Transcript Arkansas Medcaid Dental Annual Workshop 2014
DENTAL 2014
HP - Fiscal Agent for the Arkansas Division of Medical Services
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Agenda
• Arkansas Health Care Independence • Fluoride Varnish • Claim Form ADA-J430 • Billing Information • Contact Information 2 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.
Arkansas Healthcare Independence Program
Supplemental Services New Plan Descriptions Subscriber Eligibility/Service Information 3 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.
Arkansas Healthcare Independence Program
Supplemental Services
• Early and Periodic Screening, Diagnosis, & Treatment (EPSDT) for 19- and 20-year-olds • Non-emergency transportation • Interim coverage from the eligibility approval date until the date the qualified health plan takes effect Services can be accessed using the Medicaid ID number that was sent in the enrollment notice. 4 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.
Arkansas Healthcare Independence Program
New Plan Descriptions
Plan Description 06 is for ages 19 – 64.
•Beneficiaries ages 19 and 20 will receive coverage under the Medicaid Children's Dental Plan.
•Beneficiaries ages 21 and older will receive coverage under the Medicaid Adult Dental Plan.
Tip: To verify adult beneficiary benefits and coverage for the plan description 06, call the Dental Unit at (855) 703-2891.
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Arkansas Healthcare Independence Program
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Supplemental Eligibility
Effective 8-1-14
• • • • • Supplemental eligibility will show the last date of service for dental procedure codes .
D0140 (Limited Oral Evaluation) Limited to 2 per SFY D0220 (Intraoral – Periapical First Radiographic Image) Limited to 5 per SFY D0230 (Intraoral – Periapical Each Additional Radiographic Image) Limited to 5 per SFY D0240 (Intraoral – Occlusal Radiographic Image) Limited to 5 per SFY D0250 (Extraoral – First Radiographic Image) Limited to 5 Per SFY 7 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.
Fluoride Varnish
Act 90 of the 88
th
General Assembly
Allows fluoride varnish to be applied by Dentists, Physicians and Nurses to address the growing epidemic of early childhood tooth decay.
American Dental Association supports dental visits by age one.
Act 90 will enable children to receive the benefits of a fluoride varnish treatment at an early age during visits to their physician.
Practitioners can refer their patients to a dental home. 8 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.
Fluoride Varnish
Act 90 of the 88
th
General Assembly
ACT 90 requires the physician and those health care providers under his or her supervision to take a one-hour course on the application and use of fluoride varnish. Free online course provided by the Arkansas Department of Health.
http://ar.train.org
All health care providers must have an approved fluoride varnish certification on file with the Provider Enrollment Unit.
Providers included are: Dentist, Physician, Physician Assistant, Nurse Practitioner and Advanced Nurse Practitioner. 9 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.
Fluoride Varnish
Act 90 of the 88
th
General Assembly – 8-1-14
Topical fluoride treatment or fluoride varnish is covered every six (6) months plus one (1) day for beneficiaries under age 21.
Procedure Code D1206: $19.95 Fluoride Varnish is covered for (ages 0-20)
Tip: Providers must check their Supplemental Eligibility Screen to verify that topical fluoride treatment or fluoride varnish was not applied by another Medicaid provider.
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Dental Outpatient Hospitalization
Dental outpatient hospitalization for beneficiaries ages 20 and under no longer requires prior authorization. The dentist is no longer responsible for obtaining prior authorization for the facility. This change refers to the hospital revenue codes only – 0361, 0360, 0369, and 0509. Remember: Any dental procedures performed in the hospital that would normally require PA (e.g., surgical extractions, spacers, etc.) still need to be submitted to the Dental Unit for approval. 11 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.
Claim Form ADA-J430
Effective May 1, 2014 12 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.
Claim Form ADA-J430
Tip: Providers must use the new ADA-J430 (2012) claim form for all Prior Authorization requests and all paper claims submitted for payment.
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Billing Information
Provider Portal Password Reset Billing Tips Claim Issues Timely Filing Requesting Extension of Benefits Verifying Eligibility Voice Response 14 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.
Billing Information
Provider Portal Password Reset
Provider Portal accounts should be managed by one designated primary account holder who is responsible for maintaining the account.
The primary account holder can use the Medicaid Website to reset the password or contact the EDI Help Desk at 1-800-457-4454 (in-state toll free).
Provider Portal users will be locked out after six failed login attempts within an hour.
The account will automatically unlock after one hour.
