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Medicaid Updates

Medicaid Updates

Updates for Providers in the Colorado Medicaid Dental Program

DentaQuest is pleased to be working with HCPF on the important job of ensuring the Medicaid members of Colorado receive excellent dental care and that our dentists and hygienists have easy administration with prompt claim processing.  

The first month of the Colorado program was a learning experience for many.  There are new processes, payment schedules, portals and benefit administration.

We have heard that some of our providers are confused about a few of the new processes, how to understand the portal and claim denials/reprocessing.  We will address the following in this update:

  • Receiving Payment
  • Understanding DentaQuest’s Portal
  • Claim Denials & Reprocessing
  • We’re Here to Help
  • DentaQuest Provider Question of the Week


Receiving Payment
We understand prompt payment is important to running your business.  Therefore, clean claims received by DentaQuest are processed within 30 calendar days.  After a claim is processed it is placed into a payment batch.  A payment batch is processed every Tuesday evening for all claims processed in the preceding week, checks will be dated the following day.  

Once HCPF reviews and approves the payment batch and provides funding to cover the paid claims, DentaQuest immediately releases payment for direct deposit and checks for mailing.  Both direct deposits and checks are deposited or mailed within 2 to 3 business days.

The period of time from each Wednesday check run until the checks are mailed or direct deposits are transferred to accounts can be up to 21 calendar days.  In the dates below, please note where HCPF funded two check runs at once in an effort to get your dollars to you more quickly.  The average number of days between check runs and release has been less than 12 business days.


Please do not incur the cost of submitting duplicate claims without first checking to see whether it has already been processed and is in the payment cycle.  Duplicate claims will simply be denied as a duplicate and create unnecessary data on your EOB’s explaining the denial.

Viewing Claim Data on the DentaQuest Portal
A claim will have a status of:

  • Successfully Entered:  Claim was successfully entered into the portal
  • Accepted:  Claim received & accepted into our claim adjudication system
  • In Process:  Claim is currently being processed
  • Adjudicated:  Claim was determined and is pending the next pay cycle
  • Finalized:  Claim has completed processing and payment

Claim Denials and Reprocessing
We have heard that our dental providers in Colorado feel as if more claims or service lines have been denied than usual since the new program went live on July 1st.  A few challenges may have contributed to a higher denial rate.  Please read the explanations below to better understand the status of your denial.

  • Because the new program started on July 1st and only included claims for dates of service (DOS) 7/1/14 and after, claims received by DentaQuest with DOS prior to 7/1/14 denied and, depending upon timing, have been, or will be, seen as denied on your EOB.  8% of all claims received in July were denied for this reason.  To receive payment for DOS prior to 7/1/2014 dentists should send their claims to the prior vendor.  
  • Unfortunately, historical authorizations were loaded into the DentaQuest system incorrectly resulting in 641 claims denying for “Authorization Not on File.”  This issue was addressed on August 6th and all impacted claims were reprocessed for our 8/13/14 payment run.  You can expect to see your payment for this correction on the payments scheduled to be mailed the first week of September.
  • HCPF was unable to share comprehensive provider data with DentaQuest.  As a result, we have been reaching out to every office to ensure that we have your accurate information to process a correct payment.  Within the first weeks of the program, approximately 2,000 claims denied for provider data discrepancies.  As we have updated your information, we have reprocessed these claims.  If you have received a denial for provider data not active, please check the portal to see if this claim has been reprocessed and is simply waiting to be released with a future payment.  
  • D0603 and D1330 submissions have resulted in a large percent of service line denials.  HCPF has confirmed that these 2 codes have not received reimbursement in the past and remain a non-reimbursable code.  Please continue to provide education on hygiene and brushing as you and your patient population will benefit from improved oral health.  It is not necessary, however, for you to add these codes to your claims.  We appreciate the care you give to your patients!
  • We have confirmed with HCPF that a few of the benefits set up in our system were incorrect, DentaQuest has reviewed the Office Reference Manual (ORM) with HCPF and is in the process of making the appropriate changes to correct some covered/uncovered codes, age limitations, frequency limitations and prior authorization requirements.  Impacted claims will be reprocessed by the end of August.  Providers do not need to resubmit claims to receive corrected payment.


We’re Here to Help
Working with a new Dental Management Organization (DMO) and understanding new processes will take some time.  But we’re here to help you.  If you have questions, please don’t hesitate to contact our contact center at 855 225-1731 or your provider relations representative.
 

Provider Question of the Week

 

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Sunset Review Spotlight: Continuing Education

Sunset Review Spotlight: Continuing Education

September 30, 2014

The rulemaking process for the implementation of the 2014 Dental Sunset Review Bill has just begun. As rulemaking progresses, the CDA will provide in-depth information on key topics to help answer commonly asked questions from CDA members. A common area of interest related to the Sunset Review Bill is the new continuing education (CE) requirement for dentists and dental hygienists.

