Full Medicaid Adult Dental Benefit Launches July 1

Krysia GabenskiFeatured News

July 1, 2014

Starting today, July 1, a comprehensive dental benefit for Medicaid-eligible adults is available.

What does that mean?
This means that over 300,000 adults who qualify for Medicaid can access a robust schedule of dental services including restorative treatment, root canals, crowns, surgical procedures and full/partial dentures (note that prior authorization is required for certain designated codes).

What else is new?
Starting today, July 1, DentaQuest is the new administrator of the Colorado Medicaid Dental Program.  This means that all Medicaid claims billed on or after July 1, for both adults and children, will be processed through DentaQuest.  DentaQuest also has a team in Colorado dedicated to serving providers, and their provider service phone number is equipped to answer any day-to-day questions that providers may have: 855-225-1731.

These patients need you!  Please read the following details whether you are an established Medicaid provider, or a provider interested in enrolling or learning more.

  • Already a Medicaid provider?
    • If you are already enrolled as a Medicaid provider or if you have been a Medicaid provider in the past, you should not need to apply for new credentials. If you have not already received a call from DentaQuest to verify your information, please call 855-225-1731 before billing for patient care.
  • Interested in enrolling to be a Medicaid provider?
    • If you are not enrolled as a Medicaid provider and wish to begin seeing patients now, please visit http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1201542696393 to download the application form. If you have questions about the enrollment process, please view the FAQs by clicking here or call 800-237-0757.  There is also a Webinar that you can watch that offers step-by-step assistance to help you with the enrollment application.  Access the guide by clicking here.
  • Submitting claims:
    • Starting July 1, both children and adult Medicaid dental benefits will be administered by DentaQuest. Claims for all services provided to Medicaid clients on and after July 1 will need to be filed through DentaQuest. Electronic claims should be filed through DentaQuest’s online provider portal here.  Paper claims should be submitted on a 2006 or newer claim form and mailed to DentaQuest at 12121 N. Corporate Pkwy., Mequon, WI 53092.
    • Dental services provided to Medicaid patients prior to July 1 must be submitted to the State for payment.
  • Payment reimbursement:
    • DentaQuest anticipates that it will pay claims approximately 21 days after the claim is adjudicated. Claims will be adjudicated weekly.
    • DentaQuest offers direct deposit for faster payment of claims. Be sure to log-on to the DentaQuest Provider Portal to update your EFT/direct deposit information (it will not transfer if you are a current Medicaid provider). You can also call DentaQuest at 855-225-1731.
    • The final fee schedule for adult dental services has not yet been released by the state. The CDA will share this information with members as soon as it is available.
  • Getting answers:
  • Medicaid Enrollment Questions: 800-237-0757
  • DentaQuest Provider Services: 855-225-1731
    • 8 a.m. to 5 p.m. MST, Monday to Friday. Self-service available 24/7 via Interactive Voice Response.
  • DentaQuest Patient Services: 855-225-1729
  • DentaQuest Colorado Provider Relations Team:
    • Laura Jacob, Provider Relations Supervisor
    • Christie Robson, Provider Relations Representative, Territory 1 (Western CO)
    • Lisa Larkin-Allen, Provider Relations Representative, Territory 2 (North and Northeastern Colorado)
    • Karen Savoie, Provider Relations Representative, Territory 3 (Denver and Southeastern Colorado)

The CDA continues to work to improve the Colorado Medicaid Dental Program, and to establish incentives that will make it easier for Colorado dentists to participate in Medicaid. We will continue to provide news and information as details on these programs and changes are finalized.

Thank you for supporting the Colorado Medicaid Dental Program.  Dentists are essential to improving the oral health of these underserved patients in our state.