Dental Medicaid Update (2/4/16)

UPDATE ON FILING REQUIREMENTS FROM 180 DAYS TO 365 DAYS (2/4/16)

Effective Aug. 1, 2015, Louisiana changed the timely filing requirements from 180 days to 365 days for all claims submitted for payment for a covered service rendered to a Medicaid enrollee. This change is a result of Act 21 of the 2015 Louisiana Legislative Regular Session which applies to claims directly submitted to the Department and claims submitted to specified entities contracted with the Department. See Act 21 for more details.

If you have any questions regarding timely filing requirements for members enrolled in MCNA, call the Provider Hotline at 1-855-701-6262.  For questions regarding timely filing requirements for Legacy Medicaid recipients, please contact Molina the Molina Provider Relations Department at (800) 473-2783.

 


 

HOW TO CONTRACT WITH BAYOU HEALTH (Louisiana's medical Medicaid program managers, updated 1/7/16)

All five Bayou Health plans offer a limited dental benefit in addition to the current Medicaid Dental Benefit managed by MCNA.

Amerigroup, AmeriHealth Caritas of Louisiana (ACLA), and Aetna all contract with DentaQuest to manage the dental benefit. Information relative to credentialing and benefits offered can be found on the Dentist Page link at www.dentaquest.com/Louisiana or by contacting the credentialing hotline at 1-800-233-1468.

Louisiana Health Care Connections (LHC) only enroll FQHC/RHCs for the delivery dental services. Providers providing dental services via an FQHC/RHC should contact LHC for credentialing information at 1-866-595-8133.

United Healthcare Community Plan of Louisiana (UHC) ask interested dental providers to contact the United Healthcare Dental Provider Services line at 1-844-275-8751.



 


MCNA Dental Advisory Committee Meeting Update from 12-9-15

DHH announced a few weeks ago that Medicaid claims would now take an additional two weeks to be processed to increase “fraud detection.”  The main reason, though, was allowing DHH to withhold a payment from third-party claims administrators (i.e., MCNA and the Bayou Health plans) until the next fiscal year.  MCNA again confirmed to all present at the DAC meeting that there would be no change in MCNA’s handling of claims in spite of DHH pushing back its payment to MCNA.

The time allowed to request reconsideration of a claim rejected for administrative reasons has been extended from 60 to 90 days (dentist must provide an explanation of new information with the request).

When treating a referral from a G.D., pediatric dentists have been having to downcode D0150 to D0140.  MCNA will henceforth pay specialists for a D0150 (when a comp exam is actually performed) provided there is an explanation regarding the referral etc. included with the claim. (Note: generally, any narrative included with a claim kicks it out of the automated system for review by a live person.)

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