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% 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?

  • Attached is a link that will give you a quick overview of how your office would file claims, submit prior authorizations, provider resources that are available, and contact information:

http://provider.indianamedicaid.com/media/127159/communicating%20with%20ihcp.pdf

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 click on the following link:

http://provider.indianamedicaid.com/become-a-provider/complete-an-ihcp-provider-packet.aspx

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 click on the following link:

http://provider.indianamedicaid.com/become-a-provider/ordering,-prescribing-or-referring-providers/participating-as-an-opr-provider.aspx

HOW DO I SUBMIT CLAIMS FOR MEDICAID?

  • Claims can be submitted electronically or use the Web Interchange which is free.
  • See the attached link to see how claims can be submitted on the Web Interchange:

http://provider.indianamedicaid.com/media/106494/dental%20billing%20the%20easy%20way.pdf

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 the following link and enter the CDT code:

http://provider.indianamedicaid.com/ihcp/Publications/MaxFee/fee_schedule.asp

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.
  • Click on the following link and read pages 53-55 for more information:

http://provider.indianamedicaid.com/ihcp/manuals/chapter06.pdf

WHAT FORM DO I USE FOR PRIOR AUTHORIZATION?

  • Click on the following link:

                        http://provider.indianamedicaid.com/media/30243/pau-8002.pdf

WHO IS MY PROVIDER REPRESENTATIVE?

  • Click on the following link to find your regional provider representative:

http://provider.indianamedicaid.com/about-indiana-medicaid/contact-us/provider-relations-field-consultants.aspx

WHAT IS HIP 2.0?

  • The HIP 2.0 waiver has yet to be approved by the federal government (CMS).
  • If HIP 2.0 is approved, the State would like to start the program by January 1, 2015.
  • This would provide insurance coverage for approximately 350,000 people that do not qualify for any State plans and have been unable to obtain insurance through the Health Insurance Exchange due to income guidelines.
  • An additional ~100,000 healthy adults would be moved from Hoosier Healthwise (Medicaid)
  • There will be a dental benefit available however; the State has not determined the dental benefit at this time.
  • The dental benefit would be managed by Anthem, MDwise, and MHS, the current insurance companies the State uses for the Healthy Indiana Plan. The insurance companies in turn will use a dental subcontractor.
  • For more information click on the attached link:

http://provider.indianamedicaid.com/media/127174/get%20even%20more%20hip%20with%20hip%202.pdf

WHAT WOULD A DENTIST HAVE TO DO TO PARTICIPATE IN HIP 2.0?

  • HIP 2.0 is pending approval from the federal government (CMS).
  • They would have to be a IHCP (Medicaid) provider
  • They would have to sign a DentaQuest provider contract and be credentialed through CAQH (Council for Affordable Healthcare)

WHAT IS HOOSIER CARE CONNECT?

  • This is a new Medicaid plan that consolidates several State plans for the “healthy” aged, blind, and disabled population.
  • This would cover ~84,000 adults and children.
  • The anticipated start date is April 1, 2015.
  • The medical managed care organizations would be responsible for administering the benefit
  • Anthem, MHS, and MDwise have been awarded contracts and they will subcontract out the dental benefit administration to DentaQuest
  • Medicaid has not released information on what services will be covered.
  • Offices can check to see if any of their patients will be affected when they verify their eligibility on the Web Interchange
  • The following patients will move to the new program:
  • Supplemental Security Income (SSI)
  • Blind ( MA B)
  • Disabled (MA D)
  • MEDworks (MADW, MADI)
  • Please click on the link for more information on the program:
    http://www.in.gov/fssa/files/Hoosier_Care_Connect_FAQ_FINAL.pdf

WHAT RESOURCES ARE AVAILABLE TO HELP DEVELOP A COMPLIANCE PROGRAM?

  • Adding Value to Your Dental Practice
    • Helps providers on how to document medical necessity, how to implement a compliance program and report suspected practices
    • Click on the following link:

http://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Provider-Education-Toolkits/Downloads/adding-value-dental-practice.pdf

  • Medicaid Compliance for the Dental Professional Resource Guide
    • Includes a list of resources from the American Dental Association, Code of Federal Regulations, and the Social Security Act
    • Click on the following link:

http://www.cms.gov/medicare-medicaid-coordination/fraud-prevention/medicaid-integrity-education/provider-education-toolkits/downloads/medcomp-dentalpro-resourceguide.pdf

  • Medicaid Compliance for the Dental Provider
    • Click on the following link:

http://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Provider-Education-Toolkits/Downloads/med-comp-for-dentalpro-pres-handout.pdf

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