Smile like you mean it

Maverest Dental Network – Brought to you by Encore Health Network


FREQUENTLY ASKED QUESTIONS

Q. What is Maverest Dental Alliance?
maverest-logoMaverest is a preferred provider dental network owned and managed by a partnership of health care consultants and dentists. Maverest is not an insurance company or third party claim administrator (TPA). It was originally formed as Indiana Dental Alliance in 1997 and changed its name to Maverest in 2001 to accommodate its growth. Maverest provides access to over 9000 dental service locations in 28 states.

Q. Where can I find a listing of Maverest dentists?
The most up to date information on Maverest dentists can be found atwww.maverest.net. You or your covered participant can search by state, by city, by dentist name, by practice name, by specialty, by zip code, and by area code. Our website information also links each participating dentist office to a mapping program for easy to understand maps and directions to the dentist you select.

Q. What if I don’t have access to the Internet?
If you do not have access to the Internet or are not able to use the Internet, your benefit manager may be able to secure the information you need through their Internet access to Maverest’s website. Also, (upon request) Maverest will provide the most current dentist information in a directory format via email to your benefit manager, claim administrator or insurance company.

Q. How often can you change Maverest dentists?
Maverest members can use any Maverest dentist and change dentists as often as needed. Each family member eligible to use Maverest can select a different dentist including any Maverest specialist.

Important note on changing dentists: Although Maverest does not limit how many changes a covered participant can make, changing dentists may increase their out-of-pocket costs if your dental plan limits coverage for the number and type of services that can be provided in a plan year.

Q. What if my dentist is not currently a Maverest dentist?
If a covered participant would like Maverest to attempt to recruit a specific dentist there is a form they can complete and send to Maverest. Maverest’s REQUEST FOR DENTIST PARTICIPATION form can be obtained from Maverest or at www.maverest.net. (Maverest cannot guarantee the participation of any dentist. Any decision to participate in Maverest is solely the decision of the dentist.)

Q. What are the advantages of selecting a Maverest dentist?
In addition to saving money there are some other very good reasons for selecting a Maverest dentist. Each Maverest dentist has provided the appropriate credentialing information verifying that they are licensed to practice dentistry and that they meet the mandated minimum requirements for professional liability insurance.

Q. Are claims handled any differently at Maverest dentists?
No. There is no change required in the way that Maverest claims are handled by a participating Maverest dentist. Claims should be submitted directly to the claim administrator by the participating Maverest dentist (at the dentist’s usual and customary fees). The claim administrator will adjust the fees based on Maverest’s fee schedule and provide an Explanation of Benefits (EOB) to the covered participant and to the dentist.

Q. How are claims submitted for Maverest members?
Claims are submitted directly to the insurance company or claim administrator designated on the member’s health or dental benefit identification card. Maverest dentists are not required to provide services at the Maverest fee schedule if you do not provide a current dental benefit identification card which has Maverest’s logo on the card or Maverest has specifically identified those members to your practice by an ADMINISTRATIVE BULLETIN.

Q. How much is saved by using a Maverest dentist?
There are many variations in the type of dental plans offered by Maverest network clients. Deductibles typically vary from $0 to $100 per person per year. Coinsurance (the percentage of the dentist’s usual and customary fee paid by your benefit plan) can vary from 25% to 100%; the most popular dental plan coinsurance is 80% for diagnostic/preventative services and 50% for major services). If your dental plan pays 50% of the dentist’s usual and customary fee and has a $50 annual deductible, your employee must pay the $50 deductible before your plan pays any part of the dentist’s bill. Then your dental plan (based on eligibility and benefits determined by your insurance company or claim administrator) will pay 50% of the dentist’s usual and customary fee. Once your employees’ annual deductible is paid your benefit plan pays the claims based on the applicable coinsurance percentage in your benefit plan and the dentist’s usual and customary fee as allowed by your claim administrator. If your employee uses a Maverest dentist the claim will be paid based on Maverest’s fee schedule not on the dentist’s usual and customary fee. The immediate out-of-pocket savings at a Maverest dentist is the difference between the dentist’s full fee and the Maverest fee (the fee the dentist has agreed to accept for that same service). Typically it creates a savings of 25% to 30% to the employer’s claim cost and to the employee’s out of pocket cost. The following chart provides information on the typical overall savings at a Maverest dentist:

Service Dentist’s Full Fee Maverest Fee Total Savings
Silver Filling $147 $112 $35
Resin Filling $212 $161 $51
Crown $875 $669 $206
Root Canal $945 $665 $280
Orthodontia $5275 $4301 $974

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Special Authorization is required to access the Payor Updates.
Please contact one of the following Account Executives for access:
· Holly Joyce at (317) 621-4263 or hjoyce@encoreppo.com, or
· Kevin McShay at (317) 621-4264 or kmcshay@encoreppo.com

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Notice

Encore has entered into a new arrangement for chiropractic services with HSM, Inc. HSM, Inc., a Minnesota-based specialty network services organization, will administer the chiropractic network for our Encore and Encircle service areas.

HSM will directly hold contracts with all participating chiropractors; therefore, there are some changes of which you should be aware. Regarding billing, chiropractors will now send their claims directly to HSM. HSM will collect the data in their system, including treatment plans for case management, and forward claims to the appropriate Encore payor. The payor will send all payment directly to HSM, who will in turn reimburse the chiropractor according to the negotiated rates.

If you are interested in becoming a participating chiropractor in the Encore Health Network, please contact HSM at 800-432-3640 or visit their web-site at www.hsminc.com.

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Current Worker's Comp Payors

Arete USA D/B/A The Covenant Companies
HealthSmart
HFN, Inc
Indiana University
InterPlan Health Group
IU Health Plan
MCMC LLC
ASU Group
Major Hospital
ACS CompIQ Corporation, A Xerox Company

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Payor and Provider Resources

Payors please contact Account Executive Kevin McShay at (317)621-4264 or kmcshay@encoreppo.com for access.

For any provider issue, please contact Provider Contracting Coordinator, Tina Bilodeau at (317)621-4269 or tbilodeau@encoreppo.com.