MPCA Billing Network Dental Call Summary

January 30, 2018

1:00pm-2:00pm

Call Summary

Healthy Kids Dental

  • Two plans have been confirmed as participating
  • Delta Dental
  • Dentaquest
  • Dental Claims missing from CHAMPS should be reported as follows
  • HMP: reported to the Health Plan
  • Healthy Kids: reported to Delta Dental
  • A list of Dental Contract Managers has been provided via File Transfer (on 2/2/2018)

Dental NPI

  • An error was detected in which several centers were prompted to assign new NPIs for their Dental Clinic; the issues reported have been resolved and updated within the system.

Dental APM Table

  • Tables have been updated effective January 1, 2018
  • CPT Codes set to pay multiple visits but were not on the 2017 list have now been updated
  • MDHHS has created a temporary reference of the number of visits allowed per service; a copy of the table has been placed on MPCAs Billing and Finance page under Dental Billing Resources

Dental Claims Overpayment

  • On Nov. 28, 2017, the Michigan Department of Health and Human Services (MDHHS) announced the discovery of overpayments.
  • MDHHS reports a fix will occur mid to late February 2018
  • Fix will include takebacks to occur via claim adjustments beginning March 2018
  • Takeback Announcements will be provided to centers directly and via Memo within the File Transfer

FFS Dental Claims

  • FFS Claims are eligible for APM
  • MDHHS Announced error of overpayment
  • Edits will show APM has been applied
  • FFS claims will pay PPS Rate plus APM at time of adjudication
  • Centers are encouraged to continue to send claim examples to Nicole Salava for review and include Charmaine Femster in the communications for tracking and follow up

MHP Dental Claims

  • MDHHS is aware of the issue and is in the process of resolving issue internally with MHPs

Denture Claims

  • Several centers report denture claim denials. MDHHS confirmed issue has been resolved and denture claims will be reimbursed as follow
  • PPS multiplied by encounter count (7)= payment
  • If your center receives more than the calculated payment, please email Nicole Salava with examples of the overpayment for correction

Quadrant Billing

  • Prophy services cannot be billed across multiple days; it is suggested that centers bill the CPT Codes on date of completion
  • Debridement is a qualifying service and paid as one encounter; this service can be provided on a different day
  • Patients who require extensive services
  • Quadrant Dentistry can be broken into 6 segments

Multiple Visits

  • If the need arises that causes a patient to be seen on multiple visits for certain services, it is suggested:
  • The Provider must use good clinical judgment and rationale
  • Provider must have substantial details on the reason for multiple visits
  • The need for multiple visits must be listed in the patient’s treatment plan
  • Documentation must be legible, do not use shorthand as the Auditor must be able to understand the reason
  • Reimbursement will be based on Provider documentation

Institutional Billing Workgroup

Charmaine will begin working with representatives from several Health Centers mid-February to collaborate on a user-friendly report available to FQHCs that will identify the following:

  • Fee schedule for each service
  • If service counts as an encounter
  • If service qualifies for wrap

MDHHS has expressed their support in creating a report on what additional information should be included in the report from the center’s point of view, and the workgroup will specifically focus on this area and others as the need arises. If you are interested in providing feedback, please contact Charmaine directly, a status update will be sent via the Billing Network throughout the process.

Next Billing Network Call:

February 13, 2018

Please send billing questions to MPCA by emailing Charmaine Femster at . You can ask questions directly to your peers in the Billing Managers Network through the listserv at .