Imagine members of a symphony orchestra playing different arrangements of the same song at the same time. The result would be a chaotic, disharmonious noise instead of the masterpiece intended. On a similar note, the three NADP Terminology, Standards and Transactions Sub-Workgroups (SWGs) ensure dental plans are playing harmoniously from the same healthcare arrangement that encompasses the unique needs of the dental benefits industry.

The following 2020 highlights from the Codes SWG, Clinical Quality Measures SWG (formerly known as the Dental Quality Alliance SWG) and the Diagnostic Terminology SWG showcase how these groups remained in tune and advanced the industry.

Codes SWG

Twenty-three voting and seven non-voting members (additional representatives from companies already on the SWG) conducted the work of SWG via conference calls scheduled around critical dates in the American Dental Association (ADA) Code Maintenance Committee process.

Led by Chair Dr. Charles D. Stewart, Aetna, and Vice Chair Kristen Strasheim, Ameritas Life Insurance Corp., the Codes SWG completed reviews of proposed changes to CDT-2021 and submitted one (1) proposal to the Code Maintenance Committee (CMC) for substantive changes. Dr. Stewart, Ms. Strasheim and NADP Deputy Executive Director Mr. Timothy L. Brown represented NADP at the March 12-13, CMC meeting. In addition, the CMC also held an out-of-cycle meeting on April 14 to address potential codes for COVID related testing. Once the two new testing codes passed, NADP committed to convening our members to discuss the potential to put these codes in place prior to the January 1, 2021 effective date.  After discussion and consideration, the Codes SWG shared a white paper on the barrier to early implementation and agreed to reconsider early implementation if the main barriers identified could be overcome. NADP members can request a copy of the Codes SWG testing codes early implementation white paper. Further, NADP members can obtain the NADP Change Document for CDT-2021 that outlines the changes effective January 1, 2021.

The Codes SWG was once again given the opportunity to edit the DRAFT CMC report and the ASCII file of CDT-2021. Codes SWG members found and corrected minor errors in these documents prior to release or printing.

In the second half of the year, SWG members began the process of submitting and evaluating proposed submissions for CDT-2022 with proposals being solicited from the NADP membership.  The Codes SWG reviewed and developed proposals during their September and October scheduled meetings in time for submission to the CMC by the November 2020 deadline.

Clinical Quality Measures (CQM)

The CQM SWG was formerly known as the Dental Quality Alliance (DQA) SWG. The NADP Board of Directors authorized the name change in May of 2020 to eliminate confusion between the actual DQA and the NADP SWG of the same name. The 14 voting and seven non-voting members; (additional representatives from companies already on the SWG) worked via conference calls scheduled around critical DQA meeting dates. Group leadership includes Chair Dr. Mark Jurkovich, HealthPartners; Vice Chair Dr. Lynn Mouden, Avesis; and DQA Executive Committee alternate Dr. Craig Amundson, HealthPartners.

SWG members monitored the actions of the Dental Quality Alliance (DQA) and Drs. Amundson, Jurkovich and Mouden along with NADP Deputy Executive Director Timothy L. Brown participated in the June 4 DQA Executive Committee meeting and the full DQA meeting on June 5, virtually. CQM SWG members participated on the DQA Executive, Measures Development and Maintenance (MDMC), and pediatric measures development committees and Dr. Amundson chairs the MDMC.  Drs. Amundson, Jurkovich and Mouden and Mr. Brown also attended the Nov. 13 DQA Executive Committee meeting and the full DQA meeting on Nov. 13 virtual meetings.

 

DIAGNOSTIC TERMINOLOGY SWG 

The Diagnostic Terminology (DT) subworkgroup (SWG) has 13 voting and 3 non-voting members (additional representatives from companies already on the SWG). The SWG conducted work scheduled

around critical dates in the SNOMED International and Dentistry Clinical Reference Group (CRG) meeting/call dates. The SWG was chaired by Dr. Roger Adams, Avesis, for part of the first quarter 2020 with Dr. Linda Vidone, DentaQuest taking the Chair role for the remainder of the year.

The DT SWG continued oversight and review of the activities of SNOMED International (formerly known as the International Health Terminology Standards Development Organisation or IHTSDO), with Dr. Vidone and NADP Deputy Executive Director Timothy L. Brown representing NADP on the Dentistry Clinical Reference Group (CRG).

The April 2020 SNOMED International Business meeting was reduced to a few virtual meetings due to the COVID pandemic. Dr. Vidone and Mr. Brown participated in the SNOMED Virtual Expo on Oct. 8-9, and the Dentistry CRG calls throughout the year.

With the primary focus of SNOMED International being the outbreak of COVID-19 from early 2020, most work focused on the development, publication, and implementation of diagnostic terminology around the pandemic. Thus, much of the Dentistry CRG work was set aside for 2020 as other priorities prevailed. The CRG focused on finalization of concepts for gingival diseases and developing a draft work plan for 2021 to include support for the change to the 2017 periodontal classification system, updating the general dentistry refset, and determining a path forward for procedures and substances.

More TST Triumphs

The Terminology, Standards and Transactions division also includes the EDI and Operations WorkGroups (WGs). Following are highlights from each group.

Electronic Data Interchange (EDI) WG

The EDI WG reviewed and commented on mandated EDI transactions for claims processing, eligibility, claims status, eligibility, 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 & RARC), Workgroup for Electronic Data Interchange (WEDI) and American National Standards Institute X12 (X12) including the X12 Dental Caucus.

The WG contributed to the NADP 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.

COVID influenced topics in 2020 and discussion focused on possible steps to increase Dental EDI and use of D1999 for Personal Protective Equipment (PPE). Virtual Credit Cards (VCC) continued to be a big topic of discussion in 2020. 2021 should bring more integration of EDI directly at the provider desktop and Dental Practice Management Systems. Making things easier and faster than current widely used plan portals.

Operations WG

The Operations WG began the year by reviewing priorities and developing a plan for 2020 that included continued focus on enhanced relationships with Dental Service Organizations (DSOs). Major topics revolved around Provider Directory Validation and the state regulations; especially around COVID. The PDV information is available on the NADP website. A Delegated Credentialing SWG was formed to create checklists and best practices for DSOs and plans to reference when moving to a Delegated Credentialing model.

The WG continues to monitor various organizations in the credentialing space. This group watched state regulations and provides feedback and suggestions to ease the credentialing/recredentialing process.