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TST Triumphs
During the
first quarter, the Terminology Workgroup (WG) reviewed their underlying
High-Level Initiative contained in the NADP Strategic Plan and proposed a
replacement for HLI2 with operational plans as follows:
High Level Initiative #2: Execute
a strategy for the Terminology, Standards & Transactions (TST)
Workgroups to apply their expertise in providing a united industry
perspective on issues related to the use of terminology and data for the
clear exchange of dental health information in the operation of dental
plans.
HL #2 Operational Plans:
- Complete a situational analysis of TST within the dental benefits industry.
- Assess NADP’s role within the TST dental environment.
- Complete a
gap analysis between current dental industry capabilities and desired
data capabilities, including capture of diagnostic terminology and
clinical outcome data. - Complete an annual assessment of 1, 2 and 3; adjust as needed.
The three
Sub-Workgroups (SWGs) under Terminology reviewed their mission
statements and continue to develop work plans to facilitate the mission
statements and operational goals. The proposed HLI2 and operational
plans were adopted by the NADP Board in May and were incorporated into
the NADP Strategic Plan. Further, the Terminology WG proposed changing
the name of the existing SNOMED/ICD SWG to the Diagnostic Terminology
SWG. The Board approved this change in May as well.
Codes SWG:
The Codes SWG reviewed proposed changes to CDT-2019 and submitted 22
proposals to the American Dental Association Code Maintenance Committee
(CMC) for substantive changes; i.e. three revisions, 14 additions and
five deletions. The Codes SWG also submitted 21 submissions in
partnership with the American Academy of Periodontology (AAP) in the
first ever joint submissions to the CMC. Drs. Stewart, Aetna, and
Horowitz, Nevada Dental Benefits, represented NADP at the March 14-15,
2019 CMC meeting. NADP’s position prevailed on all of 22 items submitted
on our own with overwhelming support. All of the AAP/NADP joint
submissions were rejected by the CMC as a slim majority felt the
proposals would add diagnostic elements to the CDT. NADP members can
obtain the NADP Change Document for CDT-2020 that outlines these
changes.
The Codes SWG
was once again given the opportunity to edit the DRAFT CMC report and
the ASCII file of CDT-2020. Codes SWG members found and corrected minor
errors in these documents prior to release or printing.
SWG members
have already begun reviewing submissions for CDT-2021 and will continue
to do so during their meetings and calls in the first three months of
2020.
DQA SWG:
Members continued to monitor the actions of the Dental Quality Alliance
(DQA) and SWG Chair, Dr. Craig Amundson (HealthPartners) and Timothy L.
Brown, NADP Deputy Executive Director, participated in the Executive
Committee meetings held on June 13 and November 14. Drs. Amundson,
HealthPartners, Jurkovich, HealthPartners, and Mouden, United Concordia
along with Mr. Brown participated in the full DQA meetings held on June
14 and November 15. DQA SWG members participate on the Executive,
Measures Development and Maintenance, and pediatric measures development
committees and Dr. Amundson chairs the MDMC.
Diagnostic Terminology SWG:
The DT SWG sought and received approval from the NADP Board of
Directors to change their name from the SNOMED/ICD SWG to the Diagnostic
Terminology SWG. This was in tandem with the revisions, also adopted by
the Board, to the High-Level Initiative relating to the work of the
three SWGs under the Terminology WG. The DT SWG also develop a revised
mission statement and operational plans as follows:
Diagnostic Terminology SWG Mission: To
develop and implement standardized terminology with significant
granularity to improve the use of data for the clear exchange of dental
health information.
Diagnostic Terminology SWG Operational Plans:
- Complete a
situational analysis of the integration of diagnostic terminology in
dental schools, dental practice management systems, clearing houses and
NADP member plans. - NADP will
lead the integration of dental diagnostic terminology in claims
processing within dentistry and are positioned to do so. - Gap Analysis
- Complete a
gap analysis between current capabilities and desired data capabilities,
including capture of diagnostic terminology and clinical outcome data. - B. Develop a high-level NADP member plan implementation guide.
- Complete a
- Complete an annual assessment of 1, 2 and 3; adjust as needed.
