Medicaid FAQ

WHAT IS MEDICAID?

Medicaid provides health care to members that are either aged, blind, disabled, pregnant or children that meet eligibility criteria.

WHY DOES MEDICAID NEED ME?

• Over 50 percent of children in rural areas have untreated decay.
• Prenatal dental care reduces the incidence of low birth weight babies
• Many disabled adults have limited resources for dental care

IS MEDICAID A GOOD FIT FOR MY OFFICE?

This link gives a quick overview of how your office can file claims, submit prior authorizations, provider resources that are available, and contact information:

IF I BECOME A MEDICAID PROVIDER, CAN I LIMIT THE NUMBER OF PATIENTS THAT I SEE?

• As a provider, you can limit the number of Medicaid patients that you see as long as you do not discriminate based on age, ethnicity, or disability.
• For example, you can see 5 patients per year or 500 patients per year.

HOW DO I BECOME A MEDICAID PROVIDER?

• A dentist would need to complete an Indiana Health Coverage Program (IHCP) application
• For more information on the enrollment process, please visit this page.

WHAT IS AN ORDER, PRESCRIBE, OR REFER COVERED SERVICES (OPR) PROVIDER?

• A dentist who is not enrolled as a IHCP provider
• A dentist does not plan on submitting claims to Medicaid for payment of services.
• A dentist that may see an IHCP member who needs additional services or supplies that will be covered by the Medicaid program
• For example, if a patient would need a prescription, Medicaid would not pay for the prescription if the dentist was not an IHCP provider or an (OPR) provider.
• For more information, please visit this page.

HOW DO I SUBMIT CLAIMS FOR MEDICAID?

Claims can be submitted electronically or use the Web Interchange which is free. Visit this link to see how claims can be submitted on the Web Interchange.

DOES MY OFFICE BILL THE MEDICAID FEE SCHEDULE OR MY OFFICE’S FEE SCHEDULE?

Remember to bill your office’s fee schedule not Medicaid’s fee schedule. Your office staff will need to write off the amount that wasn’t paid.

HOW DO I DETERMINE IF A CDT CODE IS COVERED?

Click on this link and enter the CDT code.

HOW DO I KNOW IF I NEED PRIOR AUTHORIZATION FOR A PROCEDURE?

• Prior authorization is needed for dentures, partial dentures, relines and denture/partial denture repairs for members over age 21.
• Orthodontic services may be covered for members under age 21.
• Visit this page and read pages 53-55 for more information:

WHO IS MY PROVIDER REPRESENTATIVE?

Visit this page to find your regional provider representative.

WHAT IS HIP 2.0?

Visit this page for more information.

WHAT IS HOOSIER CARE CONNECT?

• This is a Medicaid plan that consolidates several State plans for the “healthy” aged, blind, and disabled population.
• It covers ~84,000 adults and children.
• The medical managed care organizations are responsible for administering the benefit
• Anthem, MHS, and MDwise subcontract out the dental benefit administration.
• Visit this page for more information on the program.