STI 2015 Highlights

December 2015

STI 2015 Highlights

To enhance representation of the dental benefits industry, the NADP Board of Directors approved creation of the Standards and Transaction Initiative (STI) in the fourth quarter of 2013. STI includes four workgroups (WGs): Codes, Clinical, EDI and Operations. Together, these groups strengthen your voice as they provide united industry perspective, leadership and direction on critical dental issues affecting the growth and advancement of the industry. Following are highlights from each group:

Codes WG

The Codes WG reviewed proposed changes to CDT-2016 and submitted 15 proposals to the American Dental Association Code Maintenance Committee; 14 substantive changes and 1 editorial. Drs. Charles Stewart, Aetna, and Fred Horowitz, Nevada Dental Benefits, represented NADP at the March 5-6, 2015 CMC meeting with Timothy L. Brown, NADP Deputy Executive Director, providing staff support. Of the 15 proposals submitted, the NADP position prevailed on 14 with overwhelming support on all; a few were unanimous. NADP’s approved submissions created nine new codes, deleted five codes and revised 36 codes for CDT-2016.

Once again, NADP was the ONLY organization to receive the CDT-2015 ASCII file in April before the July 1 release to other organizations. Thus, NADP members received additional time for analysis and implementation. The Codes WG was once again given the opportunity to edit the DRAFT CMC report and the ASCII file of CDT-2015. Codes WG members found and corrected substantive errors in these document prior to release or printing.

In the fall, WG members submitted and evaluated proposed submission for CDT-2017. The WG solicited suggestions for CDT-2107 from the NADP membership through the end of September and submitted proposals to the CMC prior to Nov. 1 deadline. The WG reviewed several proposals related to potential prophylaxis code(s) developed by a CMC subcommittee on which Dr. Stewart represents NADP and the dental benefits industry. The WG has already begun review of the more than70 submissions for inclusion in CDT-2017 to be decided at the March 2016 Code Maintenance Committee (CMC) meeting.

Clinical WG

Clinical WG members monitored actions of the Dental Quality Alliance (DQA) formed in 2010 and WG member, Dr. Craig Amundson (HealthPartners) and NADP Dental Informatics Manager Brian Flynn participated in the Executive Committee and full DQA meetings held on June 18-19 and the full DQA meeting held on October 30, 2015. WG members participate on the Executive, Measures Development and Maintenance, and pediatric measures development committees.

The Clinical WG continued oversight and review of the activities of the International Health Terminology Standards Development Organisation (IHTSDO). NADP represents our members on the Dentistry Special Interest Group (SIG), which reviews proposed changes to SNOMED/SNODENT in conjunction with the National Library of Medicine (NLM). Timothy L. Brown participated in the Dentistry SIG meeting in October. The WG was also briefed regularly on the development of a US dental reference set in a joint effort between IHTSDO and the ADA with Dr. Horowitz and Mr. Brown participating in face-to-face and conference call meetings throughout the year. For 2016, Dr. Roger Adams will replace Dr. Horowitz as NADP’s representative to the IHTSDO Dentistry SIG.

Further, the Clinical WG reviewed and provided comments to the American Association of Orthodontists (AAO) on their proposed definition of Medically Necessary Orthodontic Care (MNOC).

Operations WG

The Operations WG began the year by reviewing priorities and developing a work plan for 2015 that included continued focus on enhanced relationships with Dental Service Organizations (DSOs), finishing and publishing the update to the NADP Dental Plan Accreditation Standard (DPAS) and expanding the current Dental Provider Credentialing pilot from phase I to phase II to prove the process reduces the time to access a participating provider.

The Accreditation sub-workgroup (SWG) finished updating the DPAS document to the 2015 environment since the original 1999 DPAS was heavily DHMO focused. The document was approved by the WG and sent to the NADP Board for their review. DPAS was presented during CONVERGE by a panel of volunteers during a session on accreditation. After the Board approves the updated DPAS it may be sent to CMS and other accreditation organizations so they may use NADP’s DPAS as a starting point for dental specific accreditation standards rather than try to fit dental into Medical modules.

The Credentialing SWG continues to meet to expand the pilot to Phase II which includes adding more participants and generating more volume. The Subgroup has a balance of DSO and payer representatives in order to get full perspective and input. The SWG’s progress was a major topic during the full WG’s meeting at CONVERGE.

The WG also discussed in detail the role of Provider Management Consultants (PMC’s) and how most effectively to interact with payers; if the payers decide to work with and recognize the PMC’s. Interest in this topic was very high so a CONVERGE panel session was assembled and presented ideas and current practices to NADP’s members.

Electronic Data Interchange (EDI) WG:

The EDI WG reviewed and commented on mandated EDI transactions for claims processing, eligibility, claims status, explanation of benefits, electronic funds transfer and electronic health records. The members support NADP voting seats on ADA Dental Content Committee (DeCC), Health Level 7 (HL7), ADA Standards Committee on Dental Informatics (SCDI), ADA Code Maintenance Committee (CMC/CARC), Workgroup for Electronic Data Interchange (WEDI) and American National Standards Institute X12 (X12) including leadership positions on WEDI Dental Workgroup and X12 Dental Caucus.

The WG contributed to the NADP/LIMRA Claims Metric Industry Survey by reviewing the questions, making recommendations and adding to the survey. The results were discussed during the CONVERGE meeting and used to set future agenda items.