DeCare works with each business partner to provide a customized, personal solution to fulfill their dental benefit administrative needs. This may include administration of a wide variety of plans and products, including:
- Commercial
- Large Group
- Small Group
- Medicare Advantage
- Direct to Consumer
- Direct to Employer
- Medicare
- Exchange
No matter the plan or product, DeCare can tailor administrative solutions that are scaled to fit the needs of our business partners. We provide solutions that range from targeted, small-scale service packages to comprehensive, full-scale administrative plans. Some of the services we provide include:
On average 97% of the claims received by DeCare are processed within 10 business days (significantly better than the industry average).
- Claims P.O. Box
- Data entry
- Claims processing
- Load accumulators (history/orthodontic)
- Claim image retention
- Claim adjustments/suspends
- Professional claim review
- Claim payment (Explanation of Benefits, checks, etc.)
- Pre-estimate of benefits
- Overpayment recovery
- Electronic claims routing (EDI)
- Check issue files to the bank
- Electronic claims processing
- Load electronic files
- Produce member ID cards
- Produce reconciliation report
- Eligibility correspondence
- Eligibility source of truth
- Validate reconciliation reports
- Manual enrollment updates/ad hoc requests
- Develop customer contracts & member certificates
- Enter Group Setup Maintenance (GSM) for claims processing
- Distribute Summary Plan Descriptions (SPD) to group, broker, & subscriber
- Provide group set-up info for new sales, changes, & renewals
Meeting the needs of our customers and partners is a top priority. DeCare customer service staff field about 4.35 million calls a year‐mostly about benefits and participating dentists from members, group benefit administrators and dentists, and continuously delivering “best in class” service.
- Member/provider/regulatory complaints
- Appeals/grievances processing
- Manage member/provider queries re:
- Enrollment
- Benefit coverage
- Claim status or payment
- Provider participation and availability
- General correspondence (provider, member)
- Manage written inquiries
- Provider contract approval and support
- Provider complaints
- Provider recruitment and retention
- Provider conventions and education
- Provider credentialing
- Provider communication preparation and mailings
- Provider file maintenance
- Approval of provider communications and mailings
- Attend student dental associate meetings
- Fraud and abuse
- Professional claim review
- Utilization management
- Sales training
- Go to market
- Broker and sales support
- Account management
- Requests for proposals
- Marketing materials
- Prepare and submit rate filings
- Product pricing analysis
- Prepare and issue community (pooled) rates
- Prepare and submit product filings
- Prepare monthly claim reserves
- Budget and financial planning assistance
Led by a team of experts comprising of dentists, actuaries and statisticians, DeCare Analytics, a subsidiary of DeCare Dental, develops proprietary, data-driven processes to implement solutions that yield exceptional economic value to partners and customers.
- Produce 5500 Schedule A’s
- Request reports
- Reporting (client, Geo Access, provider directories, adhoc)
- Fraud, Waste, & Abuse detection
- Maintain provider reimbursement tables
- FWA investigation
- Collect premiums
- Apply cash to A/R
- Generate Risk and ASO bills
- Assist with ASO Cost Plus File (claims paid data)
- Supply 1099 claim payment data
- Annual budget & forecasting
- Quarterly & annual statutory filings
- Supply list of uncashed checks
- Broker commission payments
- IRS backup withholding assistance
- Claim levy processing
- Unclaimed property search letters, tax, and regulatory filings for unclaimed property reporting
- Appointment/maintenance of broker bonuses
- Financial statement support (journal entries, supporting documentation, account reconciliations for DeCare administered functions)
- 1099 generation for claims commission payments and B Notice processing
- Broker commission reporting
- Benefit design
- Product pricing
- Form and rate filings
- Value proposition
- Business and market intelligence
- Competitive intelligence
- Track HIPAA incidences
- Approve HIPAA authorization forms
- Performance guarantee audits
- Large group underwriting and quote proposal prep
- Small group underwriting and quote proposal preparation
- Verify minimum participation rates on renewals and new sales (large and small groups)
- Host web site for the following applications:
- employer apps
- dentist apps
- subscriber apps
- broker/agent apps
- Provide files to support web applications:
- claim file
- provider directory
To review our current third-party administrators and other payors and administrators:
Affiliated Companies and Other Payors
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