New Groups . . . . . . . . . . . . . . . . pg. 9

UpcomingEvents . . . . . . . . . . . . pg. 9

2014 CDT Code Revisions. . pg.10-13

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FROM THEDESK OF THE DENTAL DIRECTOR

As I sit at my desk on this beautiful fall day, and try to collect my thoughts, in an attempt to pen this editorial piece, myriad thoughts flutter across the landscape of my mind. Some fleeting, others lasting, but the one thought that continues its theme throughout is “change. “The old order changeth yielding way to the new, and God manifests Himself in many ways….”

ThusSpokeSirAlfredLordTennysoninhisEpic….“FromthePassing of Arthur”.

We in the dental healthcare industry are on the cusp of such change. The year 2014 promises to dawn and ushers in with it the “Affordable Care Act”, the single largest piece of legislation to impacts us in a long time.

Premier Access is proud to announce its presence on the “Exchanges” in six different states, offering a wide array ofdental products for our members. In our endeavor to offer the “Essential Pediatric Dental Benefits”, we stay committed tothe concept of establishing and supporting the concept of a

Dental Home at a very early age. Details of this concept can be explored further in an article included in this publication. The provision and implementation of these Pediatric Dental Benefits must certainly raise a lot of questions.We at Premier Accessstand are committed to support you at this time. At this time I invite all of you to avail yourselves of the resources available through the Premier Access network, both online and in person. Our experienced and knowledgeable Provider Relations team is your advocate within the company; please feel free to reach out to them for assistance.

This onward journey promises to be one laced with challenges and opportunities, but the one constant that I can assure you is of the unflinching commitment of Premier Access Insurance Company,tosupportyou,ourprizedProviderNetwork.Keepingthis in mind, I wish to extend my personal invitation as the Dental Director to feel free to reach out to me with your suggestions, concerns, and inputs to help improve your experience with Premier Access.

Cherag D. Sarkari, D.D.S.

Tel:(916)563-6011

E-mail:drsarkari@premierlife.com.

CDT CODES UPDATED FOR 2014CDT (Current Dental Terminology) codes are generally updated every two years. There are a number of additions, deletions, and revisions in the Code for 2014:

• 29newprocedurecodes

• 18revisedprocedurecodes

• 4deletedprocedurecodes

• 7changestothesubcategoriesandtheirdescriptors

Some examples of the changes include:

• Revisionofcariesriskassessmentcodestoprovideastandardmeansofreporting, especially useful in public health and Medicaid dentistry

• Provisionofdistinctcodes forcorebuildupandcrownplacement,ac-knowledging that a core build up is not always a precursor to a crown

• New guidance from the American Association of Endodontists withseparatecodesforpulpalregenerationandapexification/recalcification

• Divisionofimplantsurgeryintostages,eachwithitsownprocedurecode,for easy documentation if each stage is done by a separate dentist. Also includes codes for mini implants

• Simplifieddescriptorsfororthodonticprocedurecodesbasedonrecom-mendations from the American Association of Orthodontists

• Replacement of two “by report” codes from the prosthodontics sectionwith codes for specific procedures, eliminating the need – and extra work – of a narrative report

• Anewsubcategoryofserviceforfabricationofmedicamentcarriers

You will find a more detailed review of the changes made to CDT Codes for 2014 at the end of this newsletter.

Premier Access will change its database to reflect these new codes so it is important that you update your practice to ensure that your claims and questionscanbeaddressedinatimelymanner.

Resources: Code information was provided by the ADA who own and maintain the CDT codes. To purchase the new CDT manual, contact the ADA at www.ada.org/8832.aspx.)

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It is projected that nationwide approximately 3 million children and 800,000 adults could enroll in one of the dental plans offered through the Marketplaces. Another 3.2 million children and 4.5 million adults will be channeled to Medicaid. (In California, families whose pediatric dental care was covered under the Healthy Families Program are being transitioned into Medi-Cal.) Giventhese numbers, you may begin to see an increase in the number of new patients contacting you in 2014, depending upon the Premier Access networks in which you participate.

To put this in perspective, the ADA estimates that the Affordable Care Act will increase U.S. dental spending by an estimated $4 billion, which is less than 4 percent of current national dental expenditures. The largest effect will be seen in the Medicaid population, generating $2.4 billion in Medicaid dental spending. This represents a 28 percent increase over 2010 Medicaid dental spending levels with adults accounting for roughly two-thirds ofthe increase. An additional $1.6 billion in expenditures is expected by adults and children gaining private dental benefits through exchanges and employer sponsored coverage.

Under the ACA, most Americans are required to have healthinsurance beginning January 1, 2014. A standard for the range of benefits that must be covered has been set; these are referred toas“EssentialHealthBenefits” (EHB)andoneof theseEHBs ispediatric oral health and vision. (See companion article for further informationonEHBs.)

The“Exchanges“Healthbenefitexchanges,orhealthinsurancemarketplaces as they are described by regulators, will be available in each state, the District of Columbia and the territories to help individuals and small businesses (up to 100 employees) buy private sector coverage. The marketplaces will be accessible online and will begin enrolling beneficiaries by October 1, 2013. Initially, the exchange will be available only to individuals and small businesses. Plan designs and premiums will vary by state.

