In addition, dental providers may use OnBoard to request dental-related DME and medications, and to submit Form HP-1.0. Treatment such as endodontics (repeat root canal treatment) or crowns will not be approved in association with an existing or proposed prosthesis (artificial replacement) in the same arch, unless the tooth is a critical abutment (needed to attach a denture to) for a prosthesis provided through the NYS Medicaid program, or unless replacement by addition to an existing prosthesis or new prosthesis is not feasible. The record did not show where the teeth in need of treatment were and did not show which, if any, other teeth provided biting contact. When contacted by phone at the hearing, the Agency was not available, having provided a contact phone number that was only a recording. Include several previously exempt and excluded populations, *Enrollment numbers are based on May 2012 data. Services are provided at home or in the community. Contact DentaQuest Member Services. To make the transition as transparent and seamless as possible for both the provider and patient. What do I do if I get my medications from Walgreens or Duane Reade? Yes, any dental provider can refuse to treat a workers compensation patient for dental services. Revised policy effective November 12, 2018 - click on these links: VI. StartingJuly 1, 2021, MetroPlusHealth will cover Article 29-I Voluntary Foster Care Agency (VFCA) Health Facility services for children and youths under age 21 in foster careand other special populations, as indicated. @Rt CXCP%CBH@Rf[(t CQhz#0 Zl`O828.p|OX Dental providers may use OnBoard to submit prior authorization requests for treatment. You do not need a referral from your PCP to see a dentist. Trainings last updated: October 2022. Seniors & Patients with Disabilities Lose Out as DentaQuest Takes Over The plan must reimburse the clinic for covered dental services provided to enrollees at approved Medicaid clinic rates. Remember to bring your new ID card when you visit your dentist. The Fair Hearings described below were decided based on the OLD denture Policy, which expires Nov. 11, 2018. Mental Health and Substance Use Services for Children. 2 0 obj Without a referral, our members can seek care from any general dentist or dental specialist who participates with their dental plan. Members who need dental care should be directed to our Find a Doctor directory. Members can find a list of network pharmacies or use our online provider search tool. Here are some good practices to follow to ensure proper oral hygiene. How will I be reimbursed for procedures included under CPT but not CDT codes? Is this allowed? Navigators and Certified Application Counselors, NY State of Health, The Official Health Plan Marketplace, online at. During your appointments, the dentist can find any cavities early and treat them. Check member eligibility status. Please be sure to tell us which plan handbook for example, Medicaid you need. In addition to a plans network of dental providers, plan members have the right to access dental services at the five New York Academic Dental Center clinics licensed under Article 28 of the NY Public Health Law. All Rights Reserved. You can apply for Medicare by calling the Social Security Administration at1-800-772-1213or by applying on-line at:https://www.ssa.gov/medicare/. Services provided absent a negotiated rate with a managed care plan will be reimbursed by the plan at the FFS Medicaid rate.*. She was forced to eat by pressing food against her upper palate with her thumb. Practicing and maintaining good oral health means taking care of all the parts of your mouth, including your teeth and gums. endobj At DentaQuest, we are committed to improving oral health by redefining prevention and care. %PDF-1.4 % If you are interested in applying to become a participating provider in our Dental Plan Network, please This means that every time you visit this website you will need to enable or disable cookies again. Learn more about Medicaid and how to enroll with MetroPlusHealth below: Beginning April 1, 2023, all Medicaid members enrolled in MetroPlusHealth Medicaid, Partnership In Care, and Enhanced (HARP) plans will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program. Dental | DMAS - Department of Medical Assistance Services - Virginia Dr. Provider Update ALSO OF INTEREST *1 J "6DTpDQ2(C"QDqpIdy~kg} LX Xg` l pBF|l *? Y"1 P\8=W%O4M0J"Y2Vs,[|e92se'9`2&ctI@o|N6 (.sSdl-c(2-y H_/XZ.$&\SM07#1Yr fYym";8980m-m(]v^DW~ emi ]P`/ u}q|^R,g+\Kk)/C_|Rax8t1C^7nfzDpu$/EDL L[B@X! MetroPlusHealth has offered low-cost, quality health care for New Yorkers for more than 35 years. Nofault cases are subject to different policy interpretations. Do I need to be specialized in order provide treatment to workers compensation patients? For information regarding No-Fault Insurance, contact the NYS Department of Financial Services. Dental clinics are reimbursed on a rate basis or through Ambulatory Patient Groups (APGs) such as hospital outpatient departments, diagnostic and treatment centers, and dental schools, are required to follow the policies stated in the Dental Provider Manual. Nor was she able to establish that extraction of tooth number 18 is contraindicated for health reasons. Childrens Dental Benefit. What type of workers compensation form should the dental provider use to bill for treatment? Her looks and speech were unaffected but the lack of lower dentures were detrimental to her health because she was unable to eat the healthy diet required as an insulin-dependent diabetic. I would like to object to the dental bill. At the fair hearing the appellants testimony of how she was unable to chew properly because of the constant pain and how that pain interfered with her capacity to perform the duties of her job was found to be credible. I had to pay for some of the dental expenses outofpocket. 122 Fulton St, 2nd Floor, New York, NY 10038 4.71 65 verified reviews At Nassau Street Dental, our practice strives to achieve excellence in all aspects of dentistry especially cosmetic and our goal is to perfect your smile.
