Analytics Key to Managing Medicaid Dental Benefits in Uncertain Times

To say these are uncertain times for Medicaid dental is like saying the sun is hot at the equator.

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Dental Goes Digital in Provider Credentialing

One of the ongoing challenges payers face when building and maintaining a dental network is obtaining credentialing information from providers. Typically, it’s a time-consuming, costly process filled with repetitive manual tasks. For Scion Dental, however, much of that changed when we began using SKYGEN USA’s newly launched Credentialing Service to credential our provider networks. This unique digital credentialing solution is already driving quantifiable cost reductions while also improving

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Infographic: How Using A Centralized Service Creates Significant Time Savings When Credentialing

Imagine if instead of going to one supermarket for your weekly groceries, you had to visit individual stores to pick up each item on your list – even similar items such as specific fruits and vegetables. Your shopping trip would be extended to a needlessly long time, and your total cost would likely be much higher. Sounds ridiculous doesn’t it? Yet that’s the way payers typically have approached provider credentialing.

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Infographic: The value of a centralized Credentialing Service for providers

There’s good news for every provider who has gone through the tedious, repetitive credentialing process to join a payer’s network while thinking, “there must be a better way.”

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Time for provider credentialing to join the Digital Age

For most providers, the credentialing process must feel like the movie Groundhog Day. The office receives a multiple page application that must be filled out in order to add the provider to the payer’s network. The provider or a staff member then dutifully fills out the application and mails it back or (in the more “progressive” instances) submits it online. Next week, another application comes in asking for the same information and the office goes through the process again. Rinse and repeat

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There’s no reason provider credentialing should take so long or cost so much

Obtaining the credentials needed to build a provider network is typically an expensive, time-consuming process because: It can take weeks or months to mail out paper applications to the targeted providers, follow up by phone/email/mail/fax/carrier to get the information back, and finally enter it into your system by hand – one application and supporting document at a time. The above process can cost anywhere from $50 to $200. All of this work must be performed one provider at a time, so

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Challenges with Integrating Multiple Claims Software Systems on a Single Technology Platform

For most payers, having more than one claims software system is a fact of life. At least if they’re offering dental. Because while most of the benefits they offer – medical, vision, physical therapy, long-term care, etc. – can run on their core systems since they share coding and other characteristics, as a general rule dental claims cannot.

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Benefit Management Technology Taking an Autonomous Car Approach

You would pretty much have to spend the last couple of years alone on a tropical island to not be aware of the impending revolution being brought on by the so-called “autonomous car.” In the next few years, major automakers and tech giants such as Google and Microsoft are saying they will be putting cars on the road that completely automate the process of getting from here to there. No drivers needed – just tell the car where you want to go and it will take you there. It promises to be a

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Disruptive Benefit Management Software: Red Flags That Show It’s Time for a Change

I think we can all agree that most people don’t like change. Change is hard. It gets us out of our comfort zones. It introduces uncertainty and risk. Yet it’s often necessary, especially in business. Solutions designed for the marketplace of 30 years ago don’t always translate to the realities of today.

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6 Tips for Ensuring Dashboards Drive Operational Efficiency

Ever since the advent of the big data era a dozen or so years ago, one of the most popular business concepts has been the dashboard. The phrase “We need an executive dashboard” has echoed down the hallways and through the boardrooms of corporate America, sending operational and IT teams into a frenzy to deliver these colorful renderings of the state of the organization.

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Making reimbursement as simple and speedy as getting a flu shot

A couple of weeks ago I decided it was time for my annual flu shot. I ran out to my local pharmacy, told them what I wanted and in about 15 minutes I was (hopefully) protected against whatever nasty strains are making the rounds this year. The entire process was a marvel of efficiency. Especially when it came time to pay. The pharmacy already had my health insurance information in their system, so when they rang the transaction the insurance claim was already adjudicated and paid, and my

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Technology Helps Payers Transition for the Future

Despite all the advances in technology over the last three decades, many large health payers are still conducting aspects of their business the way they did in the pre-Internet days of the 1980s, relying on manual processes and interactions with members and providers. That mindset can no longer continue. Between the huge influx of individual members that resulted from the Affordable Care Act (ACA) and the expectations of the customer experience members have based on their interactions with

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Five Principles to Leveraging Benefit Administration Technology to Succeed During Reform

Well, no one said healthcare reform via the Affordable Care Act (ACA) would be easy. In fact, it’s proven to be quite painful at times as healthcare payers scramble to realign their organizations to accommodate an entirely different way of working without disrupting their current business.

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How client experience teams help health plans succeed

Payers who are responsible for delivering government-sponsored healthcare face several significant challenges in their mission to be the best possible stewards of the programs they administer. This includes programs such as Medicaid where payers are tasked with stretching limited dollars to provide the most access, to the most appropriate and efficient care, for the most members. 

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How Daily Payments Can Help You Build your Medicaid Dental Provider Network

Attracting dentists to a Medicaid dental provider network isn’t easy. Typically these programs pay only a fraction of what commercial plans offer. As a result, dentists tend to join because they feel a moral, altruistic calling to serve the most vulnerable population and have a desire to expand their patient rosters.

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Things Medicaid Dental Members Should Know Before Visiting the Dentist

Dental wellness is an important contributor to your overall health and wellbeing. It can have an effect on your ability to eat the foods you want, speak clearly, and even sleep at night. It can also have an effect on your self-esteem, the way you interact with others socially, and your ability to enjoy life to the fullest.

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Insurance software that improves the provider experience gives payers a competitive advantage

Much has been written in the last few years about how payers need to use insurance software to improve the customer experience in order to attract and retain members. Especially with the addition of millions of individual member policies as a result of the Affordable Care Act (ACA). Not to mention the increased importance of patient satisfaction scores.

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Become a high-performing Medicaid Dental program by keeping your focus on lower benefit costs

Whenever the talk turns to cutting Medicaid dental costs, the focus is often on reducing administrative fees. Yet while it is important to keep administrative fees low, they represent only about 5% of any program’s total cost. The biggest opportunity to bend the cost curve lies in the other 95%, i.e., the actual benefit costs. This is where the highest-performing Medicaid dental programs are focused — saving a few dollars, instead of a few pennies, per member per month.

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Addressing the Impact of Medicaid Dental Insurance Fraud

Despite greater awareness and law enforcement’s efforts to crack down, Medicaid dental insurance fraud continues to be big business. A simple Google search on that term will confirm this unfortunate fact, serving up article after article about dentists being prosecuted for fraud, waste and abuse (FWA), often on children in the Medicaid dental program.

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Rolling the dice on adding Medicare dental to your Medicare Advantage plan

For Medicare Advantage (MA) managed care plans, the decision on whether to add Medicare dental coverage is a roll of the dice. On the plus side, if adding dental helps the plan pull members away from other managed care organizations (MCOs) and increase market share, it can be a huge win.

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Offline and Falling Behind: The Risks Healthcare Providers Take In Failing To Adopt Benefit Administration Technology

I doubt that when many dentists first dreamed of going to dental school that checking patient eligibility, submitting insurance claims or chasing down payments is what they pictured. Given how time-consuming and painful those tasks can be, you’d think they would leap to sign up for free online portals that do the job faster and more efficiently. But in many cases you’d be wrong

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A look at trends that will affect payers in 2016 - and beyond

With an election year upon us once again it seems like everyone is even more interested in the future than usual. That’s what caught my eye about an insightful article in Managed Healthcare Executive from a couple of thought leaders at GE Healthcare Camden Group.

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