Dental Seminar 2010 Welcome!Slide 2
Introduction DMA Website Medicaid Updates Properly Completing Prior Approval Requests Denial Notices Test Your Dental Knowledge Top Five Claim Denials Contacting MedicaidSlide 3
DMA WebsiteSlide 4
DMA WebsiteSlide 5
Dental Seminar 2007 DMA\'s WebsiteSlide 6
Drop Down BoxSlide 9
Dental Fee ScheduleSlide 10
Division of Medical Assistance NC Medicaid Dental Program http://www.ncdhhs.gov/dma/administrations/dental.htm Mark W. Casey, DDS, MPH Dental Director Mark.Casey@dhhs.nc.gov 919-855-4280Slide 11
Medicaid UpdatesSlide 12
Budget InitiativesSlide 13
Provider Enrollment CSC (Computer Sciences Corporation) accepted obligations from DMA in April 2009 Contact Information: Phone: 866-844-1113 Fax: 866-844-1382 Website: http://www.nctracks.nc.govSlide 14
Enrollment Verification Information was sent to suppliers in December of 2009 Medicaid suppliers who have not been credentialed in the most recent year and a half Information ought to have been confirmed and come back to CSC inside 30 daysSlide 15
Budget InitiativesSlide 16
Electronic Claims Submission Mandatory as of October 2, 2009 Cost sparing measure Refer to the October 2009 notice ECS AgreementSlide 17
Electronic Claims Exceptions Any dental claim charged with one of the accompanying ADA technique codes: D0340 D0470 D8680 Unclassified and unlisted strategies: D7999 http://www.ncdhhs.gov/dma/supplier/ECSExceptions.htmSlide 18
Electronic Claim Exceptions Undelivered dentures Dental cases for uncommon thought tooth number surveys Dental right hand specialist claims with records Dental wandering surgical cases meaning aggregate surgical time in field 24 (charged on the CMS-1500 Form)Slide 19
Electronic Funds Transfer Now obligatory for all suppliers Faster access to reserves Eliminates plausibility of lost or stolen check Submit EFT shape and a voided check to EDSSlide 20
Annual MID Card Basic Medicaid Billing Guide, 2-7 through 8Slide 21
EDI HIPAA exchange 270/271 Real-time qualification Batch exchange NCECS Recipient Eligibility Verification Tool AVRS Recipient Eligibility and Coordination of Benefits Option 6 Appendix A Verification Methods NEW!! Fundamental Medicaid Billing Guide, 2-5 and Appendix FSlide 22
Recipient Eligibility Verification Tool NEW!! Access through the NCECSWeb Tool ECS Agreement required Logon ID and watchword required North Carolina Electronic Claims Submission/Recipient Eligibility Verification Web Tool September Special Bulletin Basic Medicaid Billing Guide, Appendix FSlide 23
NCECSWeb Access September 2009 Special Bulletin III, NCECS Submission/Recipient Eligibility Verification Web Tool Instruction GuideSlide 24
Recipient Eligibility InquirySlide 25
Eligibility Results ScreenSlide 26
Filing Adjustments Electronically Providers can record 2 sorts of conformities electronically: Void – claim will be recovered Replacement – claim will be recovered and reprocessedSlide 27
Dental Program Changes 2009 Budget Bill (SL 2009-451) Dental strategy modification bringing about program cost reserve funds of roughly $3.7 million in State appointments Refer to October 2009 Bulletin All dental rates were lessened by 4.52% powerful October 1, 2009Slide 28
Effective November 1, 2009 Limit all encompassing movies (D0330) to beneficiaries ages 6 and more established Discontinue scope of premolar sealants (D1351) for all beneficiariesSlide 29
Effective November 1, 2009 Reduce age limits for sealants (D1351) on every lasting molar from under age 21 to under age 16 Reduce age limits for sealants (D1351) on essential molars from under age 10 to under age 8Slide 30
D2393 - Resin-Based Composite - three surfaces, back Effective November 1, 2009, took into consideration essential and perpetual teeth For essential teeth, suppliers ought to consider rendering other secured therapeutic administrations (amalgam or stainless steel crown) when demonstrated because of degree of rot, conduct administration concerns, powerlessness to keep up a dampness free field, high caries chance, and so forthSlide 31
Resin-Based Composite Restorations Resin-based composite rebuilding efforts are permitted to reestablish a carious sore into the dentin or a profoundly dissolved range into the dentin Resin-based composite reclamations are not secured as a preventive method and are not secured for treatment of corrective issues (e.g., diastemas, stained teeth, formative inconsistencies)Slide 32
D2940 Sedative Filling Not to be utilized as a brief filling while anticipating finishing of endodontic treatmentSlide 33
New Procedure Code D3222 Partial pulpotomy for apexogenesis – perpetual tooth with fragmented root advancement Coverage viable 1/1/2009 Refer to January 2009 Bulletin Current repayment $81.09Slide 34
D3222 Limitations Limited to beneficiaries under age 21 Not took into account similar tooth on an indistinguishable date of administration from D3220, D3230, D3240, D3310, D3320, or D3330 Not to be understood as the primary phase of root waterway treatmentSlide 35