Other Areas of Impact

•Ifyouparticipateinstatepublichealthprograms,thestates will receive a 23% increase in federal matching funds for the Children’s Health Insurance Program starting in 2014.

•Grantsforstudiesthatdemonstratetheeffectivenessofcariesmanagementandforschool-baseddentalsealantprograms are available.

•Grantswillbeavailableforloanrepaymentprogramsfordental faculty.

•FundingfortheNationalHealthServiceCorpsloanrepayments has been increased, and dentists who work at free clinics will get extended medical liability protection.

•MostdentistswillbesubjecttoincreasesintheMedicarehospital insurance tax and a new tax on unearned income. The hospital tax will go up 0.9% on earnings more than $200,000 for individuals and $250,000 for couples.

•Beginningin2013,unearnedincometaxwillbe3.8%forthese higher income tax payors.

•Dentistswillpaya2.3%salestaxonmedicaldevices(implemented in 2013).

Nothing changes with your Premier Access administration.Premier Access will support you with the same services and information as we have in the past. The ACA plan documents are available

online or through Customer Service; claims will be paid through the same mechanism as in the past; your patients will present a Premier AccessIDcard;allofyourquestionsandconcernswillbeaddressedbyqualifiedPremierAccessrepresentatives.

Premier Access will be providing benefits through the Healthcare Exchanges in California, Colorado, Arizona, Nevada, Utah, and Texas. Premier Access

plans provide oral health coverage for children under the age of 19 on all of the plans we offer and adult plans are also available.

InformationalResources:AmericanDentalAssociation:WhatDentistsShouldKnowAboutTheAffordableCareAct

www.ksdental.org/what-dentists-need-to-know-about-the-affordable-care-act-aca-for-their-office-and-patients/

Dr. Bicuspid Online Newsletter “How Will Healthcare Reforms Affect Your Dental Practice?” www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=dis&ItemID=308733

HOW WILL THE ACA AFFECT MY PRACTICE?

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ESSENTIAL HEALTH BENEFITS (“EHB”)

EHB–WhatAreThey?TheAffordableCareActrequiresallnewindividual and small group health plans (for people who are not covered through their employment) to cover important health benefits like maternity, mental health, preventive, and pediatric dental care. These are the Essential Health Benefits (EHB) asdeterminedbytheDepartmentofHealthandHumanServices.Fora full list of the EHBs, go to link: www.healthcare.gov/glossary/essential-health-benefits/

Premier Access plans. Depending upon the state, enrollees selecting Premier Access dental benefits will have the option of PPO (in all states) or DHMO in California and Nevada. There are “child only” plans as well as those designed for families. The ACA prohibits the use of annual dollar limits. Copies of the plan documentscanbefoundontheExchangewebsiteforeachstateand you will be able to access them through the Premier Access website as well or call Customer Service for more information.

What procedures will be covered? This varies from state to state but benefits must fall within the Health and Human Services guidelines. The ACA dental benefits offered by Premier Access areExchangeCertifiedandhavebeen reviewedandapprovedbytheDepartmentofInsuranceineachstate.TheymeetallFederalregulations, fulfilling the obligations of the Affordable Care Act for both groups and individuals.

NEW PRIVACY PRACTICE NOTICES REQUIRED

The HIPAA privacy rule gives individuals a right to be informed of the privacy practices of health care providers and health plans. A dental practice is covered by HIPAA if it sends a “covered transaction” in electronic form, such as submitting a claim to a dental plan, or if another party such as a clearinghouse sends an electronic covered transaction on behalf of the dental practice.* Most covered entity dental practices must provide notices explaining how the practice may use and disclose patient information and some of the rights patients have to control their information. New Notices of Privacy PracticeswererequiredtobeinusebynolaterthanSeptember23,2013 in order to be compliant with omnibus final rule issued Jan. 17, 2013, and effective March 26 (for compliance by Sept. 23, 2013).

The following are some of the changes that have been implemented in the omnibus final rule:

•Expandedrightsofpatientstoreceiveelectroniccopiesoftheirelectronic protected health information;

•Anewpatientrighttorestrictdisclosuretoahealthplanwhenthe dental practice has been paid in full;

•NewrequirementsfortheNoticeofPrivacyPractices;

•Businessassociateagreementsmustberevisedtoincludenewprovisions;

•A“compromisestandard”replacesthe“harmstandard”underthe breach notification rule;

•Newrulesonthesaleofprotectedhealthinformation,marketing communications and fundraising;

•Newrulesonthedisclosureofprotectedhealthinformationofdecedents;

•Anexpandeddefinitionofprotectedhealthinformationtoinclude genetic information.

The HHS Office of the National Coordinator for Health Information Technology and Office for Civil Rights Sept. 16 released model Notices of Privacy Practices for covered entity health care providers and health plans to use to communicate with their patients and plan members.Threeprivacynoticeoptionscustomizablebyusersandatext-onlyversionareavailableatwww.hhs.gov.

* Other examples of covered transactions and information about covered entities are available from the HHS Centers for Medicare&MedicaidServices.

