Delta Dental recently introduced QCSI's aQDen -- an exclusive system for dental payers designed to administer all lines of business including Medicaid and Medicare. It also manages all relationships between the plan, members, employer and dental providers. aQDen also handles all claims processing and adjudication, pre-determinations, provider administration, employer benefit plan and policy administration and member services management.
Karl Mudra, Delta Dental's CIO, recently took a few moments to talk to Dental Economics about this new technology and what it means to those affiliated with Delta Dental.
DE: Which came first, the technology behind aQDen or the need for the technology?
Mudra: Timing was the key. No one on the market had an intelligent Dental Claims adjudication system. We were focused on aligning with Microsoft so as to prevent the tradition mixed bag approach to systems. We took our knowledge and blended it with technology savvy QCSI. The result was QCSI's dental payer application aQden.
DE: What are the main benefits to both patient and dentist of this new technology?
Mudra: Claims are processed in less than four days as much as ten time faster than the competition. This allows the dentist to receive his monies quickly and the patient will receive an Explanation Of Benefits (EOB) showing what the dentist has been paid and if they will be required to pay the dentist any deductibles or co-pays. This all occurs in a very timely fashion and on the average more than twice as fast as we previously performed.
Also, this is the infrastructure by industry terms to provide a real-time claim adjudication system which gets payment to the provider and receipts to the patient much like the credit card or ATM transactions we are accustomed to in today's fast pace "gotta have it now" realm.
DE: Do you feel that the technology is helping both dentist and patient feel more comfortable with larger treatment plans?
Mudra: The beauty of the system is the ability to grow members, enrollments, and claim treatments without the need to have linear staff increases. As a result, we provide a more efficient and automated approach for the patient and provider.
DE: Helping those on Medicaid and Medicare with quicker turnaround time would seem to be very important to those on a fixed income. Have you found that to be the case?
Mudra: We currently do not have any Medicaid or Medicare contracts, however, you are correct. This would aid anyone who is on fixed income in two ways. First we have over 75% of the dentists in the nation under a participating agreement. This means we pay the par provider directly and he/she will bill the subscriber any balance owed after we have processed the claim and notified the patient (through an EOB) and the provider (through a remittance) of any outstanding balance. The patient is only obligated to pay the provider monies we note on the EOB is patient pay, which, is normally a relatively speaking a very small if any amount.
DE: This would also seem to be a big benefit to the companies who use Delta Dental. Is it? If so, how have the companies responded to the quicker turnaround time?
Mudra: It is a huge benefit for companies and their employees. The fact we handle their employees' dental claims quickly and accurately means the employer will not have employees complaining that their dentist is billing them directly because the dentist has yet to receive payment from an insurance company. We typically are told by employers that when Delta handles their dental benefit programs they know they will not receive complaints from their work force and should a claim issue arise, they know Delta will handle this with their extremely efficient customer service where 99% inquires are answered on initial contact and all others with in 24 hours GUARANTEED.
DE: What differences will the patients and dentists notice with the new system?
Mudra: The patients and providers are noticing improvements, and we are already setting industry standards on turnaround on dental claims. The feedback has been very impressive.
DE: Talk a little about the ROI you have found with this system and how it helps the practitioner.
Mudra: Reduced corporate operating budget from 12% to under 10%. Increase hands-off 'drop-to-pay' from 8% of claims to over 75%. Since we have a total Microsoft solution, we have a fraction of the ROI cost of organizations with the mixed bag of Windows, Unix, and Legacy. Our IT costs are less than 8% of total corporate expenses, while others are well over 15%. That's a 50% savings and real money. Lastly, we now adjudicate claims on average of 2.8 days versus 12 days prior.
DE: What do you see in the future for this new system?
Mudra: Point-of-sale claims adjudication, completely web-based practice management, payment, and accounting services for the providers. On the patient/employer side, continued improvements to client's needs, wants, and service they offer to their employees. After all, the Human Resources of all companies is a benefit which employees will utilize.