Effective November 1, 2009 D4341 and D4342 Periodontal scaling and root planing per quadrant Each quadrant is permitted one (1) time per 12-month interim Requires periodontal outlining (stash profundity estimations must be more noteworthy than or equivalent to 4 mm)Slide 36
Effective November 1, 2009 D4341 and D4342 Limited to close to two (2) quadrants of scaling and root planing on similar date of administration This confinement does not make a difference to beneficiaries treated in an inpatient healing center, outpatient clinic, or walking surgical focusSlide 37
New Procedure Code D9612 Therapeutic parenteral medications, at least two organizations, diverse meds Coverage successful 11/1/2009 Allowed for the organization of anti-microbials, steroids, calming drugs, or other remedial pharmaceuticals when at least two distinct solutions are fundamentalSlide 38
D9612 Limitations Not considered the organization of tranquilizers, soporific, inversion operators, meds accessible in over-the-counter definitions, and doctor prescribed medicines that can act naturally controlled by the beneficiary preceding treatment Identify medication, measurements, and reason in the beneficiary\'s dental record and on the case frame if documented as a paper guarantee Not permitted on an indistinguishable date of administration from D9610Slide 39
Dental Seminar 2010 Properly Completing Prior Approval RequestsSlide 40
Doe, John W 123456789L 10/01/1986 X LL UR D4341 Periodontal Scaling & Root Planing Periodontal Scaling & Root PlaningSlide 41
X I.M. Smiley, DDS, North Dental Clinic 123 Main St. City, NC 27999-9999 1987654321 122300000X North Dental Clinic 123 Main St. City, NC 27999-9999 1234567890 8999999 919-555-4321Slide 42
Most Common Prior Approval Errors Field 34 Missing Teeth Information Cross out (X) missing teeth Slash (/) teeth to be removed Circle affected teeth Show space conclusion with bolts ( )Slide 43
Most Common Prior Approval Errors Box 52A Additional Provider ID Instructions: Enter Medicaid charging supplier number. This number is utilized for PA purposes as it were.Slide 44
Most Common Prior Approval Errors Box 53 Signed (Treating Dentist) Instructions: Signature or mark stamp of dental practitioner asking for endorsement is required.Slide 45
Most Common Prior Approval Errors Poor quality x-beams All teeth are not unmistakable on the x-beamsSlide 46
Good Quality X-Ray ExampleSlide 47
Poor Quality X-Ray ExampleSlide 48
Prior Approval Tips Submit all data with first mailing Send two duplicates of the demand Complete Chart 34 for fractional dentures Attach radiographs (bitewings, periapical movies, all encompassing film, or full mouth arrangement)Slide 49
Prior Approval Tips Submit all data with first mailing Attach a periodontal outlining Attach any exceptional endorsements that need voiding Attach any medicinal documentation Enter quadrant markers (UR, UL, LL, LR) in Field 25 (territory of the oral hole) for every periodontal codeSlide 50
Tips for Orthodontic Prior Approval When resubmitting earlier endorsement demands with extra data, incorporate another earlier endorsement ask for, all encompassing film, cephalometric film with following, models, and photographs Enter Medicaid Billing Provider Number in Field 52A on the banding earlier endorsement ask forSlide 51
When In Doubt… Contact HP Prior Approval Unit to evade earlier endorsement solicitations being given back numerous times for extra data 919-851-8888 or 1-800-688-6696 choice 2, then 4 for dental or 7 for orthodonticSlide 52
Dental Seminar 2010 Denial NoticesSlide 53
Denial Notices Service is denied because of an earlier administration non-secured benefit (for beneficiaries age 21 and more seasoned) does not meet approach or EPSDT criteria extra data asked for was not gotSlide 54
Denial Notices Notice is sent to the beneficiary A duplicate of the notice is sent to the supplier Appeals must be returned inside 30 days of the offer letterSlide 55
Denial Notice (Recipient Notification)Slide 56
Notice of Additional Information If the earlier endorsement demand is come back to the supplier for extra data, the beneficiary is sent a letter to advise them that extra data has been asked for The supplier ought to give back the asked for data or demand an expansion inside 15 business days of the date of the noticeSlide 57
Notice of Additional Information (Provider Notification)Slide 58
Dental Seminar 2010 Test Your Dental Knowledge!Slide 59
QUIZ TIME! How may duplicates of the earlier endorsement demand ought to a supplier send? a. 5 b. 3 c. 2 d. 10Slide 60
QUIZ TIME! At the point when charging for machines, what date of administration must you utilize? a. impression date b. wax attempt in date c. shop
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