Services & Programs Corporate Facts

LIBERTY Dental Plan is a privately held corporation with no affiliation with other health plans and uniquely positioned in dental benefits management. LIBERTY prides itself on being government program oriented and experienced. LIBERTY’s culture is member service driven by experience and technology. We strive to balance the beneficiary’s need for quality, accessible dental services and the market place’s demand to remain price competitive.

Since its inception, LIBERTY has felt that there is a disconnect between members’ overall health and their oral health. With this in mind, LIBERTY has been at the forefront of developing and implementing oral health disease management programs.

LIBERTY uses its technology to develop innovative disease management programs centered on prevention and appropriately increasing utilization to improve the overall oral health status of its members.

LIBERTY provides dental benefits administration services to state agencies and managed care organizations (MCO’s) for Medicaid, State Children’s Health Insurance Programs (SCHIP), Medicare programs, and Employer Groups on a self-funded basis. We also specialize in administering complex dental programs, specifically for Venture Capital Company’s (VNC).

QUALIFICATIONS

Specializing in administering and managing government sponsored dental benefits; LIBERTY currently contracts directly with state and local governments as well as Managed Care Organization’s serving as their dental benefits manager for their eligible beneficiaries.

LIBERTY's expertise includes:

• Outreach to beneficiaries, pursuant to state guidelines and providing culturally appropriate services such as translation and transportation services.
• Community outreach activities that generate appropriate utilization of dental services such as school based dental screenings, fluoride varnish programs and educational outreach.
• Maintaining a sufficient network in size and breadth of qualified dental providers to guarantee an appropriate level of access through assisting with arranging timely appointments and coordinating credentialing assistance.
• Providing quality customer service call center by employing dental auxilaries.
• Managing financial risk using sound actuarial principals and A priori and de facto provider compensation arrangements.
• Meeting government compliance standards in all areas of dental program performance and data reporting standards.

 

LIBERTY's approach to challenges facing Government programs:

The following table outlines LIBERTY’s approach and solutions to the typical challenges facing Government sponsored programs:

a. Reimbursement	Inadequate number of participating Dentists available to Beneficiaries	Methodical approach to increase reimbursement and recruit sufficient numbers of qualified Medicaid dentists.
b. Benefit	Limited Benefits discourage dentists to participate	Benefits are designed with health outcomes in mind Benefits reflect modern dental practices, recent advancements and terminology
c. Behavioral Issues	Missed appointments -It causes office management and financial problems for dentists as well as leading to undelivered care	Case Management/Member Advocacy: A. Logistical: Arrange for transportation Provide translational services B. Cultural: Recruit a culturally diverse network of dentists Identify and refer to culturally appropriate Dentists
d. Administrative burdens	UR policy, i.e., Priorauthorization	Simplified prior authorization process
	Claim errors	Dedicated customer service for providers and Provider hotlines •Dedicated Phone lines Local presence; provider relations staff, network managers
	Lack of local presence (accountability)	Establish a local presence, provider relations staff, network managers. Establish provider Hotline (claims hotline) Establish patient Ombudsman Simplify provider manuals
e. Difficulty to become a participating Medicaid Dentist	Credentialing Process	Simplify the process of becoming a Medicaid provider by: 1) Simplified credentialing, 2) Timely application processing

SCOPE OF SERVICES

LIBERTY’s compensation arrangements include the essential components of a successful managed dental care organization addressing the key questions:

• Will the network be adequate in size and scope?
• What mechanisms are in place to successfully manage risk?
• Will the dental benefit management be of the highest quality?

SERVICE ORIENTED CULTURE

Fostering a culture of quality customer service, LIBERTY establishes measurable performance targets that visibly demonstrate our high standards of service and care. Achieving our set goals inspire confidence among clients, members, providers, and government agencies .

