February 24, 2015
The implementation of the full adult dental benefit for Colorado Medicaid beneficiaries has had its share of hiccups, but there’s some good news to share. DentaQuest, the program’s administrator, and Medicaid have listened to dental professionals’ feedback and made some much-needed adjustments—including adding new benefits to the program and reducing prior authorization requests, extending provider participation incentives, and rolling out a new office reference manual.
Coming Improvements to the Colorado Medicaid Dental Program
The Colorado Medicaid Dental Program has proposed some changes to the adult benefit to help improve the program for both dentists and patients.
Highlights from the latest proposed rule changes follow:
Benefits Added:
– 8.201.2.A (4) (d-f) – Stainless steel crowns, protective restorations
– 8.201.2.A (7) (a-c) – Gingivectomy, Gingivoplasty
– 8.201.2.A (7) (d) – Full mouth debridement added – once every three years
– 8.201.2.A (9) (a) (vii) – IV conscious sedation added when medically necessary
– 8.201.2.A (10) – Hospital-based services when medically necessary and subject to prior authorization
PAR Changes:
– 8.201.2.A (5) (a) – PAR for crowns removed
– 8.201.2.A (6) – PARs for root canals removed (except retreatment)
– 8.201.2.A (9) (a) (i-ii) – PAR for non emergency surgical extractions removed
– 8.201.2.A (9) (a) (vi-vii) – PAR for anesthesia removed
Click here to access a copy of all proposed revisions. If you have comments or feedback on the draft, the final rulemaking hearing is expected to occur on Friday, March 13 beginning at 9 a.m. at 303 E. 17th Ave., Denver, CO 80203, in the Seventh Floor Conference Room.
Take 5 Medicaid Patients — and Earn Provider Participation Incentives
In December 2014, the CDA sent a letter to members asking them to join the association’s Take 5 Medicaid recruitment efforts. In case you missed it, there is a new Enhanced Payment Program where the state Medicaid program plans to reward dentists with an extra payment of $1,000 for seeing five new Medicaid patients. An additional $1,000 is awarded to dentists who see another 50 patients (a total of 55 new Medicaid patients). Another $1,000 is provided to dentists who see 50 more Medicaid patients (a total of $3,000 for dentists serving 105 new Medicaid patients). It’s important to note the program is available to dentists who have been enrolled with Medicaid and have been seeing Medicaid patients for years, as well as those who newly enroll in the program. The CDA just worked to secure an extension to this program through June 2016. We will share details about the program extension as the state finalizes program specifics.
Learn more, take the CDA’s Take 5 pledge, or download the credentialing application here.
DentaQuest Rolls Out New Office Reference Manual
Medicaid-participating dentists have been asking for a new office reference manual, and DentaQuest has delivered. Released Feb. 3, the manual features extensive changes, mainly to the narrative section. DentaQuest will implement a tracking system when it updates the manual in the future. DentaQuest also published a February newsletter highlighting recent reimbursement rate increases, opportunities for training and feedback, helpful billing tips and more. Click here to read the DentaQuest newsletter.