WYOMING MEDICAID SEVERE MALOCCLUSION PROGRAM UPDATES Effective - - PowerPoint PPT Presentation
WYOMING MEDICAID SEVERE MALOCCLUSION PROGRAM UPDATES Effective September 1, 2014 REFERRAL CHANGES (ages 12-18) D8660- Initial Consultation $75.00 No LOA is required for scheduling or billing General/Pediatric dentist can refer with
Effective September 1, 2014
D8660- Initial Consultation $75.00 No LOA is required for scheduling or billing General/Pediatric dentist can refer with no State
form
General/Pediatric dentist will be educated on criteria Orthodontists may see walk-ins
If a client, under the age of 12, has a condition that is in
immediate need of orthodontic attention, the dentist may refer the child to the program
The dentists must fill out the “Referral to SM program- Under 12”
form and send it in to the State
The referral must include the “medical necessity” reason in the
narrative section
The State will issue an LOA to the orthodontist to see the child
early if medical necessity is present
* Medicaid current * Age of child * 1/Lifetime benefit
1-888-863-5806 Dental Services You will need to ask the rep if the child is currently eligible for Medicaid and if they have ever had the D8660 NOTE: The D8660-Initial Consultation is a 1/Lifetime benefit. It this has been billed before the child is not eligible for another consultation.
General/Pediatric 1.
Review set criteria for the SM program
2.
Only refer clients who have a qualifying criteria
3.
Use parent handout to explain to parent why their child is not being referred
Orthodontist 1.
For walk-in clients, pre- screen for criteria
2.
Only take records on clients who meet a set criteria
3.
Use parent handout to explain to parent why records will not be taken
If an orthodontist is being sent children who do not meet the set qualifying criteria, the Program manager should be contacted. 307-777-8088 The Program manager will reach out to the office and review the guidelines for referrals.
No LOA required for D8660- Initial Consultation Submit claim to Wyoming Medicaid for D8660 with
no LOA attached* *If the child is under the age of 12, an LOA is still required but does not have to be attached to the claim
If the client is approved for treatment, an LOA will be issued to
the provider
The provider must sign and return this LOA to the Program
manager in the envelope provided and keep a copy for your records NOTE: Claims cannot be paid until the LOA is sent back
Once the child is banded, the D8080 or D8090 can be billed to
Wyoming Medicaid with no LOA attached
There are no changes to how the quarterly D8670 claims are
billed by dates of service
Please continue to list each date of service the child was seen in
the office for adjustments, repairs, or any other services (this is required by federal guidelines)
When sending in claims for the quarterly $300.00 payments, the
LOA is not required to be attached to the D8670 claim
You are encouraged to enter your claims on the Secure Web
Portal for faster and more accurate payments
will be evaluated and approved based on necessity.
qualifying criteria if the teeth are causing tissue laceration and/or loss of gingival
the laceration or loss of attachment. NOTE: These conditions have been approved in the past with only palatal irritations, inflammation, and/or indentations. In order to consistently meet the set criteria of this program, these can not be approved without sufficient documentation of destruction.
by burns or by accident; the result of osteomyelitis; or other gross pathology. *Congenitally missing teeth are not considered a Severe Traumatic
form. *A narrative should be written on Part 2 of the new request form explaining what the deviation is.
Please fill in each blank. Please check which type of treatment is being requested at this
time.
If Yes is checked for surgery, an explanation should be given as
to what type and an estimated time frame during treatment.
Please fill in all boxes that apply Please indicate the location of each missing, impacted, or
ectopic tooth
If Severe Traumatic Deviation is checked off in section 4 of the
scoring sheet, there MUST be an explanation of what the deviation is here in section 2.
Oral hygiene will be evaluated by the State on each case. If the client appears to have fair/poor hygiene, a hold may be
placed on the client. Please give your impressions of the child’s hygiene here.
Please list any restorative treatment needs, including tooth
replacement needs, if necessary
Please complete the HLD index. An X should only be placed on the index for Deep Impinging Overbite or Anterior
Crossbite if you are indicating tissue laceration or attachment loss is present. **NOTE: If you would like to indicate that the client has a Deep Overbite or an Anterior Crossbite but there is no tissue destruction present, you may state that in your narrative below for consideration.
This section has been created to allow you to give any explanation
that will substantiate your request for approval.
Please describe any reasons you feel this case is medically
necessary to receive treatment.