FREQUENTLY ASKED QUESTIONS
DENTAL PROCESSING |
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Q:
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Is a Prior Authorization (PA) required for dental procedures? |
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A:
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A prior authorization is needed for all orthodontic services. Providers should review the fee schedule
to determine if the procedure requires a PA.
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Q:
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Is a radiograph required when the PA is submitted? |
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A: |
The following codes require radiographs D2750 – D2752, D5211, D5212 and D9940.
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Q: |
Is there an age limit for the procedure code?
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A: |
Some dental codes have age limits. Provides should review their fee schedule to determine if the procedure code is
billable for the patient.
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Q: |
What is the status of my PA?
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A: |
You may use the Envision website (https://msmedicaid.acs-inc.com/msenvision/)
to retrieve current information regarding your PA.
Upon completion of the review the system will be updated to reflect the decision.
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Q: |
How do I receive additional
PA forms? |
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A: |
You may use the reorder form to order request additional PA forms
from ACS or call 1-800-884-3222.
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Q: |
Can I appeal a PA if it is denied? |
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A: |
Yes, if you have additional information that supports
the medical necessity of the procedure.
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Q: |
What should I do if I submitted a PA and the claim still denies? |
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A: |
First review the claim to ensure you submitted it correctly.
If the claim was filed correctly send a copy of the claim with the supporting
documentation to ACS advising them that the claim denied incorrectly.
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Q: |
Can providers bill Medicaid beneficiaries for missed appointments?
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A: |
According to the Center for
Medicare and Medicaid Services (CMS) and the Oral Health Technical Advisory Group,
a provider can not bill a Medicaid beneficiary for missed appointments. Current
Medicaid policy does not allow for billing beneficiaries for missed appointments because a
service was not provided; therefore, no reimbursement is available. In addition,
missed appointments are not a reimbursable Medicaid service, but are considered
a part of providers’ overall cost of doing business. In no case may providers
impose separate charges to beneficiaries. |
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Q: |
What can a provider do to minimize missed appointments?
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A: |
These are suggestions only;
they do not represent Medicaid policy. It is important to treat all Medicaid beneficiaries
in the same manner as other non-Medicaid patients are treated:
• Confirm appointments prior
to the date of the appointment by sending a post card or calling
a day or two before the schedule appointment date or both.
• Inform beneficiaries if they routinely fail to keep an appointment
or give advance notice
when they need to cancel an appointment, you may no longer accept them as a patient.
• Schedule patients to allow for those who are likely to miss a scheduled appointment.
• If a beneficiary misses an appointment, allow him or her to come in as a “walk-in” and wait
for a time in the dentist’s
schedule to become available. |