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Dental HealthChoice FAQ's

Colleagues:

As you are aware, at the instructions of Governor O'Malley, Secretary of Health & Mental Hygiene John Colmers convened the Dental Action Committee (DAC), to recommend changes in the dental Medicaid system.

Previously we outlined the DAC's recommendations, all of which were accepted by Sec. Colmers, including raising the dental fees over a 3 year period of time to the ADA 50% level for our region. We have also been attending various society meetings to explain the changes and encourage dentists to sign up to help treat our most underserved children.

During these sessions, many common questions arose, and with the combined input of the Maryland Academy of Pediatric Dentistry, Maryland State Dental Association, the Office of Oral Health of the Department of Health & Mental Hygiene and the Department of Health Promotion and Policy of the University of the Maryland Dental School, we developed the following "Frequently Asked Questions".

We hope these are of assistance and that you continue to participate as a provider so that Maryland's children have the opportunity to enjoy optimum oral health.

Frequently Asked Questions by Maryland Dentists About Medicaid
1.      How do I join?

You must first get a Medicaid provider number.  You can do this on-line at the Department of Health & Mental Hygiene (DHMH) web-site, https://encrypt.emdhealthchoice.org/emedicaid/.   On this page you will also see two links: the "Web Services User's Guide" and "EVS Help".  These links will explain how to not only enroll as a provider and get a provider number, but also how to get a user id and password that will enable you to use the DHMH web-page for patient eligibility, track payments and other pertinent information.

After receiving your Medicaid Provider Number, you must contact the Managed Care Organization(s) (MCO) with which you wish to participate.  (NOTE -- that as of July 1, 2009 the system will change and there will be only one vendor.  However, those that sign up before will be rolled over to the new system.)

The contact information for the vendors, or third party administrators that are presently administering the various MCO dental plans are:

MCO	Main Contact	Office Number
Amerigroup Maryland, Inc.	Avis Cobbs	410-981-4072 or ACobbs1@amerigroupcorp.com
Diamond Dental Plan, Coventry Health Care of Delaware	Doral Dental	800-508-6762
Medstar Family Choice	Kim Schaub	410-933-3014
JAI Medical Systems, Inc.	Jerome Tyree Adrienna McPherson	410-433-2200
Maryland Physicians Care	Aaron Young	410-401-9527
Priority Partners	Toni Jennings	410-424-4613
United HealthCare	Linda Dean, Executive Director Government Relations	1-240-683-5296

 
2.      How do I know the child's Medical Assistance (Medicaid) card is active?

• The day that you see the child you must verify eligibility. If the child's Medical Assistance card is not valid the day you see him, then you will not receive payment. 
  
• You may verify patient eligibility on the DHMH web-site at www.emdhealthchoice.org or by telephone.  By phone:
  (1) Dial 1-866-710-1447
  (2) Enter your Medicaid provider number, then the # sign.
  (3) To verify a patient's current eligibility, enter the patient's Medical Assistance Number followed by the first two letters of their last name, then #
  (4) The EVS will then report either the card being active or inactive.
  (5) To verify a patient's past eligibility status up to one year, enter the patient's medical assistance number, followed by the first two letters of their last name and date of the service, followed by the # sign.

3.      If a child has a Medical Assistance card, does that mean he is already in an MCO?

No.  With the current system it may take up to 90 days for a child to be assigned to an MCO.  Up to that time, they are covered directly by DHMH.  The fee schedule is the same.  Claims may be submitted by either electronic or paper submission of charges.  If you use paper, then you have to use the ADA 2006 form. 

4.      Must I accept every Medicaid patient that calls my office?

No.  You can accept as many or as few as you wish.

5.     May I set specific days and times to see Medicaid patients?

No, you must grant them equal access as any other patient.

6.      Can I charge for a failed appointment?

No you cannot; that being said, some MCOs offer a failed appointment payment.

7.      How do I submit for my services?

All the MCOs accept both electronic and paper claim submission.

8.      How long do I wait for payment?

The vendors that process claims are paying on a weekly basis; in some instances payments are made more frequently.  Claim processing takes between one and 4 weeks.

9.      What if I want to contest how a claim was adjudicated?

All of the vendors have professional relations offices that can be reached by telephone for these purposes.

10.   How do I refer a patient to a specialist?

Each third party administrator and/or MCO maintains a list of specialists who participate with their organization(s).  These lists can be obtained from the professional relations representative. Each referral should be accompanied by a properly filled out Maryland Uniform Dental Consultation Referral Form.  This form can be downloaded from  http://www.ucci.com/forms/UniformDentalConsultForm.pdf

11.   Can I treat Medicaid patients in the OR?

Yes.  Each MCO has its own pre-authorization procedures, so you will have to check with them as to the exact protocol.  When the Single Vendor takes over July 1, 2009 there will likely be changes in the pre-authorization process.  You will inform you of these changes as they become known.

12.   What is REM?

REM stands for Rare and Expensive Medical Conditions.  At the present time, these patients are not enrolled in an MCO, but have direct coverage by DHMH.  Claim submission is as in #4.

13.   What are the Medicaid fees and where do I find them?

The complete dental Medicaid manual and fee schedule can be found at  http://www.dhmh.state.md.us/mma/providerinfo/html/dental_agreement.htm.

14.   I heard the Medicaid Dental Program is changing; what are the changes?

Starting July 1, 2009 there will be a statewide single vendor dental Administrative Services Organization (ASO) provider for Maryland instead of the sevenMCO and the two dental  vendors.  This will greatly simplify the system for dentists and patients.

Starting  July 1, 2008 the State legislature started a three year phase in of dental reimbursement rates to the 50th percentile of the American Dental Association South Atlantic region charges for all dental codes.  The first round of increases were as follows:

D0120: Periodic Oral Examination	$	29.08
D0140: Oral Evaluation-Limited Problem Focused		43.20
D0145: Oral Evaluation, Patient < 3 years old		40.00
D0150: Comprehensive Oral Evaluation		51.50
D1110: Prophylaxis Adult 14 and Over		58.15
D1120: Prophylaxis Child up to Age 14		42.37
D1203: Topical Application of Fluoride Excluding Prophylaxis (child)		23.26
D1206: Topical Fluoride Varnish		24.92
D1351: Sealant per Tooth, maximum 4 per Quadrant		33.23
D7140: Extraction, Erupted Tooth or Exposed Root		103.01
D9248: Non-Intravenous Conscious Sedation		186.91

15.   What will the July 1, 2009 changes to the Medicaid system mean to me as I run my practice? The change will make your administrative procedures much easier, as you will be dealing with only one vendor.