Source: www.ada.org/news/9053.aspx

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LOOK INTO SOCIAL MEDIA Why should you be interested in social media as a tool to drive the

marketing of your practice?Aquicklookatsomestatisticswillgiveyou an idea of just how much impact this medium has…

• 55%oftheU.S.populationisonFacebook.

• YouTubereceivesmoreviewingtimethanFox,NBC,ABCandCBS combined.

• ForesterResearchreportsthat53%ofcompaniesexpecttoincrease their social media spending and campaigns.

• 91%ofmotherscheck-inwithasocialmedianetworkonaregular basis.

Why is this last statistic so important?

o Because moms make 80% of the buying decisions for a family

o Because moms schedule 8 out of 10 appointments for their family and/orpartner

Why Use Social Media? “Word of mouth and referrals are still the most powerful marketing tools, but the way we obtain them has changed. We now seek information from our friends and strangers in social media,” says Lisa McTigue, digital marketing consultant in an article “Creative Ways to Attract New Dental Patients Using Social Media” by Jennifer Gregory on Infusionsoft (see link below). “In social media, people respond to the ‘heart’ of a company. Give us something to care about, something to laugh about, and we’ll share it with our friends,” says McTique.“Peoplearemorelikelytoshareasimple,funvideoorpicture.”But make sure it’s natural – your audience can sense when something’s not authentic.

Social media is about building relationships. Companies everywhere are experiencing more positive results when they connect and engage their community rather than just promoting their services. In dental practice marketing strategies, one of the most effective approaches is to provide helpful information—be seen as an expert who helps people with dental advice, helpful articles and links to useful information about oral health. With a little effort, you can become the expert that people turn to for help.

That’s not to say that using social media will automatically increase your patient base; social media is not a medium you can throw out there and expect it to do all the work. To be effective, it takes a little research, maybe a little money, and someone who is dedicated to updating your accounts. It is ongoing and the more effort you put into it and the more creative you get, the better the results.

REMEMBERSocialmediawillnotreplaceyourstandardmarketing–therearestillthosepotentialpatientsouttherewhoaren’tonFaceBookor Twitter. And if it all seems too difficult or too time-intensive, you

A SMARTPHONE APP FOR BRUSHINGOral-BhaslaunchedtheOral-BApp,anewdigitaltoolforbrushing

routines that gives users insight into their oral health care.

TheappconnectswithanyOral-Bpowerbrushandprovides

•Automatedactivationofabrushtimerthroughrecognitionofthebrushmotorsoundforrecommendedtwo-minutesessions

•Timerfunctionwithquadrantguideforevenandthoroughcleaningthroughout the mouth

•Statistics function that charts brushing sessions in weekly andmonthly views to keep track of progress

•Brushinginstructionsandoralhealthtips

“Our goal for this app was to make the invisible visible by helping usersquantifyandvisualizethequalityoftheirbrushingsessions,”said Stephen Squire, Global Marketing Director, Procter & GambleOral Care. “We know that power brush users strive to stay on top of their oral health, but they don’t always know what they’re doing is sufficient between dentist appointments. Now, with this data, they can feel more confident about their oral care regimens. We like to call it ‘a personal trainer for your teeth.’”

The app provides visual feedback that supports users in following recommended oral care routines, and even offers a content feed – with calendar events, news, weather and oral care tips – to sustain theirattentionfortheentiretwo-minutesession.Italsonotifiesuserswhen it’s time to change their brush heads.

If the user doesn’t have a power brush, the app can be manually activated, recordingthelengthofeachbrushingsession.FormoreinformationandtodownloadtheOral-BAppiniOS,youcanvisittheApplestore.

Source: Based on Proctor & Gamble press release www.news.pg.com/press-release/pg-corporate-announcements/oral-b-announces-launch-new-digital-tool-better-oral-care

can hire a firm to help you manage your social media strategy. Or find the specialists who are sharing their knowledge online, such as socialmediatoday.com. They posted an excellent article recently – “9 Web Marketing Tips To Help Your Small Business”…check it out and see if it inspires you to make the leap into social media marketing.

And check out our article from Spring 2011 “Tweet. Yelp. Sqawk.What all this noise means to you.” www.premierlife.com/wp-content/uploads/Pipeline-FallWinter2011.pdf

Resources: www.jeffbullas.com/2013/09/20/12-awesome-social-media-facts-and-statistics-for-2013/#hDqO0QWq7Xm3mtWS.99

www.bigideasblog.infusionsoft.com/small-business-tips-dental-social-media/

www.thesocialmediamonthly.com/how-to-increase-your-businesss-popularity-sales-

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The Centers for Disease Control and Prevention reports that the most prevalent infectious disease for our nation’s children is dental caries. More than 40 percent of children have caries by the time they reach kindergarten. Although dental caries prevalencehasdeclinedsignificantlyamongschool-aged

children since the early 1970’s, caries rates in children aged 2-5yearshasincreased.

