STI 2016 Highlights

December 2016

STI 2016 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 2014. STI includes four WorkGroups: 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 WorkGroup

The Codes WorkGroup completed reviews of proposed changes to CDT-2017 and submitted six proposals to the American Dental Association’s Code Maintenance Committee (CMC) for substantive changes. Dr. Stewart represented NADP at the March 3-4, 2016 CMC meeting with Timothy L. Brown, NADP Deputy Executive Director, providing staff support. Of the six proposals submitted, NADP’s position prevailed on three (3) with overwhelming support. Of the three (3) that did not pass, they were part of a package of codes to revise D7230 and D7240 with only NADP supporting the changes. NADP’s approved submissions created one (1) new code and revised two (2) codes for CDT-2017.

Once again, NADP was the only payer organization on the CMC to receive the CDT-2017 ASCII file in April 2016 before the July 1 release to other organizations. Thus, NADP members received additional time for analysis and implementation. The Codes WorkGroup was once again given the opportunity to edit the DRAFT CMC report and the ASCII file of CDT-2017. Codes WorkGroup members found and corrected minor errors in these document prior to release or printing.

WorkGroup members have begun the process of submitting and evaluating proposed submission for CDT-2018. The WorkGroup solicited suggestions for CDT-2108 from the NADP membership through the end of October and will submitted proposals to the CMC by the Nov. 1 submission deadline.

Clinical WorkGroup

The Clinical WorkGroup monitored the actions of the Dental Quality Alliance (DQA) formed in 2010. WorkGroup Vice-Chair, Dr. Craig Amundson (HealthPartners) and NADP Dental Informatics Manager Brian Flynn participated in the Executive Committee and full DQA meetings held June 9-10. Workgroup members participated on the Executive, Measures Development and Maintenance, and Pediatric Measures Development Committees.

The Clinical WorkGroup continued oversight and review of the activities of the International Health Terminology Standards Development Organisation (IHTSDO), with Dr. Roger Adams and Timothy L. Brown representing NADP on the Dental Special Interest Group (SIG), in reviewing proposed changes to SNOMED/SNODENT in conjunction with the National Library of Medicine (NLM) at the SIG meeting in April 2016. Mr. Brown attended the full IHTSDO meeting in October 2016 in New Zealand. The WorkGroup also worked on the development of a U.S. realm dental reference set for general dentists that is under review by the SIG for use beyond the U.S. realm.

Clinical WorkGroup members are eager to participate fully in the development of the Big Data project and several have volunteered to serve on the Big Data Task Force being formed to develop the plan for researching the use and implementation of diagnostic codes sets.

The WorkGroup reviewed several studies for dentistry that the Communications WorkGroup will use in the ongoing release and development of information for consumers and the public.

EDI WorkGroup

Electronic Data Interchange (EDI) WorkGroup 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 Dental Content Committee (DeCC), Health Level 7 (HL7), Standards Committee on Dental Informatics (SCDI), Code Maintenance Committee (CMC/CARC), Workgroup for Electronic Data Interchange (WEDI) and American National Standards Institute X12 (X12). As well the NADP staff lead, Brian Flynn, chairs the X12 Dental Caucus.

The WorkGroup contributed to the NADP/LIMRA Claims Metric Industry Survey by reviewing the questions, making recommendations and adding to the survey. The results are analyzed and discussed during the EDI meetings and used to set future agenda items.

Operations WorkGroup

The Operations Workgroup began the year by reviewing priorities and developed a work plan for 2016 that included continued focus on enhanced relationships with Dental Service Organizations (DSOs), finishing and receiving Board approval for 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 finished updating the DPAS document to the 2015 environment since the original 1999 DPAS was heavily DHMO focused. The document was approved by the Workgroup and sent to the NADP Board for their review. The Board made some changes and approved the framework of DPAS but directed an introduction to frame the use of the document prior to dissemination. DPAS is geared to the dental benefits industry to supplant the current approach of organizations with accreditation modules today that push dental carriers to fit their Medical modules.

The Credentialing Sub-Workgroup expanded the pilot to phase II and added more participants to generate more volume. We have a balance of DSO and payer representatives entering the results into a web portal for tracking. It is too early in data collection to document the reduction in credentialing time but the Sub-Workgroup’s progress continues to be a major topic throughout the industry with multiple organizations interested in the results.