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DEA Tightens Rules on Hydrocodone

DEA Tightens Rules on Hydrocodone

September 30, 2014

The U.S. Drug Enforcement Agency (DEA) recently published a final rule putting additional restrictions on hydrocodone-containing drug products, moving them from Schedule III to Schedule II of the federal Controlled Substances Act. Earlier this year, the American Dental Association (ADA) joined several other health organizations in expressing concern over the move, which imposes additional regulatory controls and administrative, civil, and criminal sanctions on persons who handle or propose to handle hydrocodone combination products, since hydrocodone drugs are often used to treat severe pain related to dental surgery.

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New Opioid Prescribing Policy for Colorado Dentists

New Opioid Prescribing Policy for Colorado Dentists

September 30, 2014

In July, the State Board of Dentistry adopted a new policy aimed at reducing prescription drug abuse by better managing opioid prescribing. In short, the policy states that providers prescribing and/or dispensing opioids should:

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Improvements to Colorado’s CHP+ Dental Program

Improvements to Colorado’s CHP+ Dental Program

September 30, 2014

As of July 1, the CHP+ dental program was expanded with the annual max increasing from $600 to $1,000 for covered children, and new periodontic, prosthodontic and orthodontic codes were added. These newly added codes include:

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Save the Date: Cory Gardner Fundraiser

Save the Date: Cory Gardner Fundraiser

September 30, 2014

Mark Your Calendar and Join Us for an Event Honoring Congressman Cory Gardner
Colorado dentists will be hosting a fundraising event on Oct. 24, 2014 from 4:00-5:30 p.m. for Congressman Cory Gardner, the Republican candidate who is seeking the U.S. Senate seat currently held by Sen. Mark Udall. Cong. Gardner has been a good friend of dentistry, supporting the dental profession in his role on the House Energy and Commerce Committee (which oversees healthcare issues) and through his ongoing support of the Colorado Mission of Mercy (COMOM). Please mark your calendar and plan to join us for the event.

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In Memoriam: Dr Shaklee and Dr Bedard

In Memoriam: Dr Shaklee and Dr Bedard

September 30, 2014

This past month, the CDA has lost two of its members.
Dr. Roberta Shaklee
passed away on Aug. 29, 2014 after battling ovarian cancer for over two years. She began her career in dentistry nearly 40 years ago as a dental assistant and later became a dental hygienist and then a periodontist.  Please click here to read more about Dr. Shaklee.  In lieu of flowers, she wanted any gifts in her memory to be contributed to one or more of the following: Denver Hospice, History Colorado, Historic Denver, or the Dr. Roberta L. Shaklee Periodontal Excellence Award. This recognition is awarded to an outstanding Dental Hygiene Student from the Community College of Denver (CCD). Please contact Paige McEvoy at 4821 East Missouri Ave., Denver, CO 80246 to contribute to the award.

Dr. Jean-François Bédard passed away suddenly on Sept. 8, 2014. He graduated from dental school at the Universite de Montreal in 1993 and maintained a successful prosthodontic practice in Englewood, CO from 2001 until his death. The family requests donations be made in his honor to St. Jude Children's Research Hospital at 262 Danny Thomas Pl., Memphis, TN 38105, or www.stjude.org.

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State Board of Dentistry Releases Sunset Review Rulemaking Schedule

State Board of Dentistry Releases Sunset Review Rulemaking Schedule

September 15, 2014

On Saturday, the Colorado State Board of Dentistry published dates for upcoming rulemaking hearings related to the 2014 Sunset Review bill (HB14-1227). Four committees have been established to address topics addressed in the Sunset Review bill. Rulemaking will cover topics like anesthesia, continuing education, fines, licensing changes and more. Dates and details on the topics covered in each hearing are listed below. All meetings will be held at DORA’s facility at 1560 Broadway, Denver, CO 80202.

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New Amalgam Separator Requirement for Denver Metro Area

New Amalgam Separator Requirement for Denver Metro Area

September 2, 2014

The Metro Wastewater Reclamation District (Metro District), which serves the Denver metro area, has implemented new amalgam control requirements for dental offices in its service area. By February 19, 2015, dental offices served by the Metro District will be required to implement Best Management Practices (BMPs) for placement, removal and disposal of dental amalgam. These dental offices will also be required to install amalgam separators by August 19, 2015.  The Metro District service area includes most of the Denver metro and surrounding suburban areas. Click here to see the cities and sanitation districts affected.

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The Trust Announces Referral Program and New Board Position

The Trust Announces Referral Program and New Board Position

August 6, 2014

The Dentists Professional Liability Trust of Colorado Board of Directors is always working to attract new dentists into the plan.  To further those efforts, beginning this month (August 1) if you, as a Trust participant, refer a dentist who applies and receives coverage from The Trust, you will receive a $200 (Visa/MC) gift card in appreciation for the referral.

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