Source:GuidelineonInfantOralHealthCare.CLINICALGUIDELINESAMERICANACADEMYOFPEDIATRICDENTISTRYwww.aapd.org/media/

Policies_Guidelines/G_InfantOralHealthCare.pdf Reference: Dye BA, Arevalo O, Vargas CM, Trends in paediatric dental caries by poverty status in the UnitedStates,1988-1997and1994-2004.IntJPaediatricDent

PremierAccessrecognizestheAAPDpolicyofestablishingthe dental home by age one year and recommends that

providers follow the policy and guidelines set by the AAPD for providing dental care to children by the age of one year. In addition, the AAPD guidelines suggest that health care

professionals be supportive of the selection of dental home for all infants at one year of age.

Establishmentofadentalhomeshouldbeginnolaterthan12 months of age and includes referral to dental specialists whenappropriate.Thedentalhomeprovidestime-critical

opportunities to implement early preventive health practices andreducesthechild’sriskofpreventabledental/oraldisease.

Source: www.aapd.org/media/Policies_Guidelines/D_DentalHome.pdf

Dental Home by Age 1 Year The AAPD defines a dental home as “the ongoing relationship

between the dentist and the patient, inclusive of all aspects of dental health care delivered in a comprehensive, continuously accessible, coordinated,andfamily-centeredway.”TheAAPDencouragesparentsand other care providers to help every child establish a dental home by twelve months of age.

OralHealthCareForInfants.TheAmericanAcademyofPediatricDentistry (AAPD) led the way in 1986 by releasing guidelines on infant oral health care that recommended infants have an oral evaluation within 6 months of the eruption of the first primary tooth or by 12 months of age.

The American Dental Association (ADA) issued a statement emphasizingchildren’ssusceptibilitytodecayassoonastheirteetherupt. The ADA also joined the AAPD in recommending dental care for infants by 12 months of age along with education for parents and caregiversonECCprevention.TheAmericanAcademyofPediatrics(AAP)subsequentlyissuedapolicystatementin2003recommendingoral health assessments by trained health professionals beginning at 6monthsofageandestablishmentof“dentalhomes”forhigh-riskinfants by age one.Source:PreventingEarlyChildhoodCaries:LessonsfromtheField.AmyBrown,

MPH1ElizabethLowe,RDH,MPH2BethZimmerman,MHS3JamesCrall,DDS,ScD4

MaryFoley,RDH,MPH5MarkNehring,DMD,MPH

According to the AAPD, a dental home should provide comprehensive oral health care including:

•Acutecare

•Preventive services in accordance with the AAPD periodicityschedules

•Comprehensiveassessmentoforaldiseasesandconditions

• Individualizedpreventiveproceduresbaseduponperiodontalandcariesrisk-assessment

•Anticipatoryguidanceaboutgrowthanddevelopmentissues(i.e.,teething, digit or pacifier habits)

•Dentaltrauma

• Informationonchildteethandgingivae

•Dietarycounseling

•Referring to dental specialists when care cannot directly beprovided by the dental home.

The AAPD advocates interaction with early intervention programs, schools, early childhood education and childcare programs, members of the medical and dental communities, and other public and private communityagenciestoensureawarenessofage-specificoralhealthissues.

TheMedi-CalDentalServicesDivision(MDSD)stronglyencouragesall Dental Plans to follow the AAPD guidelines and educate their providers on the importance of establishing the dental home and providing dental care for children by age one year.

Source: www.aapd.org/media/Policies_Guidelines/P_DentalHome.pdf

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Common Oral Conditions During Pregnancy

• Pregnancy gingivitis

• Benign oral gingival lesions

• Teeth Mobility

• Tooth Erosion

• Dental Caries

• Periodontitis

ORAL HEALTH CARE DURING PREGNANCY Dental hygiene appointments and dental x-rays are safe for pregnant

women, according to new recommendations issued by the American College ofObstetriciansandGynecologists(ACOG;Obstetrics&Gynecology,August2013,Vol.122:2,pp.417-422).

In an interview with the online newsletter, Dr. Bicuspid, Dr. Diana Cheng, MD, Vice Chair of the Committee on Health Care for Underserved Women stated, “We can all reassure our patients that routine teeth cleanings, dentalx-rays,andlocalanesthesiaaresafeduringpregnancy.Pregnancyis not a reason to delay root canals or filling cavities if they are needed because putting off treatment may lead to further complications.”

Excerpts from the Committee Opinion (American Congress of Obstetri-cians and Gynecologists)

Regular dental care is a key component to good oral and general health. Despite the lack of evidence that prenatal oral health care improves pregnancy outcomes, ample evidence shows that oral health care during pregnancy is safe and should be recommended to improve the oral and general health of the woman. Improved oral health of the woman may decrease transmission of potentially cariogenic bacteria to infants and reducechildren’sfutureriskofcaries.Formanywomen,obstetrician-gyne-cologistsarethemostfrequentlyaccessedhealthcareprofessional,whichcreatesauniqueopportunity toeducatewomen throughout their lifespanincluding during pregnancy, about the importance of dental care and good oral hygiene.

Approximately 40 percent of pregnant woman have some form of peri-odontal disease. Research supports the conclusion that there is an as-sociation between maternal periodontal disease and preterm birth. Theo-retically, blood-borne gram negative anaerobic bacteria or inflammatorymediators, such as lipopolysaccharides and cytokines, may be transported to the placental tissues as well as to the uterus and cervix. This results in increased inflammatory modulators that may precipitate preterm labor.

