Medicaid Update, November 2014
A group of LDA representatives met with MCNA’s president, vice president of operations and Louisiana executive director on November 3, 2014. LDA brought forward the issues and complaints that we have received about MCNA from member dentists. MCNA agreed to address a number of problems that they consider to be coding issues and possible inaccurate interpretation of the provider manual by MCNA representatives. MCNA also indicated that many of the complaints concern processes and standards that they believe their contract with DHH requires of them, even if that is NOT the way things were done previously when Molina processed claims. Accordingly, MCNA and LDA plan to confer again shortly to assess exactly which issues MCNA has been able to address in the past few weeks. All other issues will be taken up at a three-way meeting between LDA, MCNA and LDA to be scheduled in December.
On the stickiest issue – extractions – the LDA made limited headway. For instance, MCNA basically promised to evaluate paying for appropriate extractions of primary teeth (e.g., patient in pain), but has concerns about abuse. MCNA considers extraction of bicuspids to create space to be orthodontia, but they MAY pay for it in cases of atopical eruption if there is photographic support. As far as extraction of asymptomatic third molars (at the same time other third molars are being extracted), MCNA largely regard that as a programmatic issue of Medicaid. In other words, their position is that Medicaid has a limited budget, and therefore DHH has contractually required MCNA to limit reimbursements to “medically necessary” treatment. Extraction of asymptomatic teeth does not meet that requirement, in their opinion.
Members who are experiencing issues with Medicaid reimbursement should contact the LDA. Be sure to provide as much specific information as possible, including dates, claim nos. etc., as this will assist LDA when we bring these issues to MCNA and/or DHH.
United's Message of Clarification to Dentists, November 26, 2014
The Louisiana Dental Association (LDA) was alerted by several members that UnitedHealthcare Community Plan of Louisiana (United) sent letters to Louisiana Medicaid providers that insinu-ated that United may become the dental benefit manager for Louisiana. (The dental benefits manager is currently MCNA, and should remain so at least until their two-year contract runs out.) The LDA contacted the Department of Health and Hospitals and United for clarification and learned this was not at all their intention and United has re-sent updated information to providers.
Basically, United is looking to develop a successful dental network as part of their Medicaid Managed Care Organization for physicians. They hope to offer a dental benefit as a value-added option in their current plan with the State. The benefit would be limited to adult Medicaid recipients who select United as their health plan. United hopes to provide quality dental care to eligible Medicaid enrollees who are without dental coverage.
United has apologized to the LDA and all Medicaid providers for any misunderstanding or confusion their first letter may have caused. United has also posted a correction on their website under their Provider Bulletin: http://www.uhccommunityplan.com/health-professionals/la/provider-bulletins.html.
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.
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