CDCS Health Claims INC.

For many years, agents and brokers in this province have relied on insurance companies to provide dental benefits for their clients.

The rates that were established reflected an averaging formula using the insurers typical source of business.

This formula included allowances for reserves, general administration, claims administration, commissions, overrides, risk, profit margins and of course taxes.

What has become evident is that this method of providing benefits is extremely expensive.

"Why pay for the whole minute when you’re only on the phone for 30 seconds?"

With the introduction of an 8% sales tax on dental insurance premiums, employers are more than ready for an alternative.

That alternative is CDCS Health Claims INC.

 

 

What Is CDCS?

 

CDCS is a convenient, cost effective dental plan administrator, designed for groups of employees.

CDCS operates a sophisticated computerized dental claims administration system, offering plan design flexibility and superior claims adjudication. Accordingly, lower administration fees are possible with no insurance and an ASO contract. (Administrative Services Only).

 

 

 

Differences

Employers will now have a number of plan options, which guarantee that costs will be kept well below current market fees. Employers have options regarding premium payment such as:

Products

CLAIMS ADJUDICATION/PAYMENT SYSTEM

Reimbursement

Claims can be submitted directly to CDCS by: employers, employees, and Dentists for reimbursement. The payments are made directly to the Dentist.

Pay Direct Dental

Dentists obtain a pre-authorization number for their patients, with the simplicity of a toll free call. Coverage verification, procedure code eligibility, maximums and deductibles will be immediately verified by CDCS.

Within 14 days, a guaranteed payment will be sent directly to the Dental professional.

 

SOFTWARE PURCHASE/LEASING OPTION

The need to control business expenses in today's economy is vital. Leasing or buying the software directly from CDCS allows the employer to completely control their benefit plan.

Employer eligibility for purchase/lease options is reviewed on a personalized basis. Reasonable commission and or a royalty payment may be negotiated between the agent/broker, the client, and CDCS.

 

CDCS Advantages

Employers

Employees

Dentists

Brokers/Consultants

 

The CDCS goal is to put control of dental plans back into the hands of employers and dentists.

 

CDCS Will

 

Claims Management Services

Managing claim costs is a very important component of our overall service. The cost of delivering dental care and the cost of comprehensive dental benefits has increased steadily over the years. Outstanding claims services along with competitive administration costs are the keys to controlling a dental benefit plan. The CDCS system can offer a new standard in both flexibility and cost-efficiency.

Adjudication

CDCS has the ability to track and limit maximums, units, or reimbursement levels on any part or individual procedure code within a dental plan. Our computerized system controls will ensure that the claims are authorized based on the plan design. Flexible plan designs need sophisticated systems support to ensure that only eligible claims are paid.

Predetermination

Our dental consultants will review treatments in advance, and where necessary, may recommend alternate procedures to provide a professional result.

Co-ordination of Benefits (CoB)

The Co-ordination of benefits on enrolment allows the plan holder to control the eligibility of claims and members, reducing claims costs. Our standard form handles positive enrollment.

Dentist Profiles

To contain costs, the CDCS system uses its database to extract provider information and claims history, which is then manipulated to monitor providers’ practices. The CDCS will continue to establish standards for procedure utilization and compare those to providers’ billings. We are then able to detect above normal utilization as well as potential billing abuses. With certificate history, we can monitor claims patient by patient, detecting abnormal patterns.

Patient Audits

CDCS undertakes selective audits to ensure that patients receive the benefits that were claimed. With the help of our Dental Consultant, we will set the criteria to do surveillance audits. The audit process will uncover over and extra billing situations, as well as normal mechanical errors.

PAYMENTS AND BILLING

Pay As You Go

The CDCS system will provide the client with a billing statement based on the claims paid during the billing period. The client is only invoiced for the claims, administration fees, commission fees, and taxes during the reporting period.

Payment is based on the invoice amount and is due on the date shown. Late payments attract a penalty as per the terms of the ASO Agreement.

With this method, reconciliation statements are not necessary, as the billing is based on actual claims paid.

 

Monthly Budget Payments

CDCS will provide the client with a monthly payment amount that allows them to easily budget for their dental plan. A monthly payment will be established, based on their plan design and experience. Monthly payments are made in advance on the 1st of the month.

Monthly reconciliation statements will provide you with information on account status. After the first six months, a statement of claims and administration charges will be re-balanced. At this time, CDCS, or the Employer shall make the appropriate adjusting payments, based on the difference between the total amounts paid to CDCS during the proceeding six-month period.

The CDCS system will charge, collect, and remit where appropriate, taxes as follows:

 

 

ASO Agreement

An Administrative Services only Agreement (ASO), will outline the terms and conditions of the contract. The plan design will be summarized in the agreement.

 

 

The CDCS Cover Card®

 

Each Employee and their spouse will be provided with a CDCS Identification card. This card contains the group number, section/division, and their certificate number. The CDCS cover card® should be presented to the dentist on each visit.

Two cards are provided if the employee has family coverage. Single card forms are used for individuals and for over-age dependants, who may need their own card.

The group and certificate number is permanently assigned to each member. This information is required on all claims forms.

The CDCS cover card® will be placed on a certificate sheet as per the enclosed example. We have provided you with the flexibility to create a special message to your members on the certificate sheet. The plan information is variable and therefore specifically designed for each client. A new dental booklet may not be necessary.

 

 

 

SAMPLE REPORTS

Set Up

Regular

Monthly

Annual

Miscellaneous (some samples)

 

* Optional Reports

 

SAMPLE FORMS

 

 

ASO Agreement

 

An Administrative Services only Agreement (ASO), will outline the terms and conditions of the contract. The plan design will be summarized in the agreement.

Any special services or considerations can be written into the plan appendix.

 

Copyright CDCS Health Claims Inc. 1999 - 2002.