Doral to Administer MassHealth's Dental Program Beginning in February

After months of quiet lobbying, negotiation and preparation, Beth Waldman, Medicaid Director, Commonwealth of Massachusetts, sent an advisory letter out to Masshealth provider dentists all over the commonwealth. There is a new Third Party Administrator (TPA) in town. February 1, 2007, Doral Dental USA will take over support of member and provider services for MassHealth dental. Doral is a subcontractor to Dental Services of Massachusetts (AKA Delta Dental of Massachusetts or DSM) and a subsidiary of DentaQuest, Inc. DentaQuest is the for profit subsidiary of DSM (DSM is a non-profit organization). Aside from the complicated family tree, the hope is that Doral will be able to simplify the interactions of the Commonwealth of Massachusetts, patients and dentists.

Why would the Commonwealth contract outside the state to obtain these services? Dr. Mike Monopoli, Director of Public Health Policy for DSM, gave a thorough response by e-mail to this question.

Customer service for the MassHealth dental program has been provided as a component of the Maximus (a service company located in Reston, Va.) customer service contract. That unit always provided dental customer service for providers and members as a sub set of customer service for all provider types and member issues. It is clear that customer service has been overwhelmed and that the unit was under trained to provide adequate dental customer service.

Doral is a company that only supports public dentistry programs. By removing dental services from the Maximus contract, their staff will be free to provide better support to medical health issues. Clients will have more expert support for their dental issues. No jobs will be lost in Massachusetts. In fact, Doral has an office in Charlestown, Ma, with member intervention, professional relations, management and support staff for a net gain of jobs in the state.

Last year, MassHealth began operating under a new directive. The decision of Healthcare For All (HCFA) V. Mitt Romney et al instructs the Commonwealth to increase availability of dental services to MassHealth's approximately one million dental clients. Currently, there are many communities across the state that have no dentists who work with MassHealth.

The Commonwealth is complying with HCFA V. Mitt Romney by making MassHealth more dentist friendly. While the fees of the MassHealth program do not equal fees dentists receive from most other third party payers, MassHealth's new, higher fees will attract more dentists to provide treatment for MassHealth members.

Until last year, Massachusetts law required that dentists could not limit the number of MassHealth clients in their offices. A major reason that dentists would not sign on, was the fear that MassHealth clients would fill their schedules causing financial and management problems. Today, dentists may limit MassHealth clients to any number that they find comfortable.

Prior authorization is the practice of giving dentists permission to provide some kinds of treatment to MassHealth clients. The dentist submits a special form that answers procedure specific questions. For example, if a patient needs a new set of complete dentures, MassHealth would like to know if there is a current set and if there is, what is wrong with the current set of dentures. Dentists provide similar pretreatment information to other insurance companies as a pretreatment estimate. The difference is that while insurance companies use the standard claim form for this procedure, MassHealth uses a proprietary, two page form that is different from other dental forms. MassHealth has already improved the turnaround time on this form. Soon, Doral will allow dentists to use the standard claim form (the ADA 2002/2003 claim form) for prior authorization as well as for billing for services rendered. Additionally, MassHealth is decreasing the number of procedures that require prior authorization, which increases dentist and patient satisfaction with the program.

Since the HCFA V. Romney verdict, MassHealth pays dentists more, quicker and easier than ever. Client and provider service is much better than before. Dentists who provided treatment to MassHealth clients in the 1980's notice a dramatic difference in customer service. For example, in years past, clients would call MassHealth for assistance in finding a provider. MassHealth customer service specialists would give the client the names of three providers in their area. Often, the names on the list were not up to date. Now, MassHealth keeps the list up to date. The list, conveniently available on-line, is only four days old, today.

Finally, MassHealth effectively pays dentists for the work that they do. At a recent meeting, MassHealth providing dentists agreed that they are receiving payment for services about three weeks after billing, even when submitting claims by the slower paper claim route.

MassHealth is far better than in years past. Current providers are happier. MassHealth's management team is working hard to deliver their message to the dental community. Non-provider dentists warily attend informational meetings on the new MassHealth. They ask questions like how will being a provider affect my compensation from other insurance companies? If a MassHealth patient is a problem due to behavior in the office or not showing up for appointments, can I stop treating them? How easy is it to limit the number of MassHealth patients in my office?

MassHealth provides specialists such as Dr. Timothy Martinez, the Dental Director of MassHealth, to answer these questions. Dr. Martinez is an employee of the Commonwealth and was a plaintiff in HCFA V. Romney. At a recent meeting (January 10, 2007, in Marlboro, Ma.) introducing Doral to the organized dental community, Dr. Martinez told leaders of the Massachusetts Dental Society that all of these changes are due to "the voice of the dental community".
Briefly, the state's compensation to dentists for treatment of MassHealth Patients will not effect their compensation from other insurance companies including Delta Dental. MassHealth patients may be dismissed from a dental office the same as any other patient. Dentists may change their status from accepting new patients to not instantly, on the current MassHealth website or with a phone call.

What improvements will Doral bring to MassHealth? Marcel Tetzlaff, Doral's Director of Provider Services, addressed the same meeting in Marlboro. Mr. Tetzaff began by describing Doral's background, providing management services to public dental plans. Incorporated in 1993, Doral is the nation's largest multi-site administrator of government dental programs. Doral manages over 9 million enrollees in 19 states including Massachusetts, and the District of Columbia.

Mr. Tetzlaff outlined how Doral will simplify dentists' management of MassHealth. Doral will accept prior authorization information on the standard claim form. Doral will improve support of dentists and clients in the Massachusetts market. Doral designed a new website, MassHealth-dental.net, to supplant the one that is currently operated by MassHealth. The site will provide real time information for dentists on client eligibility, claims information, and even the ability to submit claims directly to Doral from the same site using their convenient software.

Doral will not recredential current MassHealth providers. They will streamline the credentialing process for new providers.

Mr. Tetzlaff introduced Debbie Hartman, Doral's Massachusetts Outreach Coordinator. Ms. Hartman is a former school teacher who among other duties, will be responsible to council MassHealth clients who miss their dental appointments. Through Doral, MassHealth will pay travel expenses for clients who need help getting to the dentist. Ms. Hartman and her associates will teach clients about the importance of dental care for their children and themselves.

Doral will learn of patient compliance issues through a new, optional form available from their web site. Dentists and staff may fax or mail the "Broken Appointment Log", a letter, or a computer report to Doral to inform them of
problems with patients. A stated benefit of reporting missed appointments is that the information will be available to Doral client relations staff if a client complains that a dental office refuses to give them another appointment. This may be the only instance of a dental benefit management company offering to work with the provider to improve compliance.

The administrations of MassHealth, DSM, and Doral, believe that Masshealth's new association with Doral will take this important and necessary program to a higher level of service and satisfaction. January 25 - 27, 2007, Doral will conduct information sessions for Massachusetts dentists at the Yankee Dental Congress in Boston. The hope of MassHealth and the public health community is that many dentists in Massachusetts will choose to treat a small number of MassHealth clients apiece. That way, the increasing access to dental care will satisfy the spirit of HCFA V. Mitt Romney.

Dr. David Leader has practiced in Malden since 1989. He is a member of the Medical Advisory Board of the Scleroderma Foundation, New England Chapter; the Professional Advisory Committee of Tri-CAP Head Start, and the Massachusetts Dental Society Council on Dental Care and Benefits Programs. Dr. Leader is an Assistant Clinical Professor of General Dentistry of Tufts University School of Dental Medicine. Past articles are available on Dr. Leader's website: www.theMaldenDentist.com