Samples of specific critical constituent performance standards include:

DENTAL BENEFITS ADMINISTRATION AND MANAGEMENT:

LIBERTY  performs  all  related  administrative  activity  required  to  support  a  managed  care  dental  plan.
LIBERTY’s definition of quality dental plan administration incorporates four key components:

• Efficient and accurate operations
• Accurate and timely data
• Personal constituency service
• Evidence based dental quality management guidelines

The following is a short list of services that LIBERTY provides:

Service to Members:

• Eligibility
  • Eligibility processing and re-conciliation
  • Eligibility reporting to providers; monthly rosters, phone eligibility, IVR, and online (real time)
• Enrollment and Fulfillment
  • ID card and fulfillment processing
• Member Services
  • Handling member calls in any language
• Grievance/Appeals for members
• Network Development and Expansion

Service to Providers:

• Network information and administrative procedures manuals
• Credentialing/Network Management
  • Maintaining and managing provider network as well as the active recruitment of general and specialist dentists
• Referral Processing
  • Maintaining and managing the entire referral process
• Prior-Authorization Processing
• Fraud and Abuse Investigation/Prevention
• Utilization Review/Management
  • Oversight by state licensed dentists
• Quality Assurance/Management program
  • LIBERTY’s Dental Director and the QM committee report all QM activities on a quarterly basis; including all QM activities, committee minutes, credentialing reports.

Service to Community through Outreach:

LIBERTY brings value added service and performance in two ways:
- Access Driven Community Outreach with measured improvements in service utilization. - Local and personal community services to clients, providers, enrollees and government agencies. LIBERTY representatives have local knowledge of geographic patterns, practice patterns, and ethnic demographics.

Our outreach efforts and community programs are geared toward improving utilization and as such are deployed selectively to address specific circumstances. Key to these programs are:

Member Advocate Role - Unlike conventional member servicing, the advocates manage the service needs of the membership thru system tracking of access and service utilization throughout the year. Using management by exception techniques, reports are produced showing all members who have not had services for a predetermined period. The advocates are charged with contacting members, discussing their cases and expediting their care.

School Based Dental Screening- LIBERTY has had success when cooperation occurs with school districts attended by enrollees. Two such programs include:

• Fluoride Varnish Program
• Dental Hygienist Screening Program

Operations:

• Claims Processing and Adjudication
  • Verification and application of secondary coverage
  • Coordination and subrogation of benefits
  • Payment processing
  • Performance and payment accounting
• Data Analysis and Reporting

Regulatory Compliance Management:

• LIBERTY prepares and submits all necessary reports to appropriate agencies on; such as provider dispute resolution, Benefit-PCD reports, encounter data reports, cost reports, etc

RISK MANAGEMENT MECHANISMS

LIBERTY uses several mechanisms to control cost and reduce unnecessary utilization. LIBERTY‘s Utilization Management Program assesses several key areas including:

(What mechanisms are in place to successfully managed risk?)

• Analysis of the utilization data
• Analysis of utilization trends
• Analysis of procedure ratios (i.e.: crowns/fillings, root canals/extractions, etc.)
• Analysis of provider trends
• Evaluation of members access and availability to service
• Evaluation of denial and appeal rates
• Provider referral and specialist care patterns or practice
• Specialist access, ancillary services and access to appropriate preventive dental services are monitored

Additionally, LIBERTY monitors provider performance retrospectively through colleague comparisons of practice patterns. Practice patterns of clinical and evaluations of treatment outcomes are based on quantitative data obtained from claims and encounter data, which are compiled into reports that are reviewed by LIBERTY’s Utilization Management team. These data provide the administrative staff a method of evaluating the clinical practice patterns of each provider in relationship to established benchmarks for appropriate utilization. Analyzing data on a continued basis enables LIBERTY to detect cases of under- and over-utilization. These outcomes are shared with providers so they may adjust there practice patterns accordingly. Utilization findings are included in individual provider profiles and are compared each month to identify patterns, outliers, and opportunities for improvement. Results are reviewed with the UM Committee. Services are categorized according to the following:

• Preventative Services (X-ray, Exam, Prophylaxis, Sealants)
• Restorative Services (Amalgam & Composite restorations, Root Canals)
• Extractions
• Major Services (Crown, Bridge, Denture)
• Referral  ( Perio, Endo, OS, Pedo, Ortho)
• Referral type ( Routine, Emergency)
• Referral Status (Approved, Denied, Modified)
• Case Management of Complex and Special need cases
• Claims Summary Reports
• Facility/Chart Audits