To download the full Committee Opinion, Oral Health Care During Pregnancy and Through the Lifespan, click on

www.acog.org/Search?Keyword=oralhealthcare

DENTAL HOME INITIATIVEPremier Access, in collaboration with the Los Angeles Prepaid Health

Plan (LAPHP) and the Geographic Managed Care (GMC) in Los Angeles and Sacramento counties, has started a dental home initiative. The collabora-tion’s goal is to increase awareness of the importance of oral health and secure comprehensive, ongoing dental care from a consistent provider (a dental home) for children with the specific target to increase the percentage of young children who have established a dental home by age 24 months.

There are two primary challenges to improving dental health among children:

• Manyparents, caregivers and educators are unaware of the importantrole early dental visits and an established dental home play in preventing dental problems.

• Thereareuniquechallengestoprovidingdentalcaretoyoungchildren.Many general dentists and hygienists are not comfortable welcoming the youngest children into the office.

We will be working with the collaboration on family education and outreach materials, as well as strategies to increase the number of par-ticipating dentists providing successful dental homes for these youngest members.

Complete guidelines on infant oral health care available on the AAPD website. www.aapd.org/media/Policies_Guidelines/G_InfantOralHealthCare.pdf

ONLINE CE CLASSES NOW AVAILABLEPremier Access is very pleased to offer online continuing education for our contracted dentists. We believe this is a positive step toward increasing the quality of care for young patients.

Premier Access, in collaboration with the Dental School at the University of Texas Health Science Center at San Antonio, has developed a comprehensive pediatric services education curriculum forprimarycaredentists.Thisaccreditedon-lineeducationprogramis available to all Premier Access contracted providers.

For more information and instructions on how to access theseclasses, please see the article in the Spring/Summer edition ofPremier Pipeline. (www.premierlife.com/wp-content/uploads/Pipeline-SpringSummer2013.pdf )

As a dental care professional contracted with Premier Access, these educational courses are provided to you at no cost, to complete on your

own schedule.

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QUALITY MANAGEMENT COMMITTEE (QMC)

The QMC and subcommittees provide direction and oversight of the Quality Management Program activities. These committees include staff representation from key Premier Access departments and network and non-network providers representing primarycare and specialty dentistry. Providers are voting members on all committees.

Provider participation is an integral component of the QMC and itssubcommittees.Theyaretheprimarydecisionmakersonqualityissuesrelatingtothedeliveryofdentalcare.Toensureadequateprovider representation on QMC and subcommittees, participating providers receive an honorarium for their time. In exchange for this honorarium, the providers are expected to, among other duties…

•Provideexpertiserelatedtohis/herareaofdentistry.

•Assistwith developing annual specific,measurable goals andobjectives, focused study topics and performance measures for monitoring dental care delivery.

•Attendamajorityofregularlyscheduledmeetings.

•Participateincommitteedecisions.

•Evaluateallaspectsofthedeliveryofdentalcare.

•Conductpeerreview.

•Assist with determinations regarding provider and memberappeals.

•Assist with resolutions for member and provider grievances/appeals.

•AssistwithmonitoringeffectivenessoftheQMP.

To participate in the QMC and subcommittees, providers must

•Be enthusiastic and available to participate in a majority ofcommittee meetings.

•Meetallcredentialingand/orre-credentialingstandards.

•Haveexpertiseintheareaunderreview.

Formoreinformation,pleasecontact Provider Services at 800.270.6743.

PEER REVIEW SUBCOMMITTEE The Peer Review subcommittee meets quarterly or as needed

and is chaired by the Dental Director. This subcommittee conducts unbiasedandobjectiveinvestigationstodeterminetheadequacyof the treatment provided to members, the skills with which treatment is provided, and treatment outcomes. Committee members have access to all necessary information to make fair and informed decisions.

The Peer Review subcommittee also meets as needed whenever issues arise which, in the opinion of the Dental Director or the QMC,requireimmediateaction.Committeemembersmakerecom-mendations for corrective actions to be implemented by a provider whose conduct and/or clinical judgment are determined to bedetrimental to member safety, or contrary to accepted standards of care.

Depending on the nature of the issue, the action may include: requestingasecondopinionfromanotherprovider;requestinganexaminationofthememberbytheDentalDirector;orrequestinganon-siteofficereview.ThePeerReviewsubcommitteemonitorstheprovider for a designated period of time to ensure that corrective actions have been implemented and are effective.

In addition to above activities, the Peer Review subcommittee is responsible for reviewing and making determinations on:

•Allqualityofcareissuesrelatedtonetworkfacilitysiteaudits.

•Thequalityofdentalcarethroughthereviewofspecificcases,making recommendations on improving or correcting care as needed.

•Member grievance/appeal cases that have clinical qualityimplications, making recommendations accordingly.

•Providergrievances/appealsofadversequalitydeterminations.

•Credentialing and re-credentialing or providers, includingcredentialingandre-credentialingpolicies.

•Theselectionofprovidereducationmaterialsand/ortrainingtoachieve the goals of the QMP.

•Regular survey information from Premier Access providers,forwarding its analysis of this information, with recommenda-tions, to the QM committee.

