Unresolved Medicaid Fee-For-Service Claims, September 24, 2014
From the Dept. of Health & Hospitals Medicaid Dental Program: Oct. 31, 2014, will be the last day that Medicaid will accept post authorization requests for services rendered prior to July 1, 2014. Standard timely filing requirements still apply when submitting claims to Molina for payment. Effective immediately, all authorizations are to be mailed to: Department of Health & Hospitals Medicaid Dental Program, Attn: Cordelia Clay, P.O. Box 91030, Baton Rouge, LA 70821-9030.
UPDATE, August 21, 2014
The Managed Care of North America Dental (MCNA) Provider Manual that all Medicaid dentists need to properly file claims after July 1, 2014, can be found and downloaded online at http://docs.mcna.net/manuals/louisiana. (If you have trouble with this direct link, go to http://mcnala.net/ and the link to the Provider Manual can be found under "Documents and Resources.") MCNA Executive Director Dr. David McKeon, who previously ran the dental Medicaid Prior Authorization unit at the LSUSD, has been able to work with providers on most issues since the July 1 changeover to MCNA. If you are having issues, call him at 1-866-263-6534 or (504) 941-8206. If you still have issues or concerns after communicating with Dr. McKeon, please contact the LDA office, and we will follow up.
MCNA TYPO for Professional Liability Limits
Our endorsed company for professional liability insurance received calls from several dentists asking to increase their limits per MCNA’s request. There was apparently a typo on a document that said dentists needed $1m/$3m limit as a requirement for professional liability insurance to become accredited with MCNA and to be approved as a Medicaid provider. Brown and Brown of LA, the endorsed marketing agency in Louisiana for Fortress, reached out to MCNA and verified that the dentists were given incorrect information. LA dentists may be approved Medicaid providers with limits of $100k/$300k and participation in the LA Patients' Compensation Fund (PCF).
MCNA Provider Manual Now Available Online
The Managed Care of North America Dental (MCNA) Provider Manual that all Medicaid dentists will need to properly file claims as of July 1, 2014, can now be found and downloaded online at http://docs.mcna.net/manuals/louisiana. (If you have trouble with this direct link, go to http://mcnala.net/ and the link to the Provider Manual can be found under the "In-Person Training Sessions.") Enrollment information can also be found at http://mcnala.net/. If you are a Medicaid provider and have not enrolled yet with MCNA, please do so IMMEDIATELY.
Dentists Receive Notices about RAC Audits (6/4/14)
The LDA has received calls from a number of members alerting us that Medicaid Recovery Audit Contractors (RAC) are sending notices to Louisiana dentists regarding their preliminary audit findings. The "RAC audit" notices primarily concern an issue relating to frequency limitations for prophys (cleanings) performed on children under 3 years old (thus, most of the dentists who have received notices are pediatric dentists).
Dr. David McKeon, who runs the dental Medicaid Prior Authorization unit at the LSUSD, believes the auditors have misinterpreted the frequency rules, and he is working to get things straightened out. He suggests that you request an informal hearing to forestall any electronic recoupment while he is working with DHH to clarify. If you have received one of these notices, call him at the school at 1-866-263-6534 or (504) 941-8206.
DHH Schedules Dental-Specific Calls for Medicaid Providers or Providers Interested in Signing up for Medicaid (4/17/14)
The Department of Health and Hospitals has scheduled dental specific call-in dates until the anticipated “go live” date in July. Here are those dates:
• April 30
• May 14
• May 28
• June 11
• June 25
All calls will be conducted from noon to 1 p.m. DHH staff and MCNA representatives will be online to answer questions. The call-in information (pre-registration is not required) is the same:
• Call-in #: 1-888-278-0296
• Access Code - 6556479#
Message from MCNA Regarding Credentialing (4/9/14):
We are very pleased to announce that MCNA Dental was selected by the Louisiana Department of Health and Hospitals to administer its Medicaid and CHIP dental programs statewide. MCNA would like to invite you to join the MCNA network of dentists. For your convenience, the documents that must be completed and submitted for credentialing are available on our website http://www.mcnala.net/
• Credentialing Application (Please submit one application per dentist)
• W-9 Form
• Direct Deposit EFT Form
DENTAL CALL NOTICE: DHH to host dental provider Q & A call (April 1, 2014)
The Department of Health and Hospitals (DHH) will host a teleconference for providers beginning noon Wednesday, April 2 as it prepares to launch its new Dental Benefit Management Program.
