Star Ratings Are Out. Is Your Dental Benefit Delivering?
A benefit members can use. Value health plans can see.
With the latest CMS Star Ratings released, your health plan leaders may be celebrating a successful rating while also reviewing areas to maintain excellence or opportunities for improvement – this often includes the operations of vendors and partners that can indirectly impact a health plan’s Star Rating.
Dental is no exception. As a dental benefits administrator, DentaQuest, a part of Sunlife, understands the importance its operations and delivery systems play on the overall member experience - finding a dentist, understanding dental coverage, accessing care and a positive dental experience.
We understand what it takes to offer a meaningful and member-focused benefit and often the answer takes a closer look at access, service, cost and the operations behind them.
A network that works where members live
A member needs more than a name in a directory. They need a participating dentist who provides the care they need and can offer an appointment.
DentaQuest’s Medicare Advantage network includes over 84,000 unique providers nationwide. That gives Medicare Advantage plans an established network, while integrating local recruitment and provider relationships help address the needs of individual markets. Network scale matters. So does knowing where to focus the work. For a plan evaluating its dental partner, the useful questions are specific: Are members having difficulty finding care? What are the members needs? What network or benefit adjustments can be done to positively impact the member?
A clear answer can make someone’s day
“Is this covered?” sounds like a simple question. Answering it may require checking eligibility, benefit limits, provider participation and whether additional review is needed.
The member needs an understandable answer and a next step. The benefit representative needs reliable information and a clear path to resolve the question.
DentaQuest has invested in our contact center and has integrated modernization through our systems to focus on answering questions quickly. Better routing, representative guidance, self-service and assisted support are designed to make help easier to navigate.
Reported results from the new contact center platform include 79% fewer call transfers and 66% fewer repeat calls.
Those results matter because getting help can become harder calls are not resolved on the first attempt – leading to unsatisfactory service levels and minimizing a member’s likeliness to stay with their Medicare Advantage plan.
We understand technology is only part of the work. Training, quality monitoring and feedback help teams understand which questions recur and where support still needs attention. Tracking a member’s experience guides efforts to better serve our health plan partners and the members.
The provider experience reaches the member
What happens behind the scenes can affect what happens at the dental office and the overall member experience.
Providers need clear eligibility information, understandable benefit guidance and dependable claims processing. When those processes work well, offices can spend less time resolving administrative issues and more time providing quality care to their patients.
DentaQuest reports 90%+ of claims paid within seven days and 99%+ financial and processing accuracy.
DentaQuest understands that supporting providers, paying claims timely and accurately strongly impacted the satisfaction of a member and how it reflects on the overall Medicare Advantage experience.
Make the dental promise real
Star Ratings often provide a reason to celebrate or an incentive for change. The priorities will differ by many reasons, but the goals are the same. DentaQuest is here to partner with health plans who value member experience, impactful benefit design, accessible network of providers, quality services, and a partnership that encourages growth and retention.
PULSO PREVENTIVO
El boletín informativo diseñado para todos los que deseen mejorar su salud bucal para sí mismos, sus familias, clientes y comunidades.