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Premier Pipeline is published by Premier Access Insurance Company and Access Dental Company, for the sole use of their contracted providers.

Board of Directors RezaAbbaszadeh,DDS,Director,Secretary,ChairmanoftheBoard&CEO

EmeryDowell,Director,RetiredSeniorVicePresidentandDirectorofBlueCrossofCalifornia

ArulkannanKothandaraman,Director;CEOofDataTelesis

JohnRamey,Director;ExecutiveDirectoroftheLocalHealthPlansofCalifornia

RichardFulton,Director;ChiefMarketingOfficerofPremierAccess

DebraAbbaszadeh,Director;OwnerofSimpleWishes

JefferyElder,Director;Consultant,Self-employed

Senior Staff RezaAbbaszadeh,DDS,PresidentandCEO

Robin Muck, Sr. Vice President, Strategic Plan Operations

RichardFulton,ChiefMarketingOfficer

Courtney Barnes Ransom, Senior Vice President, Regulatory and Operational Compliance

Lorri Detrick, Chief Operating Officer of Clinic Operations

Dental DirectorCherag D. Sarkari, D.D.S., B.D.S., M.D.S.

Provider Relations TeamLynn Thompson, Director

KathyButler–California,Virginia

Joseph Canas – California, New Jersey, Pennsylvania

Amanda Yoakam – California, Ohio, Utah

Stephanie Battle – Nevada, Texas

NEW GROUPSPremier Access continues to add new groups, which means more members are being marketed to your practice. The groups listed below are new clients and have more than 100 eligible employees.

Council for the Spanish Speaking - Simpson Strong-Tie Co., Inc. -PhilcorTV&ElectronicLeasing, Inc.-ModestoIndustrialElectricalCo., Inc. - Prime-Line Products - California Custom Fruits andFlavors, Inc. AutoCrib, Inc. -CG Investments - SOSMetals, Inc. -LeRoy Haynes - Algos, Inc. - Diamond Wipes International - LosAngeles Regional Food Bank - Anderson Pacific EngineeringConstruction,Inc.–Danmer,Inc.-ScottDBorasInc.–Preece,Inc.-CountyofSutter-DioceseofStockton-MarianiPackingCo.,Inc.- Twin PeaksWinery Inc. -Marlu InvestmentGroup - Caranything.com-FlintcoPacific Inc. -ElEncantoHealthcareandHabilitationCenter-TurningPointCommunityPrograms-HallstenCorporation-Community Child Care Council of SantaClara County, Inc. - ClineCellars-LenthorEngineering,Inc.-TheAscentServicesGroup-OnTimeAirConditioning&Heating-TelecomTechnologyServices,Inc.-SubacuteSaratogaChildren’sHospital-GiantCreativeStrategyLLC-O’GaraCoachCompanyLLC-UniversalBuildingServices-NWSignIndustries Inc. -WanderfulMedia,LLC-CharlesWDavidsonCo. -AmericanEtc.,Inc.-Hilbers,Inc.-AuctivaCorporation-CaliforniaOliveRanchInc.-CarriereFamily-FarmsInc.-SilveradoContractors,Inc.-BaysideInsulationandConstruction-Vanderlans&SonsInc.-Sacramento Motor Cars, LLC

UPCOMING EVENTS - 2014 ____________________________________Rocky Mountain Dental Convention January 23 - 25 Denver, CO

Southwest Dental Conference January 30 - February 1 Dallas, TX

American Association for Dental Research March 19 - 22 Charlotte, NC

CDA Annual Conference & Exhibition April 3 - 5 Pomona, CA

Western Regional Dental Convention April 3 – 5 Phoenix, AZ

American Association of Orthodontists April 25 - 29 New Orleans, LA

National Oral Health Conference April 28 - 30 Ft. Worth, TX

American Association of Public Health Dentistry April 28 - 30 Ft. Worth, TX

American Association of Endodontists April 30 - May3 National Harbor, MD

The Art & Science of Dentistry May 15 - 17 Anaheim, CA

American Dental Hygienists’ Association June 18 - 24 Las Vegas, NV

FOLLOW US ON

Your comments and suggestions are always welcome. Please contact us at ProviderRelations@PremierLife.com

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The Annual CDT Codes updates have been completed and are ready to be implemented effective January 2014. Changes include the addition of new language and the deletion of some. The changes are summarized below.

The team at Premier Access hopes that this information is useful as a guide to the current changes being implemented and please feel free to reach out to our Provider Relations team for any further assistance.

D0100-D0999 l. DiagnosticD0350 oral/facial photographic images obtained intraorally or extraorallyPost processing of image or image sets {Note: New subheading}D0393 treatment simulation using 3D image volumeThe use of 3D image volumes for simulation of treatment including, but not limited to, dental implant placement, orthognathic surgery and orthodontic toothmovement.D0394 digital subtraction of two or more images or image volumes of the same modalityTo demonstrate changes that have occurred over time.D0395 fusion of two or more 3D image volumes of one or more modalitiesD0601 caries risk assessment and documentation, with a finding of low riskUsing recognized assessment tools.D0602 caries risk assessment and documentation, with a finding of moderate riskUsing recognized assessment tools.D0603 caries risk assessment and documentation, with a finding of high risk.

