Effective September 1, 2008, all participants with HUSKY A and B, Title XIX fee for service and State Administered General Assistance (SAGA) programs will receive their dental services through the State of Connecticut¡¯s ¡°Dental Carve Out¡±.

 

Why has a change with state dental services taken place?

 

As a result of the settlement conditions of the longstanding Carr vs. Wilson – Coker dental lawsuit, the State agreed to remove all HUSKY dental services from the managed care system and provide dental services under the management of a single plan by an Administrative Services Organization (¡°ASO¡±).  From a financial perspective, it does not make sense to have many vendors for the same service. As such, all dental programs are now included under the new ASO arrangement.

 

Why should I participate in the new dental program?

 

One out of four children in the State of Connecticut is enrolled in HUSKY.  Families could not afford to provide medical or dental care without HUSKY.   Our children need caring dentists and hygienists and would benefit from your participation with the program.  By becoming an enrolled dentist, you¡¯ll be providing services to children and adults who need dental care. 

 

Who is the company responsible for providing services for the ¡°Dental Carve Out¡±?

 

Dental Benefit Management, Inc. (¡°BeneCare¡±) is the ASO that is responsible for the management of all dental services which had been previously been performed in Connecticut by various Managed Care Organizations (¡°MCOs¡±) and their subcontractors.  Under this new model BeneCare will be responsible for the coordination of provider services, the evaluation of prior authorization requests and the handling of client services.

 

What is ¡°new¡± about the HUSKY program?  

 

As of September 1, 2008, all dental services will be ¡°carved out¡± of HUSKY and other programs.  The dental carve out operates independently from the medical managed care system.  

 

¨ª      Dental services for HUSKY clients will no longer be provided through multiple managed care programs. 

The dental services provided through all of the Medical Assistance Programs have been placed under one system.

 

¨ª      There is a single ASO, BeneCare, instead of four MCOs and their dental subcontractors. 

 

¨ª      BeneCare will be paid a fee for the management of dental benefits and will not assume any cost risk, unlike the former MCO structure. 

 

¨ª      All providers will be paid by procedure code under one uniform schedule for children and adults, with higher rates which went into effect April 1, 2008.

 

¨ª      The reformation of a ¡°Dental Advisory Committee¡± with representation from advocacy groups, the Connecticut State Dental Association (¡°CSDA¡±), University of Connecticut Health Center School of Dental Medicine, a representative from each CSDA component specialty society and other state agencies.

 

¨ª      Many new processes will be phased in during the first year of the dental carve out to help alleviate past problems.  For example, BeneCare will track and monitor client compliance and record no show rates.  If a client has an extensive no show rate (to be determined) they will not have access to your office.   BeneCare will monitor and remind clients of periodic appointments and assist with appointment scheduling and transportation.  BeneCare will also work with DSS to waive prior authorization requirements for targeted offices (criteria to be determined at a later date).

 

¨ª      A new program feature is Care Management and Care Coordination.  These two features will target children who are at risk for developing decay and provide education and management services to help reduce the risk of caries or periodontal disease for the children and their families.  Of course, this will be done in conjunction with the primary care dentist and primary care provider.

 

¨ª      The dental carve out will not be solely for HUSKY children and adults, it will include SAGA and adult Medicaid/Title XIX clients.  The program has different rates for children and adults.  The dental carve out will receive a new name which will be announced at a later date. 

 

Can I limit the number of HUSKY patients I take?

 

Yes.  Your patient capacity is up to you.

 

Do I have to take all adult patients?

 

If you are a pediatric dentist, you only need to take children.  If you treat adults with special needs, the Department requests that you consider treating a few patients in your practice.  However, DSS cannot determine your client panel.

 

If you are a general dentist, the Department requests that you consider enrolling the parents of HUSKY children to help with the continuity of care with families and support the primary care dentist model.  The Department cannot decide the composition of your client panel.

 

Can I limit the geographic location of patients I take?

 

Yes.  Many providers serve clients located within their township or by zip code.  Some providers limit their patients to the prefix of the phone number in which the patients reside using caller IDs.

 

Can I submit claims electronically?

 

Yes.  Claims can be submitted electronically directly to EDS or through a clearinghouse.  EDS also offers software to allow your office to perform electronic claims submission free of charge.  The software can be downloaded after you are enrolled with EDS. 

 

Can I submit claims by hard copy?

 

Yes.  The claims must be submitted on a 2006 Red ADA (J404) claim form.

 

 

 

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How often will claims be processed?

 

Clean claims (claims without errors) will be processed and paid every two weeks.

 

Can I get paid using electronic funds transfers directly into my account?

 

Yes.  To do this you must complete the ¡°Trading Partner¡± forms. 

 

 

 

 

Can I get paid with a paper check?

 

Yes.

 

How do I enroll to become a dental provider with the New Dental Program?

 

There are several ways for you to enroll with EDS to participate with the New Dental Program.  You can also call BeneCare¡¯s Network Development Manager, Michael Massarelli, to speak with him directly at (860) 507–2303. 

