Dental Refresher Workshop Presented by The Department of Social - PowerPoint PPT Presentation

Dental Refresher Workshop Presented by The Department of Social Services & HP Enterprise Services 1

Training Topics • Provider Bulletins • Electronic Messaging • Client Eligibility • Provider Enrollment and Re-enrollment • Demographic Maintenance • Dental Fee Schedule • Prior Authorization • Program Limitations • Web Claim Submission • Frequent Claim Denials • Messages Archived • ICD-10 Updates • Available Resources • Questions CT interChange MMIS 2

Provider Bulletins Provider Bulletins Access the Publications page by selecting Publications from • either the Information box on the left hand side of the home page (www.ctdssmap.com) or from the Information drop- down menu. Bulletin Search allows you to search for specific bulletins (by • year, number, or title) as well as for all bulletins relevant to your provider type.  When searching by provider title, you can search by any word as long as that word is in the title of the bulletin. CT interChange MMIS 3

Provider Bulletins Provider Bulletins – Searching by Year and Type CT interChange MMIS 4

Provider Bulletins Recent Dental Provider Bulletins: Provider Bulletin 2015-27 “ Changes in Dental Coverage • for Bitewings ” Effective May 1, 2015 there is a limitation of one time bitewing » radiographs per calendar year for members under the age of 21. Provider Bulletin 2015-15 “ Dental Regulations Regarding • Placement of Amalgam Restorations ” Medicaid does not cover resin-based composite restorations to the » molar teeth (tooth numbers 1, 2, 3, 14, 15, 16, 17, 18, 19, 30, 31, and 32) Provider Bulletin 2014-71 “ Tobacco Cessation; New • Screening Code and Program for Dental Hygienists ” D1320 tobacco counseling payable to dental providers effective October » 1, 2014. D0120 not payable to dental hygienists as of 10/1/2014. New codes to » be used are D0601-3. CT interChange MMIS 5

Provider Bulletins Recent Dental Provider Bulletins: Provider Bulletin 2014-62 “ Update to the Medicaid Dental • Services Fee Schedule and Policy ” New codes were added to the Dental Fee schedule and some codes » were removed; reimbursement was adjusted for specific codes. Age restrictions for specific codes. » Code restrictions for specific specialties, which meant changes to prior » authorization/post procedure review requirements for designated specialties. Effective September 1, 2014, both children and adults are eligible for » four problem focused evaluations (D0140) per calendar year. Effective October 1, 2014, all clients who reside in long term care » facilities are eligible for an additional cleaning, fluoride and examination (twice yearly rather than once yearly) without prior authorization . Tooth Surface Designation for specific teeth - Dental providers to be » reimbursed for the total number of surfaces restored on a single tooth per one year period for each provider. CT interChange MMIS 6

Provider Bulletins Provider Bulletins – Searching by Title • Searching by the word “Electronic Messaging”,” only brings up bulletins with the word “Electronic Messaging” in the title of the bulletin. CT interChange MMIS 7

Electronic Messaging • Provider Bulletin 2015- 23 “Implementation of Electronic Messaging - Replacement to the Mailing of Bulletins/Policy Transmittals ” • The Department of Social Services (DSS) and HP are pleased to announce the implementation of electronic messages replacing the mailing of bulletin/policy transmittals. • Dental providers and their office staff can subscribe to receive pertinent Connecticut Medical Assistance Program (CMAP) program information via e-mail messages. • DSS will no longer distribute any paper communications to providers as of June 30, 2015. CT interChange MMIS 8

Electronic Messaging • DSS and HP will use electronic messaging to distribute:  Provider bulletins and policy transmittals.  Workshop invitations.  Program updates and reminders. • There are many benefits to the electronic delivery of communication.  Faster distribution of information to the provider community.  Any office personnel can subscribe to receive program information via e-mail.  Provides a simplified subscription process that can be completed very quickly allowing information to get into the right hands. CT interChange MMIS 9

