NYSDA Alerts
Friday, June 29, 2012Medicaid Managed Care Transition Effective July 1, 2012
EMedNY issued an e-mail reminder on June 28th to all Medicaid dental providers in accordance with MRT 1458: Care Managed Population and Benefit Expansion, Access to Services, and Consumer Rights:
All dental services, other than orthodontia, become part of the Medicaid Managed Care (MC) benefit package effective July 1, 2012. Orthodontia services will transition to managed care on October 1, 2012.
Dental office staff will be able to identify that a patient is covered by Medicaid Managed Care if the MEVS/Eligibility Response returns that the coverage is “PCP Eligible.” The response will also include the Plan Name, address and the telephone number.
This policy change requires all managed care companies that enroll Medicaid recipients to include dentistry in their benefit package. If a patient’s MEVS Eligibility response indicates that the patient is enrolled in a managed care plan and you are not a contracted provider with the managed care plan in which the patient is enrolled, you will not be reimbursed by Medicaid for that patient’s treatment.
Please have the patient contact the plan from your office. Document the outcome of the call to help verify that these patients are receiving appropriate and timely referrals for their dental treatment. If a patient’s managed care plan does not provide the patient with the names of participating dental providers who are available to see this patient, contact the NYS Department of Health at 1-800-206-8125. Keep a log of these transactions for your records that shows the patient’s name, date and time of the call, the managed care plan called, and a brief summary of the response. NYSDA would also be interested in having this information aggregated (it can be sent to NYSDA without patient names) in order to make certain that Medicaid patients are receiving the access to dental services that they are entitled to from the managed care plans.
Note that the managed care plans are required to provide payment to out-of-network providers when they do not have dentists enrolled in their networks. If a managed care company requests that your office treat a presenting patient, you may wish to have the company send you an authorization to perform treatment at an agreed upon fee via facsimile. It would be advisable to document the company’s acceptance of your fee requirements and a time frame for payment before agreeing to perform treatment.
