BeneCare Training Deck PDF

HOUSE KEEPING  Clean Desk  Time off  Dress code  WFH days  PTO/Sick time  Schedules  Attendance  ADP clocking in and out  Camera’s always on in meetings benecare.com...

HOUSE KEEPING  Clean Desk  Time off  Dress code  WFH days  PTO/Sick time  Schedules  Attendance  ADP clocking in and out  Camera’s always on in meetings benecare.com | 09/30/2024 Proprietary and Confidential 1  POP QUIZ TIME © 2018 BeneCare Dental Plans. All rights reserved. Proprietary and confidential MANAGEMENT PHILOSOPHY benecare.com | 09/30/2024 Proprietary and Confidential 3  MASSHEALTH DENTAL PROGRAM Administered by © 2018 BeneCare Dental Plans. All rights reserved. Proprietary and confidential WHAT IS A DENTAL PLAN  A dental plan is the combination of covered dental services, participating practitioner network (if any), schedules of allowances, member out of pocket costs (deductibles, copayments, and/or co-insurance), annual or lifetime benefit dollar limitations (if any) and the limitations and exclusions that are used to adjudicate and pay claims for dental services provided to enrolled and eligible members benecare.com | 09/30/2024 Proprietary and Confidential 5 WHAT IS MASSHEALTH?  MassHealth provides benefits and help paying for them to qualifying children, families, seniors, and people with disabilities living in Massachusetts  MassHealth and Contracted with BeneCare(the administrator) to help manage the Mass Health Dental Programs? benecare.com | 09/30/2024 Proprietary and Confidential 6 benecare.com | 09/30/2024 Proprietary and Confidential 7   Access to Oral Health during childhood leads to longer, healthier lives, higher educational attainment, and successful futures. When pregnant people receive dental coverage, their children have better health outcomes during adulthood, including reduced rates of obesity, hospitalizations, and improvements in oral health. ~ MassHealth benecare.com | 09/30/2024 Proprietary and Confidential 8 BENECARE’S ROOTS  BENECARE CREATED ITS VALUE-BASED MODEL IN 1979  THE GOAL — BETTER ORAL HEALTH  OUTCOMES THAT MATTER  A Different Approach- Access to Care benecare.com | 09/30/2024 Proprietary and Confidential 9 SOME OF OUR DAILY RESPONSIBILITIES ARE  Working to increase  Helping navigate your and keep the number benefits and answer of Dentists. questions about your MassHealth Dental Program  Help schedule an  Help our constituents appointment if needed find a Dental Provider that fits their needs. benecare.com | 09/30/2024 Proprietary and Confidential 11 KEY PERFORMANCE IDENTIFIERS & SERVICE LEVEL AGREEMENT  What is the difference?  Per Harvard Business Review and Cousera  How does this impact my day to day? benecare.com | 09/30/2024 Proprietary and Confidential 12 benecare.com | 09/30/2024 Proprietary and Confidential 13  SLA PER OUR CONTACT 90% of call 75% First Call receiving a passing Resolution quality of rating for Provider Calls 80% Of calls 85% of Customers Answered with in Reported they were 45 Secs “very satisfied” benecare.com | 09/30/2024 Proprietary and Confidential 14 SCOPE OF SERVICES Dental Provider Network Administration Services Customer Services Claims Administration and Processing Services Prior Authorizations Program Integrity Inquires, Ombudsman Services, and Appeals Data Management and Systems Requirements Contract Administration and Reporting Quality Assurance benecare.com | 09/30/2024 Proprietary and Confidential 15 CONSTITUENT SERVICES  The BeneCare customer service model has 3 distinguishing characteristics.  No Wrong Door  A 360- View  Dental Office experience benecare.com | 09/30/2024 Proprietary and Confidential 16 Questions? benecare.com | 09/30/2024 Proprietary and Confidential 17 HISTORY OF DENTISTRY 1700s-1900s 1800s- Now  Dentistry is one of the oldest  In 1840, the first dental college (Baltimore College of Dental medical professions, dating back Surgery) opened. to 7000 B.C. with the Indus Valley Civilization.  Alabama led the way by enacting  By the 1700s, dentistry had the first dental practice act in 1841, become a more defined and nearly 20 years later, the profession. In 1723, Pierre American Dental Association (ADA) was formed. Fauchard, a French surgeon  Harvard University Dental School, credited as the Father of Modern was founded in 1867. Dentistry, when he published his  By 1873, Colgate had mass first book produced the first toothpaste ©2015-2024 American benecare.com | 09/30/2024 Proprietary and Confidential 18 Dental Education HISTORY ETC.  