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SKYGEN USA

How Daily Payments Can Help You Build your Medicaid Dental Provider Network

By Gail Buenger

SKYGENUSA Powering Healthcare for the Digital Age

ABOUT: GAIL BUENGER, VICE PRESIDENT OF OPERATIONS

Attracting dentists to a Medicaid dental provider network isn’t easy. Typically these programs pay only a fraction of what commercial plans offer. As a result, dentists tend to join because they feel a moral, altruistic calling to serve the most vulnerable population and have a desire to expand their patient rosters.

It can be challenging to build a Medicaid dental network that provides full, convenient access to quality dental care throughout the state. That’s why it’s critical for managed care organizations (MCOs) to develop strategies to attract and keep more dentists in the network.

One of the latest innovations in this area is daily payments, a strategy which enables electronically submitted, clean Medicaid claims to be paid each day. Two things are required to make daily payments happen.

The first is continuous claims processing, which replaces the old industry standard of following a batch cycle that can take up to two weeks or more with a system that instantly processes all clean claims so they’re instantaneously ready to be paid. The other is the dental provider must be set up for electronic fund transfers.

With daily payments, dental providers could see money from their Medicaid dental work come in every business day, giving them an attractive cash flow that offsets some of the pain of reimbursement that is lower than the typical commercial rates. But here’s the challenge: MCOs must be willing to fund the program with their dental benefit administration partner on a daily basis. That’s something they’ve traditionally been reluctant to do.

The float no longer floats

Often the reason for that reluctance is that MCOs tend to like to capture the float. The thinking is that by paying only once a week the MCO can keep the money in the bank a few extra days and accumulate additional interest before having to pay it out.

A decade or so ago, when interest rates were high, that was a much better strategy. Today, though, it is far less valuable. The annual percentage yields banks are paying are at historic lows – in the neighborhood of 1% (often far less for short-term investments). Rather than focusing on smaller short-term gains, MCOs are finding the smarter long-term investment is to use this money to fund daily payments to attract more high-quality dentists to the dental provider network and build the organization’s reputation as a good partner to the states it serves.

Making daily payments work

Convincing dental providers to submit the clean electronic claims required for daily payments, and to agree to be paid electronically, should not be a hard sell.

It costs both payers and dental providers significantly less when providers submit claims electronically through a web portal versus submitting them via paper. With paper forms, dental providers (or a staff member) must fill in all the information each time, locate and make copies of attachments, stuff it all into an envelope, attach postage and put it in the mail. Then they have to wait anywhere from days to weeks while the information is taken out of the envelope, entered into the system, processed, filed and payment is mailed back.

With electronic claims, repetitive information (such as the provider’s name, address, license number, etc.) is pre-populated. The only information that must be entered is whatever is specific to that claim, yielding immediate time savings. Once the provider hits “submit,” the information is received immediately by the benefit administrator’s system, where it can be managed, and the claim paid, immediately.

These efficiencies are the reason why it has been found that transitioning from fully manual to fully electronic processes, for just six types of transactions, could save health plans and providers more than $8.5 billion annually.

There are many other advantages to using a web portal. Electronic submission cuts back on human error that can cause a claim to be delayed or even denied. In fact, web portals like the ones set up by Scion Dental will actually check the submission and help prevent providers from making errors, such as forgetting to submit an attachment or inputting the right information in the wrong field.

A web portal also helps providers quickly get answers to questions about claim status and other areas (such as patient eligibility and pre-claim estimates) by enabling them to look this information up themselves instead of calling and waiting. (This capability benefits the MCO as well by reducing live support costs.) There are so many advantages it’s easy to see why more than 60% of providers in programs managed by Scion Dental are now registered on our web portals, and that usage continues to grow.

Convincing argument

Convincing dental providers to join a Medicaid dental network can be a tough sell. Most need some extra incentive before they will sign on – or stay on. So make it an easy decision for them.

The prospect of creating immediate cash flow on a regular basis, while doing less administrative work, is a powerful inducement. By adopting a daily payments strategy, MCOs will be able recruit more effectively – and demonstrate to state decision-makers how they’re serving members better while acting as good stewards of the taxpayers’ money. That’s a win for everyone.

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Gail Buenger

About
Gail Buenger

As Vice President of Operations, Gail Buenger guides Scion Dental’s progress in its next stage of rapid growth. She is responsible for strategy execution, relationship development, and change acceleration in both internal- and customer-facing operations that furthers the company’s strong track record of innovation in dental benefit management. Ms. Buenger oversees all operational functions of Scion Dental including the departments of Client Services, Provider Relations, Claims and Administration, and the Call Center.

Ms. Buenger is an accomplished healthcare operational business leader with experience in driving change and organizational growth. Before joining Scion Dental, she was Director/Chief Integration Officer of the Healthcare Division’s Revenue Cycle Solutions practice at Navigant Consulting, Inc., a global professional services firm. Prior, she spent 13 years with a leading regional integrated health care delivery system, Aurora Health Care, in Milwaukee, Wisconsin. She held positions of increasing responsibility, including Aurora’s first Director of Corporate Compliance, and then Regional Vice President of Operations. After creating the Office of Project Management Services, she was appointed to the role of PMO Vice President. Additionally she served in a dual capacity as Chief of Staff to Aurora’s Chief Operating Officer. While at Aurora, the largest private employer of Wisconsin-based employees in the state, Ms. Buenger earned her law degree.

Ms. Buenger is active in the community, currently serving as a Board Member for The Guest House of Milwaukee, a non-profit that provides shelter, housing, education, employment, and health-related services to the homeless in Milwaukee. Previously she served as an appointed community member serving the Ozaukee County Health and Human Services Board for a number of years.

Ms. Buenger, a life-long Wisconsin resident, holds a Juris Doctorate from Marquette University Law School, as well as a certificate in alternative dispute resolution from the University. She earned her Bachelor of Science from the University of Wisconsin-Milwaukee.

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