News
NADP Workgroup Steers Us Toward Operational Excellence
By Mike Adelberg, NADP Executive Director
August 26, 2024
The foundation of any successful business is its operations. So, I’m happy to note that one of NADP’s largest member workgroups (WG) is the Operations Workgroup, with 60 members from 40 member companies. In the last year, the Operations WG has been busy and made progress in developing helpful resources for NADP members on two important and complicated areas — delegated credentialing and network leasing.
For obvious reasons, the work of the Operations WG and the resources they develop is for NADP members only. Yet I want the many people who read this blog to know that the dental insurance/benefits industry is very serious about continually improving our work processes. So, I will briefly discuss the important work of the Operations WG below in a way that is informative to blog readers without offering up information that is proprietary to NADP and its members.
In the last year, the Operations WG has been active in developing new resources or re-working existing resources with respect to managing dental plan provider networks. Two topics — delegated credentialing and network leasing — are particularly prominent.
Provider Delegated Credentialing: The Operations WG has developed three delegated credentialing related resources for NADP members. They cover the minimum elements of a delegated credentialing program, delegated credentialing program elements, and plan-to-plan delegated credentialing.
NADP members are diverse. The credentialing work processes of a medical plan owned dental plan, for example, may be different than that of a stand-alone dental plan. But these resources represent the collaboration of different company types, and indeed all types of dental plans and benefit administrators.
Network Leasing Best Practices: After months of dedicated work, the Operations WG issued a network leasing best practices resource that enumerates elements of successful leasing agreements and elements of a successful data management and communications strategy. Pieces of that document are summarized below.
Leasing agreements should include provisions covering:
- service levels
- in-scope service areas (defining both geography and products covered)
- claims processing information
- rules of the road regarding so-called “claims stacking”
- opt-out language.
The Operations WG document also considered data sharing and quality best practices in the following areas:
- File format
- Data accuracy
- Data matching
- Notification requirements for file format changes
- File exchange contingency plans.
Finally, the Network Leasing best practices resource documents necessary communications regarding network leasing. These include:
- Regular updates/communications
- Education and training
- Avenues for accessible support
- Feedback mechanism(s)
- Clear agreement terms.
The Best Practices document was rolled-out and supported by a well-attended member webinar.
It is well understood that best practice documents are not requirements. Rather, they are the result of thoughtful discussion between dental plans and allied organizations. The collaboration necessary to develop a best practice resource necessarily spreads an understanding of those best practices. It also causes member companies to reflect on the state of their operations vis-à-vis perspectives offered by well-informed plan and non-plan stakeholders. There are good reasons that a particular NADP member cannot adopt a particular element of a best practice document; in such cases, the best practice documents still served as a useful diagnostic for considering a different approach.
As NADP nears its 35th anniversary (on October 5) and prepares for its annual CONVERGE conference this fall, the collaboration shown in developing these operational best practice resources is a best practice in itself—and embodies the collaborative volunteerism at the core of NADP membership.
See you at CONVERGE!
