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.