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Billing Information
Billing Tips
Faxing Provider Enrollment
When faxing information such as licenses, address changes, and etc. to Provider Enrollment, follow up with a phone call to verify your information has been received.
Faxing Dental Claims to HP
Please call or email [email protected]
when faxing a claim.
Paper Claims
Make sure all requirements for billing paper claims have been followed. (We cannot make changes to claim forms.) 16 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.
Billing Information
Claim Issues
Claims with Interim Coverage
Please send HP the following: • A note explaining your request and containing your contact information • A copy of eligibility showing the service coverage indicator • A paper claim for the date of service (After May 1, 2014, send ADA-J430.) Each claim is reviewed case by case for processing. Mail to:
HP Enterprise Services Attn: Research Analyst P.O. Box 8036 Little Rock, Arkansas 72203
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•
Billing Information
Timely Filing Medicaid requires providers to submit all claims no later than 12 months from the date of service. The 12-month filing deadline applies to all claims.
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Billing Information
Requesting Extension of Benefits
Requests for extension of benefits are considered only after a filed claim is denied because the patient’s benefit limits are exhausted.
To request extension of benefits: 1.
2.
3.
All applicable records that support the necessity of extended benefits are required.
Submit the request on the ADA claim form indicating in field 35 this is an extension of benefit. To expedite your request, include a copy of the page from the Remittance and Status Advice (WebRA) of the denied claim. This will reflect the claim’s denial for exhausted benefits.
4.
Mail to:
DHS Division of Medical Services Dental Care Unit Extensions P.O. Box 1437, Slot S410 Little Rock, AR 72203-1437
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Billing Information
Verifying Eligibility
Provider ’s Responsibility
• Although you may search eligibility for past dates, AR Medicaid will only accept proof of verifying eligibility if it was checked
on the date of service
.
• AR Medicaid will process your claim only if you can provide proof of checking eligibility on the date of service. If you checked eligibility the day before or after, it will not be accepted as proof of verifying eligibility. • Remember to print the Supplemental Eligibility.
Tip: The charge for confirmation of eligibility is 10 cents.
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Billing Information
Voice Response
Providers can verify a beneficiary’s eligibility by calling the automated Voice Response System (VRS). By dialing the Provider Assistance Center line and selecting option 3, providers can use the VRS to retrieve beneficiary Medicaid eligibility, PCP, and other information based on the beneficiary ID or date of birth and Social Security Number and dates of service requested.
Toll-free in Arkansas: (800) 457-4454 Local or out-of-state: (501) 376-2211
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Contact Information
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HP Enterprise Services
Provider Enrollment
Monday through Friday (8 a.m. – 5 p.m.)
• Toll-free in Arkansas • Local or out-of-state • Dedicated fax (800) 457-4454 (501) 376-2211 (501) 374-0746 HP Enterprise Services PO Box 8105 Little Rock, AR 72203-8105 23 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.
HP Enterprise Services
Provider Assistance Center (PAC)
Your first point of contact for billing, claim status, and other general questions is the Provider Assistance Center:
Monday through Friday (8 a.m. – 5 p.m.)
• Toll-free in Arkansas • Local or out-of-state (800) 457-4454 (501) 376-2211
Please Note: Provider Assistance no longer verifies eligibility.
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HP Enterprise Services
Electronic Data Interchange (EDI)
The HP Enterprise Services EDI Support Center assists providers with electronic claim submission issues, 997 batch responses, PES software delivery and setup support, software training and data transmission failures.
Monday through Friday (8 a.m. – 5 p.m.)
• Toll-free in Arkansas • Local or out-of-state • Email Address (800) 457-4454 (501) 376-2211 [email protected]
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HP Enterprise Services
Research Analyst
The HP Enterprise Services Research Analyst answers emails sent to region mailboxes, researches claims issues from providers and submits eligible claims with appropriate override.
Providers need to attach a cover letter explaining the reason for their inquiry and attach an original red and white claim form with their cover letter to the address below.
HP Enterprise Services Attn: Research Analyst PO Box 8036 Little Rock, AR 72203 26 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.
DHS Division of Medical Services
Dental Care Unit
DHS Division of Medical Services, Dental Care Unit PO Box 1437, Slot S410 Little Rock, AR 72203-1437 • Main Line • Toll-free • Chawnte Booker, Program Manager (501) 320-6230 (855) 703-2891 (501) 320-6211 27 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.
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What four tips were included in this presentation?
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Questions?
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Thank You
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