DHH used a competitive procurement process to select Managed Care of North America Dental (MCNA) to provide dental services for 1.2 million Medicaid and LaCHIP enrollees. The anticipated go-live date for the dental program is July 1, 2014.
The call will be conducted from noon to 1 p.m. DHH staff and MCNA representatives will give an overview of the program and address any questions providers may have. The call-in information (pre-registration is not required) is as follows:
Notices are posted on the DHH Making Medicaid Better website (http://new.dhh.louisiana.gov/index.cfm/newsroom/detail/2936) announcing the dental provider call. DHH anticipates this will be a regular call, but how often has not yet been determined. They will update the notice online when more information is available.
March 21, 2014 - This release can be found at: http://www.dhh.louisiana.gov/index.cfm/newsroom/detail/2992
Note: DHH is currently aiming for a July 1, 2014 launch.
BATON ROUGE -The Louisiana Department of Health and Hospitals today announced that Managed Care of North America Dental (MCNA) is being recommended for the contract as the Dental Benefits Program Manager to provide dental services for 1.2 million Medicaid and LaCHIP enrollees.
Hiring a Dental Benefits Program Manager will enable Louisiana to improve coordination of access to care and improve dental health outcomes. The contractor will provide a network of dentists that will provide quality, cost-effective care in addition to member outreach services. In addition, the Dental Benefits Program Manager will be required to provide education and outreach to dentists, dental hygienists and the state dental association.
"Dental health plays a very important role in increased health outcomes in Louisiana," said DHH Secretary Kathy Kliebert. "We are very excited that MCNA will be joining the DHH team by managing Medicaid dental benefits. I know this will increase dental services and quality across our state."
DHH used a competitive procurement process to select MCNA, issuing a Request for Proposals on Jan. 8, 2014. In total, four companies submitted proposals. The companies that were not selected are:
• Dental Health and Wellness of Louisiana
• Delta Dental
DHH used a consensus scoring process to extensively evaluate all proposals. Evaluators reviewed each proposal to examine the proposer's ability to provide services for Medicaid recipients. The evaluation team then determined scores for each proposal.
MCNA is a dental benefit administrator headquartered in Fort Lauderdale, Fl. MCNA Dental Plans has operated as a multi-state dental insurance administrator since 1992 and currently serves over three million members. MCNA will offer the full range of required core benefits and services currently available to Medicaid and LaCHIP recipients, as outlined in the Louisiana Medicaid State Plan. Additional benefits above and beyond that core may be offered at the contractor's discretion. DHH will immediately begin negotiating a contract with MCNA, with the final contract and selection requiring the approval of the Division of Administration.
MCNA will undergo a thorough readiness review before any network can begin providing services to Medicaid recipients. To ensure network adequacy, MCNA must demonstrate it has a robust network of providers in place to treat patients, sufficient support staff to handle administrative processes and provider relations, and the ability to meet all the deliverables specified in its proposal.
Additionally, the contract requires Centers for Medicare and Medicaid Services approval because the entity will be responsible for coordinating dental services for eligible children and adults who received these services through Medicaid. MCNA will be reaching out to members with toolkits, phone calls, mail and other communication means. DHH's original timeline called for implementation to begin May 1, 2014. The department is revisiting that timeline to ensure adequate time exists for readiness reviews and provider and recipient education. DHH is currently aiming for a July 1, 2014 launch.
More information on the Medicaid Dental Benefit Management Program can be found online at www.MakingMedicaidBetter.com.
The Louisiana Department of Health and Hospitals strives to protect and promote health statewide and to ensure access to medical, preventive and rehabilitative services for all state citizens. To learn more about DHH, visit http://www.new.dhh.louisiana.gov.
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