D1000-D1999 lI. PreventiveD1999 unspecified preventive procedure, by reportD2000-D2999 lII. RestorativeD2921 reattachment of tooth fragment, incisal edge or cuspD2941 interim therapeutic restoration – primary dentitionPlacement of an adhesive restorative material following caries debridement by hand or other method for the management of early childhood caries. Not considered a definitive restoration.D2949 restorative foundation for an indirect restorationPlacement of restorative material to yield a more ideal form, including elimination of undercuts.D2950 core buildup, including any pins when requiredRefers to building up of coronal structure anatomical crown when restorative crown will be placed, whether or not pins are used. A material is placed in the tooth preparation for a crown when there is insufficient tooth strength and retention for the crown a separate extracoronal restorative procedure. A core buildup is not This should not be reported when the procedure only involves a filler to eliminate any undercut, box form, or concave irregularity in the a preparation.

D3000-D3999 lV. EndodonticsApexification/Recalcification and Pulpal Regeneration Procedures {Note: Revised subheading}D3351 apexification/recalcification/pupal regeneration ‐ initial visit (apical closure/calcificrepair of perforations, root resorption, pulp space disinfection, etc.){Note: No change to descriptor}D3352 apexification/recalcification/pulpal regeneration ‐ interim medication replacement(apical closure/calcific repair of perforations, root resorption, pulp space disinfection, etc.) {Note: No change to descriptor}Pulpal Regeneration {Note: New subheading}D3354 pulpal regeneration – (completion of regenerative treatment in an immature permanent tooth with a necrotic pulp); does not include final restorationIncludes removal of intra‐canal medication and procedures necessary to regeneratecontinued root development and necessary radiographs. This procedure includesplacement of a seal at the coronal portion of the root canal system. Conventional root canal treatment is not performed.D3355 pulpal regeneration ‐ initial visitIncludes opening tooth, preparation of canal spaces, placement of medication.D3356 pulpal regeneration ‐ interim medication replacementD3357 pulpal regeneration ‐ completion of treatmentDoes not include final restoration.D3410 apicoectomy/periradicular surgery ‐ anterior

Revisions for CDT Codes 2014

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D3421 apicoectomy/periradicular surgery ‐ bicuspid (first root) {Note: No change to descriptors.}D3425 apicoectomy/periradicular surgery ‐ molar (first root)D3426 apicoectomy/periradicular surgery (each additional root)D3427 periradicular surgery without apicoectomyD3428 bone graft in conjunction with periradicular surgery ‐ per tooth, single site Includes non‐autogenous graft material.D3429 bone graft in conjunction with periradicular surgery ‐ each additional contiguous tooth in the same surgical siteIncludes non‐autogenous graft material.D3431 biologic materials to aid in soft and osseous tissue regeneration in conjunction with periradicular surgeryD3432 guided tissue regeneration, resorbable barrier, per site, in conjunction with periradicular surgery

D4000-D4999 V. PeriodonticsD4263 bone replacement graft ‐ first site in quadrantThis procedure involves the use of osseous autografts, osseous allografts, or nonosseous grafts to stimulate periodontal regeneration when the disease process has led to a deformity of the bone. This procedure does not include flap entry and closure, wound debridement, osseous contouring, or the placement of biologic materials to aid in osseous tissue regeneration or barrier membranes. Other separate procedures delivered concurrently are documented with may be required concurrent to D4263 and should be reported using their own unique codes.D4264 bone replacement graft ‐ each additional site in quadrantThis procedure involves the use of osseous autografts, osseous allografts, or nonosseous grafts to stimulate periodontal regeneration when the disease process has led to a deformity of the bone. This procedure does not include flap entry and closure, wound debridement, osseous contouring, or the placement of biologic materials to aid in osseous tissue regeneration or barrier membranes. This procedure code is used if performed concurrently with one or more bone replacement grafts to document D4263 and allows reporting of the exact number of sites involved.D4920 unscheduled dressing change (by someone other than treating dentist or their staff)D4921 gingival irrigation ‐ per quadrant Irrigation of gingival pockets with medicinal agent. Not to be used to report use of mouth rinses or non‐invasive chemical debridement.

D5000-D5899 VI. Prosthodontics, removableD5860 overdenture ‐ complete, by reportDescribe and document procedures as performed. Other separate procedures may be required concurrent to D5860D5861 overdenture ‐ partial, by reportDescribe and document procedures as performed. Other separate procedures may be required concurrent to D5861D5863 overdenture ‐ complete maxillaryD5864 overdenture – partial maxillaryD5865 overdenture ‐ complete mandibularD5866 overdenture ‐ partial mandibular

D5900-D5999 VII. Maxillofacial ProstheticsD5991 topical vesiculobullous disease medicament carrierA custom fabricated carrier that covers the teeth and alveolar mucosa, or alveolarmucosa alone, and is used to deliver topical corticosteroids and similar effectiveprescription medicaments for treatment for maximum sustained contact with thealveolar ridge and/or attached gingival tissues for the control and management ofimmunologically mediated vesiculobullous mucosal, chronic recurrent ulcerative, and other desquamative diseases of the gingiva and oral mucosa.D5994 periodontal medicament carrier with peripheral seal – laboratory processed A custom fabricated, laboratory processed carrier that covers the teeth and alveolar mucosa. Used as a vehicle to deliver prescribed medicaments for sustained contact with the gingiva, alveolar mucosa, and into the periodontal sulcus or pocket.

