Presentation to: Dental Advisory Committee
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Presentation to: Dental Advisory Committee August 25, 2006 A New Day For Oral Health In Virginia
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Transcript of Presentation to: Dental Advisory Committee
- 1. Presentation to: Dental Advisory Committee August 25, 2006 ANewDay For Oral Health In Virginia
2. Pediatric Utilization (Ages 0-20)
- 16,748
- 29%
74,329 57,581 Total Eligibles Receiving a Dental Treatment Service
- 21,833
- 20%
131,319 109,486 Total Eligibles Receiving a Preventive Dental Service
- 16,876
- 13%
145,093 128,217 Total Eligibles Receiving Any Dental Service Total Increase Doral SFY 06 (7/1/05- 6/30/06) CMS 416 FFY 05 (10/1/04- 9/30/05) 3. Enrolled vs. Actively Billing Providers
- Based on claims paid, the percentage of network providers actively participating inSmiles For Childrenhas increased from 58% to 78%.
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- In the 1 stquarter, 528 providers submitted claims.
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- By the 4 thquarter, 665 providers submitted claims.
- Enrolled refers to providers that have agreed to participate in theSmiles For Childrenprogram, but are not actively participating as evidenced through the submission of claims for services.
4. Distribution of Dental Services
- Of the 1,391,585 services performed, 951,152 (69%) of services rendered were for Diagnostic and Preventive Services.
- The balance, 440,433(31%), of services rendered was for Treatment Services.
5. Distribution of Paid Claims
- Of the $73,184,363 paid claims, $27,004,357 (37%) was paid on Diagnostic and Preventive Services
- The balance, $46,180,006 (63%), was paid on Treatment Services.
6. Claims 7. Time Frame for Claims Adjudication
- Average Number of Claims Adjudicated Per Month for the Year:33,139
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- In the 1 stquarter, the average number of claims processed for the quarter was20,490 . In the 4 thquarter, the average number of claims processed for the quarter was40,550.
- Average Turnaround Time (July 2005 June 2006) 19.73 Days
- 99.8%of all clean claims adjudicated within 30 days of receipt of claim:
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- Performance Standard: 90% of clean claims are adjudicated within 30 calendar days of receipt of claim.
- 100%of all claims processed within 60 days
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- Performance Standard: 99.5% of all provider claims for services are adjudicated within 60 calendar days.
Performance Goal:
