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Medicaid Updates

Medicaid Updates

Updates for Providers in the Colorado Medicaid Dental Program

DentaQuest is pleased to be working with HCPF on the important job of ensuring the Medicaid members of Colorado receive excellent dental care and that our dentists and hygienists have easy administration with prompt claim processing.  

The first month of the Colorado program was a learning experience for many.  There are new processes, payment schedules, portals and benefit administration.

We have heard that some of our providers are confused about a few of the new processes, how to understand the portal and claim denials/reprocessing.  We will address the following in this update:

  • Receiving Payment
  • Understanding DentaQuest’s Portal
  • Claim Denials & Reprocessing
  • We’re Here to Help
  • DentaQuest Provider Question of the Week


Receiving Payment
We understand prompt payment is important to running your business.  Therefore, clean claims received by DentaQuest are processed within 30 calendar days.  After a claim is processed it is placed into a payment batch.  A payment batch is processed every Tuesday evening for all claims processed in the preceding week, checks will be dated the following day.  

Once HCPF reviews and approves the payment batch and provides funding to cover the paid claims, DentaQuest immediately releases payment for direct deposit and checks for mailing.  Both direct deposits and checks are deposited or mailed within 2 to 3 business days.

The period of time from each Wednesday check run until the checks are mailed or direct deposits are transferred to accounts can be up to 21 calendar days.  In the dates below, please note where HCPF funded two check runs at once in an effort to get your dollars to you more quickly.  The average number of days between check runs and release has been less than 12 business days.


Please do not incur the cost of submitting duplicate claims without first checking to see whether it has already been processed and is in the payment cycle.  Duplicate claims will simply be denied as a duplicate and create unnecessary data on your EOB’s explaining the denial.

Viewing Claim Data on the DentaQuest Portal
A claim will have a status of:

  • Successfully Entered:  Claim was successfully entered into the portal
  • Accepted:  Claim received & accepted into our claim adjudication system
  • In Process:  Claim is currently being processed
  • Adjudicated:  Claim was determined and is pending the next pay cycle
  • Finalized:  Claim has completed processing and payment

Claim Denials and Reprocessing
We have heard that our dental providers in Colorado feel as if more claims or service lines have been denied than usual since the new program went live on July 1st.  A few challenges may have contributed to a higher denial rate.  Please read the explanations below to better understand the status of your denial.

  • Because the new program started on July 1st and only included claims for dates of service (DOS) 7/1/14 and after, claims received by DentaQuest with DOS prior to 7/1/14 denied and, depending upon timing, have been, or will be, seen as denied on your EOB.  8% of all claims received in July were denied for this reason.  To receive payment for DOS prior to 7/1/2014 dentists should send their claims to the prior vendor.  
  • Unfortunately, historical authorizations were loaded into the DentaQuest system incorrectly resulting in 641 claims denying for “Authorization Not on File.”  This issue was addressed on August 6th and all impacted claims were reprocessed for our 8/13/14 payment run.  You can expect to see your payment for this correction on the payments scheduled to be mailed the first week of September.
  • HCPF was unable to share comprehensive provider data with DentaQuest.  As a result, we have been reaching out to every office to ensure that we have your accurate information to process a correct payment.  Within the first weeks of the program, approximately 2,000 claims denied for provider data discrepancies.  As we have updated your information, we have reprocessed these claims.  If you have received a denial for provider data not active, please check the portal to see if this claim has been reprocessed and is simply waiting to be released with a future payment.  
  • D0603 and D1330 submissions have resulted in a large percent of service line denials.  HCPF has confirmed that these 2 codes have not received reimbursement in the past and remain a non-reimbursable code.  Please continue to provide education on hygiene and brushing as you and your patient population will benefit from improved oral health.  It is not necessary, however, for you to add these codes to your claims.  We appreciate the care you give to your patients!
  • We have confirmed with HCPF that a few of the benefits set up in our system were incorrect, DentaQuest has reviewed the Office Reference Manual (ORM) with HCPF and is in the process of making the appropriate changes to correct some covered/uncovered codes, age limitations, frequency limitations and prior authorization requirements.  Impacted claims will be reprocessed by the end of August.  Providers do not need to resubmit claims to receive corrected payment.


We’re Here to Help
Working with a new Dental Management Organization (DMO) and understanding new processes will take some time.  But we’re here to help you.  If you have questions, please don’t hesitate to contact our contact center at 855 225-1731 or your provider relations representative.
 

Provider Question of the Week

 

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State Board of Dentistry Releases Sunset Review Rulemaking Schedule

State Board of Dentistry Releases Sunset Review Rulemaking Schedule

September 15, 2014

On Saturday, the Colorado State Board of Dentistry published dates for upcoming rulemaking hearings related to the 2014 Sunset Review bill (HB14-1227). Four committees have been established to address topics addressed in the Sunset Review bill. Rulemaking will cover topics like anesthesia, continuing education, fines, licensing changes and more. Dates and details on the topics covered in each hearing are listed below. All meetings will be held at DORA’s facility at 1560 Broadway, Denver, CO 80202.