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. Roger Adams,
Guardian/Avesis and Mr. Brown representing NADP on the Dentistry
Clinical Reference Group (CRG)
Dr. Adams and
Mr. Brown attended the April 7-10 SNOMED International Business meeting
in April. They will also attend a Dentistry CRG meeting as part of the
combing ADA/FDI meeting on Sept. 4. Dental community participation at
the SNOMED meetings continues to grow with more international
representatives joining the dynamic work of the CRG including an ongoing
odontogram project, periodoic terminology updates and requests for
assistance from both US and international members.
The primary
work of the DT SWG in 2019 was focused on the development, proposal and
acceptance of the revised HLI2 and the accompanying mission statement
operational plans for the SWG.
For more information about TST, contact Deputy Executive Director Timothy L. Brown.
More TST Triumphs
Through the
work of the Terminology, Standards and Transactions Workgroups, NADP
represents the dental benefits industry to stakeholder organizations
governing electronic standards and also offers solutions designed to
increase efficiencies. The TST Initiative includes the three previously
mentioned sub-workgroups and two additional workgroups: EDI (Electronic
Data Interchange) and Operations. Following are 2019 highlights.
EDI (Electronic Data Interchange) WorkGroup
The mission statement for the EDW WorkGroup is to:
- Review and
comment on mandated EDI transactions including, but not limited to,
claims processing, electronic funds transfer, electronic remittance
advise, eligibility verification and electronic health records - Develop,
review and comment on changes and updates in mandated EDI transaction on
behalf of the dental benefits industry • Liaison with other state and
national organizations engaged in the EDI arena - Support for
NADP voting seats on Dental Content Committee (DeCC), Health Level 7
(HL7), Standards Committee on Dental Informatics (SCDI), Workgroup for
Electronic Data Interchange (WEDI) and American National Standards
Institute X12 (X12) including leadership positions on the X12 Dental
Caucus
EDI 2019 Accomplishments
The EDI
Workgroup grew to 25 members representing Payers, Dental Service
Organizations (DSO’s) and Clearinghouses. The work was conducted via
conference calls held on the first Friday of each month.
The 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 supported 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)
including the 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 are analyzed and discussed during the EDI meetings and used to
set future agenda items.
Virtual Credit
Cards (VCC) was a big topic of discussion in 2019. VCC was discussed
and dismissed a few years ago but now it is back, and acceptance is up
by both providers and plans. This is a direct result of EFT staying at ~
10-12% for the last 10 years. Payers are looking at other options to
move away from paper. A VCC session will be held at CONVERGE.
The WG is
monitoring a HL7 Dental Provider initiative. The HL7 Payer/Provider
Information Exchange WG is developing Consolidated Clinical
Documentation in order for providers to pass patient information
electronically to other providers from their practice systems.
Operations WorkGroup
The mission statement for the Operations WorkGroup is to:
- Develop,
review and comment on proposals for dental plan accreditation with
accreditation organizations and federal representatives - Develop,
review and comment on proposals for uniform
credentialing/recredentialing within dental benefits organizations,
providers and outside vendors. - Serve as
liaison to dental service organizations (DSOs) and the Dental Group
Practice Association (DGPA) on initiatives of interest to both.
2019 Operations WG Accomplishments
The Operations
Workgroup has over 50 members representing Payers, Dental Service
Organizations (DSO’s), Clearinghouses and Provider Consultants. The work
was conducted via conference calls as needed. Most of the work is via
sub-workgroups s consisting of approximately 10 volunteers. The WG
decided this was best to be more efficient.
The WG began
the year by reviewing priorities and developed a plan for 2019 that
includes continued focus on enhanced relationships with Dental Service
Organizations (DSOs). A major topic revolved around Provider Directory
Validation and the state regulations. The SWG will meet at CONVERGE to
continue pushing the solution. The PDV information is available on the
NADP website.
The WG
continues to monitor various organizations in the credentialing space.
This group watches state regulations and provides feedback and
suggestions to ease the credentialing/recredentialing process.
For more information about EDI or Operations WGs, contact Dental Informatics Manager Brian Flynn.
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