Third Party Affairs
Memo on Medicaid Billing
The MDA collaborated with the Minnesota Department of Human Services in issuing a memo to clarify Medicaid billing regulations for dentists.
Notably, the briefing clarifies that a dental provider who does not participate in Medicaid can treat and directly bill a Medicaid enrollee.
Please contact the MDA should third party payers indicate a non-enrolled dentist cannot directly charge a Medicaid-enrolled patient.
Updates
Coding and Minnesota Care (Provider) Tax
Last year, in response to several requests from MDA members, the Dental Marketplace Committee began researching the response of third party payers to code D9999, with descriptor, as used by many of our dentists to itemize provider tax. The research revealed that it was not consistently being recognized and processed appropriately. The MDA has requested that the ADA consider a new code for the 2017 CDT code set that would be specific to provider tax, both in Minnesota and in states that have similar situations. This is along the line of the sales tax CDT code created a few years ago. However, to currently address D9999 as being used as an adjunctive code with descriptor, the ADA crafted this letter last month and it was sent, with supporting information, to the Minnesota Department of Commerce to help clarify the use of the code and support pass through of the tax. The MDA recently met with the Department of Commerce to further clarify this request and talk about options to increase consistency among payers, allowance of the code, and pass through of the tax. We will continue to work on resolving the concerns of our members regarding the tax.
Form to send to payers that deny D9999 for tax reporting
UCare Plan Changes
Effective January 1, 2015, dentists participating in the Delta Dental network CivicSmiles will be considered in-network providers for members covered under UCare plans, as UCare will now be administered under the CivicSmiles network agreement. This applies to all UCare plans, including senior plans and plans purchased on the MNsure health insurance marketplace.
Medicaid Tools Available from the ADA
The ADA’s Action for Dental Health Medicaid Initiative recently released these three tools to assist dentists with understanding how to succeed as Medicaid providers:
Medicare Opt out
Per Federal Centers for Medicare and Medicaid requirements, dentists are required to enroll or opt out of the Medicare program. The opt in/out requirement has now been extended by the Centers for Medicare and Medicaid Services (CMS) until January 1, 2019. Medicare does not normally cover dental services. Dentists that bill Medicare for oral surgery or procedures, such as a biopsy, may want to further consider implications of enrollment.
According to CMS, dentists that accept Medicare Advantage products for dental services for seniors must complete full Medicare enrollment or enroll as an Ordering and Referring Provider in order to continue to get reimbursed by the plans. If you have already opted out and sent in an affidavit, you have 90 days to change enrollment. If you would like to become an enrolled Medicare provider or a Medicare Ordering and Referring provider, here is the enrollment portal to get started.
If you are looking to opt out, here is the ADA Sample Medicare Opt Out Affidavit. After completing the paperwork, send it to the correct state contact. For assistance in finding the right contact, refer to this list: Medicare Contact List. Send to the Medicare B contact address for Minnesota.
ADA UPDATE on CMS Rule regarding Medicare Advantage plans enrollment
Sample Medicare Opt-Out Private Contract
Medicare Provider Enrollment, Chain and Ownership System (PECOS)
Medicare Enrollment Guidelines for Ordering and Referring Providers
Coordination of Benefits
Understanding coordination of benefits can be a complicated process. It is not always clear how it should be calculated while considering write-off information and patient responsibility. Here are some helpful resources:
Information for Providers: Dental Insurance Plans and Coordination of Benefits
Dental Benefits: An Introduction
Minnesota Statute 62A.046 Coordination of Benefits
ADA Dental Benefit Video Series
If you have questions about third party affairs, please call 612-767-8400.
ICD-10 Information
The use of ICD-10 is not required in dentistry at this time. However, it can be used for enhanced dental benefits and dental clinics that are submitting medical claims for oral surgery, orthodontics, sleep apnea and TMD appliances. Learn More by watching this WEDI ICD 10 Dental Presentation.