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New Amalgam Separator Requirement for Denver Metro Area

New Amalgam Separator Requirement for Denver Metro Area

September 2, 2014

The Metro Wastewater Reclamation District (Metro District), which serves the Denver metro area, has implemented new amalgam control requirements for dental offices in its service area. By February 19, 2015, dental offices served by the Metro District will be required to implement Best Management Practices (BMPs) for placement, removal and disposal of dental amalgam. These dental offices will also be required to install amalgam separators by August 19, 2015.  The Metro District service area includes most of the Denver metro and surrounding suburban areas. Click here to see the cities and sanitation districts affected.

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The Trust Announces Referral Program and New Board Position

The Trust Announces Referral Program and New Board Position

August 6, 2014

The Dentists Professional Liability Trust of Colorado Board of Directors is always working to attract new dentists into the plan.  To further those efforts, beginning this month (August 1) if you, as a Trust participant, refer a dentist who applies and receives coverage from The Trust, you will receive a $200 (Visa/MC) gift card in appreciation for the referral.

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Updated Draft Rule for the Medicaid Children’s Benefit

Updated Draft Rule for the Medicaid Children’s Benefit

August 6, 2014

The state recently released an updated draft of the rules outlining approved Medicaid dental benefits for children ages 0 to 20. A copy of the draft children’s benefit rule can be accessed by clicking here. The draft children’s benefit rule addresses coverage for exams, diagnostic imaging, preventive, restorative, periodontal, prosthetic, oral surgery and anesthesia services. The document lists code descriptions for procedures and any frequency limitations or prior authorizations required. This rule does not address adult dental benefits or children’s orthodontic benefits, as these topics are addressed in separate rules.

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After Years of Waiting, EPA Finally Moves on Proposed Amalgam Separator Rule

After Years of Waiting, EPA Finally Moves on Proposed Amalgam Separator Rule

August 6, 2014

The ADA has learned that the federal Office of Management and Budget (OMB) is now reviewing an Environmental Protection Agency (EPA) proposed rule to reduce the amount of dental amalgam that dental offices release into wastewater systems. Following the OMB's review (assuming OMB approval, usually within 90 days) EPA will publish the proposed rule for comment. This is the first significant development on an amalgam separator mandate since the EPA first announced its intention to develop a rule in September 2010.

The ADA has consulted with the EPA a number of times since 2010. The EPA understands that the ADA supports a reasonable national pretreatment standard for amalgam waste as long as it is not unduly burdensome on dental professionals.

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CO Medical Services Board Member Needed

CO Medical Services Board Member Needed

August 6, 2014

The governor’s office is seeking applicants for a vacant position on the Medical Services Board (the state board that oversees the Medicaid program across many professions). While a dentist has served in the past, currently no dentist serves on this board.  Having a dentist would provide good expertise, given the ongoing changes to Medicaid dental benefits. The person appointed to this position must reside in Congressional District 7 (generally north and west metro Denver area), be either a registered republican or an unaffiliated voter and have knowledge of medical assistance programs. Anyone who is interested in being considered for an appointment to the board should submit an application for membership through the Governor’s Office of Boards and Commissions.

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All Dentists Must Register with Colorado’s PDMP by Oct. 31

All Dentists Must Register with Colorado’s PDMP by Oct. 31

August 6, 2014

A recently passed bill, HB14-1283, requires all dentists with a DEA registration to register with Colorado’s Prescription Drug Monitoring Program (PDMP) by Oct. 31. The PDMP is a secure, online database created in 2005 that provides objective information about patients’ controlled substance prescription records to assist Colorado healthcare providers in offering appropriate treatment to their patients. If you have not already signed up to use the PDMP, you may register for an account at: http://www.hidinc.com/copdmp. If you are already registered or are a current user of the PDMP database, no future action is needed at this time to meet the state requirement.

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Full Medicaid Adult Dental Benefit Launches July 1

Full Medicaid Adult Dental Benefit Launches July 1

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.

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Dr. Brett Kessler, New CDA President

Dr. Brett Kessler, New CDA President

June 6, 2014

Dr. Brett Kessler became the CDA's 128th president on June 6 at the CDA House of Delegates meeting.  Having served the CDA as an officer for the past four years, it is an honor to have Dr. Kessler lead the association and organized dentistry in Colorado. Dr. Kessler has a private practice in the Stapleton area of Denver.  He is a past board member of the Metro Denver Dental Society as well as a former part-time faculty member of the University of Colorado School of Dental Medicine. He also serves as the chair of the Dental Well Being Committee for the State of Colorado.  In 2007, Dr. Kessler testified before congress on behalf of the ADA on the ravages of methamphetamines on oral health. He speaks internationally regarding this subject.  Dr. Kessler is passionate about organized dentistry, and advocacy for oral health and patient care.

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