Focused Review

The affiliated Delta Dental Plans of Indiana, Michigan, New Mexico, North Carolina, Ohio, and Tennessee have established the Focused Review program to help monitor claims and ensure accurate processing and contract fulfillment.

Of the very few providers that are placed on Focused Review, the majority are randomly selected. An even smaller number of providers may be on Focused Review because a claims analysis shows a statistical difference from their peers or a complaint has been filed against them.

Providers selected for Focused Review will receive a packet of information, including a list of procedure codes requiring additional documentation and how to submit claims to the Focused Review Department. Review this information carefully to ensure a smooth process and timely claims payment.

Running a well-organized practice is important all the time, but especially when going through the Focused Review process. Focused Review requires additional information be submitted for specific procedure codes. By maintaining good notes and records on ALL performed services, your office will easily be able to provide the necessary documentation during Focused Review.

• Make sure notes written in patient charts are legible.
• Document any patient concerns or issues communicated to you.
• Clearly label all x-rays with the patient name and date the x-ray was taken.
• Thoroughly document treatment plans, even using a separate section if necessary, to completely document treatment recommendations and the priority in which treatment should occur.
• Progress notes should include all details relating to the patient’s treatment including procedures, specialized services, supplies, etc.
• Always submit claims under the license number and/or Type 1 NPI number of the provider that rendered the services.
• Request pre-treatment estimates—Every group contract is different, so ensuring a procedure is covered helps prevent angry patients who don’t understand why they have a bill.