Q & A Session for Keep Kids Smiling A THSteps Dental Webinar
Wednesday, July 28, 2010
Starting time: 12:47 PM
Q: Does that mean that we can bill a 0145 every three months and a regular dental checkup every six months?
A: Yes.
Q: I want to be sure I understand the information regarding limitations, someone who needs code D2750 under the age of 13 requires Pre-Auth?
A: Yes, due to age restriction on certain codes. If the client is in need of a service that has age restrictions they don’t meet, you will always need to obtain an auth.
Q: Where do I need to go to print out benefits & limitations on website?
A: Procedure codes, limitations and maximum fees for benefits can be found in dental fee schedule located at tmhp.com.
Q: If we provide all the information needed to review the authorization, how long does it take to get a response?
A: Authorization responses should be received within 3-5 days of submission.
Q: I’m not sure I went to the right place on the website, I want to print out a copy of the Benefits & Limitations like shown on page 27, and I can’t find it.
A: The table on pg 27 is just a sample from the provider manual. Please refer to the Children’s Services Handbook starting on page CH-122 through CH-184. These are all of the dental guidelines.
Q: If a client continuously cancels or does not show up for appointments, do we have to report it to Medicaid?
A: It is recommended for all THSteps; clients.http://www.dshs.state.tx.us/thsteps/Missed%20appointment%20form%200209_secure.docComplete and fax Missed Appointment Referrals to 512-533-3867.
Q: Will the R & S report still be available on the website?
A: Yes. The R & S will continue to be available through TexMedConnect online.
Q: If a client went to another provider and that provider billed for composites and the client went to a different provider and NO composites were done, how can we manage that since the patient needs sealants?
A: You have no way of tracking where the clients have gone for services. We encourage you to ask the client when their last dental visit was and what services were provided prior to billing, but if that information is not provided you can submit the claim to TMHP with supporting documentation indicating that you were not aware of the prior services rendered.
Q: When a tooth has history of composite and the composite needs to be redone due to poor oral hygiene and the tooth maximum has been met, can we charge the patient to redo the composite previously done by a different provider?
A: No, you need to submit an auth request to the dental unit for approval of the services. If the auth department denies for lack of medical necessity, then at that time you can have the client sign a private pay agreement and charge the client.