DENTAL WORKSHOP 2016 Billing tidbits
MEET FRANK & ADRIANA
NEW CODES D9223-General anesthesia 15 minutes D9243-IV Sedation each 15 minutes D0191- Assessment of a patient in a nursing home. Billed once per 12 months. Must be on NH plan and not been to the dentist in the past 12 months.
BABY AND TODDLER PROGRAM D0145-Oral Evaluation of a patient under 3 (0-3 yrs) D1310-Nutritional Counseling (0-3 yrs) D1330- Oral Hygiene Instructions (4 yrs)
NITROUS OXIDE Nitrous Oxide/Analgesia (D9230) Nitrous Oxide is a covered benefit for any clients under ten (10) years old or disabled clients of any age who are on the DDAW, DDCW, SUAW, COAW, or ABIW benefit plans (Appendices A.3, Medicaid and State Healthcare Benefit Plans), who exhibit behavior(s) that require additional support to complete extractions or restorative treatment safely. Nitrous will only be reimbursed in conjunction with extractions or restorative procedures. Supporting documentation of why the client required the use of nitrous must be part of the patient’s record and be available upon request. It is the provider’s responsibility to verify the client’s eligibility and Medicaid plan prior to providing services. When checking eligibility, the provider must verify if the client is under the age of 10 or is covered by a DD waiver plan. The client must be on the DDAW, DDCW, SUAW, COAW or ABIW benefit plan.
BROKEN APPOINTMENTS No Show Appointment/Broken Appointments (D0000) When submitting a claim to Medicaid for missed/broken appointments an amount of $0.00 should be entered in box 31 (fee) of the claim form. All claims billed with this code will show as denied lines on your Remittance Advice. This code is for tracking purposes only.
PRIOR AUTHORIZATION Codes that required an LOA in the past will now require Prior Authorization prior to services rendered Prior authorization is issued from April Burton 307-777-8088 The following codes require an approval prior to performing the services, from the Division of Healthcare Financing, Medicaid, in the form of a Prior Authorization (PA): D0367, D5863-D5866 , D6010-D6999, D7941, D7943, D7944, D7945, D7946, D7947, D7948, D7949, D7950, D8000-D8999 RETRO PAS will not be issued after services are provided
CLAIMS SUBMISSION Wyoming Medicaid PO BOX 547 Cheyenne WY 82003 Please do not address claims to anything except for Wyoming Medicaid, as of Oct 1 st The Electronic Data Interchange will not support any name besides that of Wyoming Medicaid.
SUBMITTING ATTACHMENTS If entering claim in web portal and sending attachments you will need to put a yes on the question are you sending backup documentations? You will be asked what you will be sending (EOB, medical notes, ETC……..) then you will be asked how you will be sending ( Mail, transfer, or electronic) if you are sending your documents electronically this section will gray out and you will receive an attachment control number (ACN) ( AFTER YOU VERIFY CLAIM) please write this number down you will this for step 2. After you have submitted claim you can then you will have a section where you can up upload your attachments electronically. You will be asked for the pay to providers NPI, the client ID and the ACN that was given to you in the claim. After you have done this step you will receive a reference number for the attachments and you could use this if your claim denies for missing attachments when calling Provider Relations. If submitting a claim for attachments through a clearinghouse or other software Verify claim first , Your clearinghouse or software will need to have the ACN in claim You will log on to the web portal and you will go to submissions and click on electronic claims you will add the pay to provider NPI, client ID and the ACN that was given on the claim you will be asked sending (Mail, transfer or electronically) You will receive a reference number for the attachments and you could use this if your claim denies for missing attachments when calling Provider Relations.
CONTACT FOR OTHER DENTAL PROGRAMS Marginal Dental Program-Cassandra Walkama 307-777-5777 Sealant Program-Cassandra Walkama 307-777-5777 Senior Dental Program – No longer available SMP/Medicaid – April Burton 307-777-8088 SMP/Uninsured – Cassandra Walkama 307-777-5777
ELECTRONIC BILLING As of Oct 1 st providers will no longer be permitted to bill via paper claims and must bill electronic either through a clearing house or the web portal. Paper claims will be returned without being processed after this date.
READING YOUR RA Remittance advice (Medicaids EOB)
READING YOUR RA
READING YOUR RA
READING YOUR RA
CONTACT INFO Amy Reyes Dental Supervisor 307-772-8421 My email amy.reyes@xerox.com Fax 307-772-8405 Dental Services 888-863-5806
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