May 19, 2015
The Colorado Medicaid Dental Program continues to evolve based on feedback from providers. Recently of note, the Division for Intellectual and Developmental Disabilities (DIDD) program for disabled adults will be incorporated into the Colorado Medicaid Dental Program in July 2015, the state implemented changes to the Adult Dental Services Rule, and DentaQuest released an updated office reference manual (ORM). Read below for details and additional updates.
Changes for DIDD Providers
Beginning July 1, 2015, providers offering dental services to adults with intellectual and developmental disabilities through the DIDD program must submit all claims through DentaQuest. DIDD providers must be credentialed through Medicaid and sign up to use the DentaQuest portal in order to continue billing for services provided to these individuals. Previously, DIDD providers submitted claims through Community Centered Boards, and enrollment as a Medicaid provider was not required to participate in the program. With the upcoming changes, DIDD providers still continue to receive an enhanced fee schedule when seeing DIDD patients. Dentists who sign up as Medicaid providers in order to continue to provide services to DIDD patients may choose to only see these existing patients or to expand services to other patients as desired. In Colorado, dentists are not obligated to see all Medicaid patients; a dental practice is always free to limit the size of its Medicaid caseload and to choose to only serve certain patient populations. To learn more about these changes or to access the fee schedule, click here. Helpful tips and tools for enrolling as a Medicaid provider are available here.
Adult Dental Services
In March 2015, revisions to the Adult Dental Services Rule were adopted to align dental rules for children and adults. These changes took effect in May 2015. Four new adult services were added, including prefabricated stainless steel crowns (permanent tooth), prefabricated stainless steel crowns with resin windows, protective restoration, and full mouth debridement. In addition, the revision removed prior authorization request requirements for single crowns, core buildups, posts and cores, root canals, nonemergency surgical extractions, general anesthesia, and IV sedation. Instead of prior authorization, these procedures will require documentation for prepayment review moving forward.
Colorado Medicaid Dental Services ORM
On April 30, DentaQuest published a new ORM. Click here to view the latest version of the ORM. As requested by providers, DentaQuest has begun itemizing updates to the Colorado Medicaid Dental Services ORM in a change log, including the updates listed above. This should help simplify review of changes for providers when a new ORM is released. In the change log, which begins on page 88 of the current ORM, you’ll find detailed descriptions of the updates listed above, as well as the dates these changes take effect.
Medicaid’s Medical Services Board Seeking New Members
The governor’s office is seeking applicants to fill a vacant seat on the Medicaid MSB. Considering the many recent rule changes regarding Medicaid dental benefits in Colorado, it would be beneficial for a dentist to provide his or her expertise on the board. In the past, a dentist has been appointed to the board, but currently there is no representation from the oral health community. Potential board members must meet five general requirements to fill the vacancy. Those interested can click here to learn more.
DentaQuest May Newsletter
Stay up-to-date with all the changes to the Colorado Medicaid Dental Program through the DentaQuest newsletter. Click here to read the latest version.