Medicaid Announces Changes to Orthodontic Billing Policies

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In October, Health First Colorado (formerly known as Colorado Medicaid) hosted an orthodontic stakeholder meeting and announced plans to revise the payment methodology for orthodontic services delivered to Medicaid patients. Currently, Health First Colorado pays the full fee for orthodontic services at the time care is initiated. The program plans to transition to a system of multiple payments and incorporate all billable codes into a global fee. A set fee will be established for denied cases. A full overview of the proposed changes can be accessed through the links below.

Health First Colorado originally proposed to implement these changes starting Jan. 1, 2017. The implementation timeline for most changes has been postponed to July 2017 to allow additional time for consideration of stakeholder feedback and needed adjustments in affected practices. Health First Colorado continues to investigate questions regarding continuity of care, rates and specific billing processes (including self pay protocols for patients who lose coverage). Additional updates on these protocols are expected to be shared with stakeholders in coming weeks.

In January 2017, certain system edits related to prior authorization policies will be implemented in DentaQuest’s portal. In December, DentaQuest will publish a new office reference manual detailing these policies. These changes will affect orthodontists who participate as Medicaid providers, as under the Colorado Medicaid program, only orthodontists are currently authorized to deliver most orthodontic appliances.

Resources

For additional information, contact Kimberley Smith, Health First Colorado Stakeholder Relations, at 303-866-3977 or Kimberley.Smith@state.co.us.