In 1954, for the International  In 1966, Delta Dental Plans Longshoremen’s and Association was formed Warehousemen’s Union and the Pacific Maritime Association under the name National (ILWU-PMA), it was dental Association of Dental benefits. The first three dental Service Plans. benefits organizations were formed. The Washington Dental Service was founded in 1954 and the Oregon Dental Service and the California Dental Association Service in 1955. benecare.com | 09/30/2024 Proprietary and Confidential 19  INSURANCE ? What Is Insurance? Why is it important? How it works benecare.com | 09/30/2024 Proprietary and Confidential 20 benecare.com | 09/30/2024 Proprietary and Confidential 21  MassHealth Under 21 Exams & cleanings Fillings Crowns Root canal therapy & retreatment Extractions & oral surgery Partials & dentures Orthodontia/Braces (with prior authorization) Athletic guards & occlusal guards Non-covered services (prior authorization for medical necessity) benecare.com | 09/30/2024 Proprietary and Confidential 22  MassHealth over 21 Exams & cleanings Fillings Crowns Root canal therapy & retreatment Partials & dentures Extractions & oral surgery benecare.com | 09/30/2024 Proprietary and Confidential 23  MassHealth Limited * Only for emergency services 7 codes Exam Radiographs Extraction Palliative treatment benecare.com | 09/30/2024 Proprietary and Confidential 24  CMSP Yearly cap of $750 Exams & cleanings Fillings Crowns Root canal therapy & retreatment Extractions & oral surgery Partials & dentures Athletic guards & occlusal guards benecare.com | 09/30/2024 Proprietary and Confidential 25 Health Safety Net Partial Same as Health Safety Net but has deductible. Benecare will treat members with HSN partial as regular HSN. Implementation after 2/1/2. benecare.com | 09/30/2024 Proprietary and Confidential 26 PUBLIC/ PRIVATE PARTNERSHIPS  Government Programs that cater to underserved population have an ethical obligation to deliver high- quality care to the populace and fiscal responsibility to the taxpayer while meeting local regulatory requires.  BeneCare outcomes-based model satisfies all of these criteria and has a trac records of documenting success benecare.com | 09/30/2024 Proprietary and Confidential 27 TREATMENT MODALITIES benecare.com | 09/30/2024 Proprietary and Confidential 28 BENECARE’S VISON  Value Proposition  Usability  Affordability  Flexibility  Predictability  Stability benecare.com | 09/30/2024 Proprietary and Confidential 29 STANDARD NOMENCLATURE  Member  Dentist or Practitioner ( Dental Professional)  Sponsor  Producer or Benefit Consultant  Constituent Services benecare.com | 09/30/2024 Proprietary and Confidential 30 TERMINOLOGY  What are some common terms you have heard while go ing to the Dentist.  What are some common terms you have heard while on the phone with your insurance. benecare.com | 09/30/2024 Proprietary and Confidential 31 SCENARIO  My daughter is having some pain and sensitivity for the past few days and I need to find an _______ Dentist?  I just got out of an appointment with my dentist and they said I need a new crown are these services ______? benecare.com | 09/30/2024 Proprietary and Confidential 32  RIGHTS AND RESPONSIBILITY Why are these so important: benecare.com | 09/30/2024 Proprietary and Confidential 33 BENECARE ORGANIZATIONAL OVERVIEW  Oral Health Literacy  Person Centered Care  Prevailing Community Standard of Care  Third-Party Admin  UM (Utilization Management) benecare.com | 09/30/2024 Proprietary and Confidential 34 TABLE SLIDE 1 Column 1 Column 2 Column 3 Column 4 Column 5 Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text benecare.com | 09/30/2024 Proprietary and Confidential 36 TABLE SLIDE 2 Column 1 Column 2 Column 3 Column 4 Row 1 Text Text Text Text Row 2 Text Text Text Text Row 3 Text Text Text Text Row 4 Text Text Text Text Row 5 Text Text Text Text Row 6 Text Text Text Text Row 7 Text Text Text Text Row 8 Text Text Text Text benecare.com | 09/30/2024 Proprietary and Confidential 37 TABLE SLIDE 3 Column 1 Column 2 Column 3 Column 4 Column 5 Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Total Total Total Total Total benecare.com | 09/30/2024 Proprietary and Confidential 38 TABLE SLIDE 4 Column 2 Column 3 Column 4 Column 5 Row 1 Text Text Text Text Row 2 Text Text Text Text Row 3 Text Text Text Text Row 4 Text Text Text Text Row 5 Text Text Text Text Row6 Text Text Text Text Row 7 Text Text Text Text Total Total Total Total benecare.com | 09/30/2024 Proprietary and Confidential 39