Medicaid - Non-Covered Procedures

As a provider of services for the Medicaid population, there are a few requirements that you should be aware of regarding non-covered procedures. Please read the excerpt below from the Doral provider manual:

"2.02 Payment for Non-Covered Services Participating Providers shall hold Members, Doral, Plan and Agency harmless for the payment of non-Covered Services except as provided in this paragraph. Provider may bill a Member for Non-Covered Services if the Provider obtains a written waiver from the Member prior to rendering such service that indicates:

• the services to be provided;
• Doral, Plan and Agency will not pay for or be liable for said services; and
• Member will be financially liable for such services."

Please remember to obtain the patient's written waiver and signature before collecting or billing for non-covered procedures. If you need additional information on this requirement or assistance with writing your waiver documents, contact your D-TECH account representative.

DC Alliance and DC Medicaid Changes

I have great news! D-TECH has been working feverishly with Doral USA, Unison Health Plan, the DCPCA and local public health providers to enhance the benefits for the DC Alliance and DC Medicaid dental programs. Effective April 1, 2009, Unison has increased their fee schedule to participating providers and added five new procedure codes to their Adult Alliance benefit schedule. Based upon feedback from our providers, the following benefits have been added:

¨ D0330 Panoramic film

¨ D4355 Full mouth debridement

¨ D9110 Palliative treatment

¨ D9220 Deep sedation/general anesthesia – first 30 minutes

¨ D9221 Deep sedation/general anesthesia – add 15 minutes

Please note the effective date for D0330 and D9110 under the Adult Alliance program has been back dated to May 1, 2008. All previously denied claims for codes listed above are being reprocessed back to the effective dates.

Unison will also be covering Medicaid Adults(DC Healthy Smiles) effective May 1, 2009. If D-TECH is responsible for your reimbursements, we will make all of the necessary changes in your system to ensure a smooth transition. Please contact your account representative at D-TECH is you have questions about how these changes affect your office.

Onward and Upward!