D6000-D6199 VIII. Implant ServicesD6010 surgical placement of implant body: endosteal implantIncludes second stage surgery and placement of healing capD6011 second stage implant surgerySurgical access to an implant body for placement of a healing cap or to enableplacement of an abutment.D6013 surgical placement of mini implant

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D6052 semi‐precision attachment abutmentIncludes placement of keeper assemblyD6080 implant maintenance procedures, when prostheses are removed and reinserted, including cleansing removal of prosthesies, cleansing of prosthesis and abutments and reinsertion of prosthesisThis procedure includes a prophylaxis to provide active debriding of the implant(s) and examination of all aspects of the implant system(s), including the occlusion and stability of the superstructure. The patient is also instructed in thorough dailycleansing of the implant(s). This is not a per implant code, and is indicated for implant supported fixed prostheses

D7000-D7999 X. Oral and Maxillofacial SurgeryD7950 osseous, osteoperiosteal, or cartilage graft of the mandible or maxilla ‐ autogenous or nonautogenous, by reportThis procedure is code may be used for ridge augmentation or reconstruction toincrease height, width and/or volume of residual alveolar ridge. It includesobtaining autograft, and/or allograft graft material. Placement of a barrier membrane, if used, should be reported separatelyD7953 bone replacement graft for ridge preservation – per siteOsseous autograft, allografts or non‐osseous gGraft is placed in an extraction or implant removal site at the time of the extraction or removal to preserve ridgeintegrity (e.g., clinically indicated in preparation for implant reconstruction or where alveolar contour is critical to planned prosthetic reconstruction). Does notinclude obtaining graft material. Membrane, if used should be reported separately.D7955 repair of maxillofacial soft and/or hard tissue defectReconstruction of surgical, traumatic, or congenital defects of the facial bones, including the mandible, may utilize autograft, allograft, or alloplastic graft materials in conjunction with soft tissue procedures to repair and restore the facial bones to form and function. This does not include obtaining the graft and these procedures may require multiple surgical approaches. This procedure does not include edentulous maxilla and mandibular reconstruction for prosthetic considerations. See code D7950

D8000-D8999 XI. OrthodonticsD8693 rebonding or recementing; and/or repair, as required, of fixed retainersD8694 repair of fixed retainers, includes reattachmentLimited Orthodontic TreatmentOrthodontic treatment with a limited objective, not necessarily involving the entire dentition. It may be directed at the only existing problem, or at only one aspect of a larger problem in which a decision is made to defer or forego more comprehensive therapy. Examples of this type of treatment would be treatment in one arch only to correct crowding, partial treatment to open spaces or upright a tooth for a bridge or implant and partial treatment for closure of a space(s).

Interceptive Orthodontic TreatmentTreatment using codes for interceptive orthodontic treatment are for procedures to lessen the severity or future effects of a malformation and to eliminate its cause. Interceptive orthodontics is an An extension of preventive orthodontics that may include localized tooth movement. Such treatment may occur in the primary or transitional dentition and may include such procedures as the redirection of ectopically erupting teeth, correction of isolated dental crossbite or recovery of recent minor space loss where overall space is inadequate. When initiated during The key to successful interception is intervention in the incipient stages of a developing problem, interceptive orthodontics may reduce to lessen the severity of the malformation and mitigate eliminate its cause. Complicating factors such as skeletal disharmonies, overall space deficiency, or other conditions may require subsequent future comprehensive therapy. Early phases of comprehensive therapy may utilize some procedures that might also be used interceptively, but such procedures are not considered interceptive in those applications.

Comprehensive Orthodontic Treatment

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These codes should be used when there are multiple phases of treatment provided at different stages of dentofacial development. For example, the use of an activator is generally stage one of a two‐stage treatment. In this situation, placement of fixed appliances will generally be stage two of a two‐stage treatment. Both phases should be listed as comprehensive treatment modified by the appropriate stage of dental development. This is used to report the Comprehensive orthodontic care includes a coordinated diagnosis and treatment leading to the improvement of a patient’s craniofacial dysfunction and/or dentofacial deformity which may includeing anatomical, functional and/or aesthetic relationships. Treatment usually, but not necessarily, may utilizes fixed and/or removable orthodontic appliances and may also include functional and/or orthopedic appliances in growing and non‐growing patients. Adjunctive procedures, such as extractions, maxillofacial surgery, nasopharyngeal surgery, myofunctional or speech therapy and restorative or periodontal care, to facilitate care may be coordinated disciplines required. Optimal care requires long‐term consideration of patient’s needs and periodic re‐evaluation. Treatment Comprehensive orthodontics may incorporate treatment several phases with focusing on specific objectives at various stages of dental dentofacial development.

D9000-D9999 XII. Adjunctive General ServicesD9985 sales tax