MCNA Dental Advisory Committee Meeting Update, September 27, 2017
Restriction on billing panorex taken on the same day as operative treatment provided.
This service is payable as long as an exam is billed at the same time. MCNA has agreed to remove the system edit requiring the exam in order for the service to be paid. MCNA said the turnaround should take 2-3 weeks.
Bundling of reimbursement for x-rays.
The panoramic xrays will not be part of bundling and dentists will be paid for each procedure (versus bundling as a full mouth series). Dentists will be able to come back and take bite wings and still be reimbursed. Dentists can take a panoramic xray the same day that restorative is done, if needed.
Inclusion of zirconium anterior crowns as a reimbursable procedure.
LA Department of Health (LDH) will research and discuss options.
Partial payment for a denture when patient loses Medicaid eligibility prior to denture actually being delivered.
MCNA will amend the provider manual allowing providers to balance bill the recipient, so they can receive the denture. This policy will help both patients and providers.
1. The committee would like us to consider Sliver Diamine Fluoride treatment (D1354) which slows cavity growth. LDH will research.
2. The committee thinks the appeals and reconsideration process is not clear in the MCNA provider manual. MCNA asked them to submit questions and they will look at revising.
3. The committee dislikes the auto assignment of children to a dental home. MCNA explained there is an algorithm that looks for prior service and links the member. If nothing exists, they go by distance. She will provide the flowchart to the committee for review and recommendations. A problem they sometimes see is a child being assigned to a provider who does not accept children. Ginger explained the provider should submit information when it changes to keep the directory up to date. MCNA also does updates during site visits, and every provider is re-credentialed every 3 years. LDH will check the contract to see if auto assignment is a requirement and what the provisions are. Also noted is that members are not locked into a dental home and can change at any time, and it also does not keep them from seeing any network dentist for service.
4. The Preferred Provider Program was discussed, which will remove some Prior Authorization requirements from providers with proven track records in order to reduce administrative burden on frequently billed services. MCNA is currently looking into this possibility.
a) The sealant campaign has been approved for extension through 12/31/2017.
b) MCNA is part of a Dental Quality Alliance (DQA) representing health plans and they have met with CMS. MCNA reported that they did not meet the sealant performance goals with LA, and that some of the problems are because of the way measures are calculated. If a child is enrolled for 90 days, they are placed in the denominator. The DQA recommends extending 90 day requirement to 6 months and also removing any children who are not otherwise eligible for sealants (prior sealants, extractions, restorations) from the denominator. If this could be done, MCNA’s percentages would increase drastically. They studied how this would affect both Louisiana and Texas’ numbers and provided examples.
6. Outreach/Performance Improvement Project - A recommendation was made to partner with the Medicaid MCO’s to make sure pediatricians realize they should refer children to dental providers at 1 year of age instead of 3 (new guideline). MCNA participates in a project in Florida where large practices are given tear off “prescription pads” telling recipients that the child should see a dental provider and gives a list of enrolled dentists. This would help the MCOs with their EPSDT requirements and is a possible joint PIP for MCOs/MCNA.
Dental Advisory Committee Successful in Working with MCNA to Achieve Improvements in Dental Medicaid Guidelines (posted 8/11/17)
Dentists representing LDA, LAPD, LSUSD and LSBD serving on the Dental Advisory Committee (DAC) regularly present dentists’ concerns about Medicaid at meetings with MCNA executives. In response, MCNA has adjusted the rules for the age cutoff in conducting behavioral health assessments without an authorization and made adjustments to 3 of the rules impacting annual bitewings. A table with details of all the changes is attached. All radiograph rule changes have been made retroactive to dates of service 1/1/17. According to MCNA, any claim denied with a date of service 1/1/17 or after has already been, or is in the process of being adjusted. Your office will not need to contact MCNA or request a reconsideration.
Issue: Behavior management not reimbursed for patients 6 & up – LDH has affirmed policy of not reimbursing for older kids unless they are disabled; will continue to discuss with LDH.
Issue: very young patients being “auto-assigned” to dentists who don’t treat kids that young – MCNA will review “welcome letter” new Medicaid recipients receive and edit as necessary to ensure parents know they have a choice of dentist.Issue: Frequency limits being “re-set” for claims filed, but denied – MCNA will look into correcting this in their system.
Issue: Partial payment for dentures when patient eligibility changes (only payable if dentures submitted to MCNA and NOT delivered to patient): MCNA will look into updating eligibility on their portal overnight after receiving data from LDH. MCNA will talk to LDH about % of regular fees paid in such cases and allowing payment of % even if dentures have been delivered to patient who is no longer eligible. MCNA has launched a preventive health campaign that will, among other things, increase by $10 the reimbursement for each sealant on first permanent molars for 6-9 year olds and increase by 25% fees for prophies and fluoride for members without record of preventive care over the last twelve months. Campaign ends 9/30/17. Details can be found on the MCNA provider portal.