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Frequently Asked Questions |
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1 . What is the difference between Dentcare, IHS and Healthplex?
Dentcare Delivery Systems, Inc. is a not-for-profit Health Services Corporation licensed by the New York State Insurance Department. The company was established in 1978 and provides managed care and reimbursement dental plans. Most of the plans offered to groups and individuals are available through various networks of participating dentists.
International Healthcare Services, Inc. (IHS) is a Dental Plan organization certified by the New Jersey Department of Banking and Insurance. Established in 1981, IHS offers managed care dental plans through its network of participating dentists.
Healthplex Insurance Company was licensed in 2001 by the New York State Insurance Department and offers reimbursement plans to groups of all sizes.
Healthplex is a Third Party Administrator that specializes in the field of dental benefits. The company designs and administers numerous dental programs for insurance companies, HMOs, businesses of all sizes and self-funded groups. Healthplex also provides claims processing, customer service and other functions for insurance companies and HMOs .
2. What is the turnaround time for claims payment?
Claims that are submitted 'complete' are normally processed within ten (10) days of receipt. Claims that require additional information (x-rays, tooth numbers, signatures, patient information, etc.) will be processed within ten (10) days after the requested information is received.
3. How can I determine the appropriate copayments and coinsurance?
If a patient is enrolled in your office under a managed care program, you should first check your monthly roster or the patient's ID card to determine the correct group number. Then, go to the appropriate plan benefit column in your provider manual. All co-payments paid by the insurance company (amounts in parentheses) will be shown in the group column. If the patient is enrolled in a reimbursement plan, their identification card will show their deductible and their co-insurance percentages. As an example, if 100/80/60/50 is shown on the card in the co-insurance section, the following benefits will apply:
- 100% Diagnostic & Preventive Services
- 80% Basic Restorative, Endodontic, Basic Periodontal and Oral Surgery Services
- 60% Major Restorative, Major Periodontal and Prosthetic Services
- 50% Orthodontic Services
Depending on the specific plan, the above percentages may be based on UCR fees, a schedule of allowances or your actual fees charged. If the identification card does not reference the basis for reimbursement, you may call our Customer Service department at 516-542-2200 or 800-468-0600. This number can also be used for verification of Managed Care Plan co-payments.
Time permitting, pre-determinations can also be used to confirm co-payments or co-insurance amounts.
4. Do you accept electronic claims processing?
For most plans, Healthplex will accept electronic claims that are submitted through an electronic clearing house (EMDEON, Tesia, ANS, Dentalxchange). For some self-funded or other groups that require original signatures for legal purposes, Healthplex may not be able to process claims in this manner. For a list of groups not allowing electronic claim submission, please contact our Provider Relations department at 888-468-2183.
If radiographs or other diagnostic materials are necessary, electronic submissions will not be processed faster than paper claims.
5. What types of dental plans do you offer?
Healthplex offers a wide range of dental plans that are underwritten by various insurance companies or HMOs. Some plans compensate dentists through monthly capitation fees plus co-payments. Others compensate providers with fee-for-service reimbursements that are based on UCR fees or fixed schedules. There are also closed panel plans (that only operate through participating dentists), open panel plans (that offer patients freedom of choice), point-of-service plans (that give patients both in and out-of-network options) and many other combinations.
For information about specific programs, contact a Provider Relations Representative at 516-542-2743 or use the 'Contact Healthplex' option on your screen.
6. Why must all dentists in an office be credentialed?
Many dental benefit companies use the credentialing process to guarantee the credibility of their networks. This is especially important to groups and patients who are concerned about the quality of participating dentists. By definition, the process applies to individual dentists as opposed to a particular 'office'. As such, every dentist who treats a covered patient must be individually credentialed. In performing this task, Healthplex not only follows the guidelines established by the National Committee For Quality Assurance (NCQA) but has been certified as a Credentials Verification Organization by NCQA. NCQA is a non-profit organization that certifies credentials verification organizations (CVO's) and accredits managed care organizations.
7. How many new patients can you guarantee me?
Unfortunately, we are seldom able to guarantee a specific number of patients for participating dentists.
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