Electronic Messaging • To subscribe for electronic messaging, providers and office staff must perform the following steps:  Access the www.ctdssmap.com Web site.  Select Provider > E-mail Subscription from the drop-down menu. CT interChange MMIS 10

Electronic Messaging  Once on the E-mail Subscription page, enter the e-mail address you wish to subscribe under New Subscriber.  Re-enter the e-mail address for verification and click Register.  A confirmation message will be displayed at the top of the page.  If you receive an error message, correct the error(s) and click Register again. CT interChange MMIS 11

Electronic Messaging  From the right hand side of the page, use the checkboxes to select the available subscriptions you would like to receive.  Once complete, select Save. CT interChange MMIS 12

Electronic Messaging • Providers that supplied e-mail addresses at the time of enrollment or re-enrollment in CMAP, or during the setup of their Secure Web portal account, will automatically be subscribed for e-mail notifications.  Please note that the email addresses on file for clerk accounts will not be included in the auto-subscribe process and will need to subscribe separately. • Once you have subscribed, you may modify your subscriptions at any time by performing the following steps.  Access the www.ctdssmap.com Web site.  Select Provider > E-mail Subscription from the drop-down menu. CT interChange MMIS 13

Electronic Messaging  Once on the E-mail Subscription page, enter the e-mail address you wish to modify in the Existing Subscribers section of the panel and click Update.  From the right hand side of the page, use the checkboxes to modify your subscriptions and click Save. • Once you have successfully modified your subscriptions, you will receive a confirmation notice that includes the provider type(s) and/or topic(s) you selected from the checkboxes. CT interChange MMIS 14

Electronic Messaging • To Unsubscribe your subscription, you will need to take the following steps:  Access the www.ctdssmap.com Web site.  Select Provider > E-mail Subscription from the drop-down menu.  Once on the E-mail Subscription page, enter the e-mail address you wish to unsubscribe in the Unsubscribe section of the panel. Once complete, click Unsubscribe.  A confirmation message will be displayed at the top of the page. CT interChange MMIS 15

Client Eligibility - Verification DSS recommends that providers verify a client’s eligibility on the date of service prior to providing services. To verify a client’s eligibility through the secure Web site www.ctdssmap.com – click on the Eligibility tab on the main menu. CT interChange MMIS 16

Client Eligibility - Verification Search by Service Type Codes • Providers have the option to search up to five (5) different service type codes. The service type codes allow providers to verify the client’s eligibility benefit coverage for specific services.  The first service type code field defaults to 30 – Health Benefit Plan Coverage. If the provider searches by that default selection, it will return with all the service type codes that are covered for the client’s benefit plan .  The specific service type code for Dental providers is “35” for “Dental Care.” CT interChange MMIS 17

Client Eligibility - Verification • Enter enough data to satisfy at least one of the valid search combinations; click search.  When entering a full name as part of your search, a middle initial is required if present in his/her CMAP profile. CT interChange MMIS 18

Client Eligibility - Verification Search by Service Type Codes 35 – Dental Care CT interChange MMIS 19

Client Eligibility - Verification HUSKY B client eligibility search response • HUSKY B copay amounts will not show on the eligibility screen, provider should refer to the dental fee schedule. CT interChange MMIS 20

Client Eligibility - Third Party Liability (TPL) Update To correct or update Third Party Liability (TPL) information: You must obtain a TPL form from the following options: • Print out form located on Web site at www.ctdssmap.com under Information → Publications → Forms → Third Party Liability Forms → TPL Information Form. • Call Health Management System, Inc. (HMS) 1-866-277-4271. HMS staff will mail or fax the form to the provider. • E-mail request to ctinsurance@hms.com and form will be e- mailed back to provider. CT interChange MMIS 21

Client Eligibility - TPL Update Submit completed forms mail to: Health Management Systems, Inc. Attn: CT Insurance Verification Unit 5615 High Point Dr. Suite 100 Irving, Texas 75038 • Fax to HMS with HIPAA compliant cover letter to 866-389-5451. • Scan completed forms and submit through e-mail to ctinsurance@hms.com. CT interChange MMIS 22