 

The application form itself is eight pages long.  The contract you need to sign contains 32 pages including the instructions on how to fill out the forms.  The required documentation to enroll is:

 

¨ª      Completed and signed Enrollment/Re-enrollment Form, followed by pages 2-6;

¨ª      Signed Provider Enrollment Agreement;

¨ª      Completed W-9 Form;

¨ª      Completed Determination of Separate Practice Location Form (if applicable);

¨ª      Completed Electronic Funds Transfer (EFT) Form;

¨ª      Complete Addendum to Provider Enrollment Agreement Concerning the Acceptable Use of Electronic Signatures;

¨ª      Completed and signed Affidavit Re: Section 6032 of the Deficit Reduction Act (if applicable – if the practice income is $5 million or greater from a Title XIX Program in the previous FEDERAL Fiscal Year).

 

You can choose to enroll by directly downloading an application or have us mail you a paper application.  You may also choose to enroll on – line with an ¡°Enrollment Wizard¡±. 

To Enroll On-line:

¨ª      The website is www.ctdssmap.com;

¨ª      Go to the ¡°Provider¡± box and scroll down to ¡°Provider Enrollment¡±;

¨ª      Click on ¡°¡±Next¡± to start enrollment wizard. It will walk you through the information needed; 

¨ª      Please note, you should review materials needed to enroll before beginning the process.  Once you begin the enrollment process, you cannot save the information and return to it at a later date;

¨ª      For information describing the types of documentation that are required to enroll, choose ¡°Provider¡± on the home page.  A drop down box will appear,

¨ª      Click on ¡°Provider Matrix¡± and scroll down and choose ¡°Enrollment Requirements for Dental Providers¡± (or other dental classifications as the selection may apply to you).

 

To Enroll Using a Hard Copy:

¨ª      The website is www.ctdssmap.com;

¨ª      Click on ¡°Information¡± and a drop down box will give the option ¡°Publications¡±

¨ª      Choose this option, and then scroll down the page to the ¡°Forms¡± section;

¨ª      Continue to scroll down the list to ¡°Other Forms¡± and click on ¡°Enrollment Package¡±.

¨ª      The enrollment package will download as an Adobe Acrobat (pdf) file.

 

Assistance with the enrollment process is available by calling EDS Provider Relations at toll–free (800) 842–8440 or local (860) 269–2028 in the Farmington area, Monday through Friday from 8:30 a.m. to 4:30 p.m.

 

Who do I call if I need help with credentialing?

 

 

Information is available on the website www.ctdssmap.com or call EDS Provider Relations at toll–free (800) 842–8440 or local (860) 269–2028 in the Farmington area, Monday through Friday, 8:00 a.m. to 4:30 p.m.

 

You can also call BeneCare¡¯s Network Development Manager, Michael Massarelli, to speak with him directly at (860) 507–2303. 

 

What is taxonomy classification and which code should I choose when I enroll?

 

The National Health Care Provider Taxonomy is the generally accepted classification system for medical providers.  It is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.  The Provider Taxonomy Code List allows a single provider (individual, group, or institution) to identify their specialty category.

 

General Practice Dentist                                 1223G0001X

Hygienist                                                           124Q00000X

Endodontist                                                       1223E0200X

Oral and Maxillofacial Pathologist                          1223P0106X

Oral and Maxillofacial Radiologist                         1223D0008X

Oral and Maxillofacial Surgeon                1223S0112X

Orthodontist                                                     1223X0400X

Pedodontist                                                       1223P0221X

Public Health Dentist                                 1223D0001X

Prosthodontist                                                  1223P0700X

 

 

What do I need to do to enroll as a provider in a Group Practice?

 

For group practices, this means the Provider Enrollment Unit at EDS must also enter an enrollment/re-enrollment application not only for the group practice, but for each individual participating member of the group who wishes to deliver dental services.  When individual providers are enrolled under a group practice, they are enrolled in a ¡°group member only status¡± sometimes called a ¡°performing provider¡± instead of an active status sometimes called ¡°enrolled provider¡±.

 

What you need to fill out to enroll as an individual in a group:

¨ª      A completed enrollment/re-enrollment packet with all supporting documentation for the group;

¨ª      A Master provider agreement for the entire group that is completed and signed

by the group¡¯s chief executive officer;

¨ª      If the provider is not currently enrolled in the Connecticut Medical Assistance

Program, a fully complete enrollment packet must be completed for each new member of the group (with the exception of the EFT form);

¨ª      If the existing provider is already enrolled in the Connecticut Medical Assistance Program, a provider agreement must be signed by that provider and the enrollment form (page 1) needs to be completed.

 

Where should I call if I have questions about the enrollment form?

 

If you have any questions about the enrollment form, you can call EDS Provider Relations at (800) 842–8440 and select ¡°1¡± for prompt assistance.

 

What is the Deficit Reduction Act Form?

 

The ¡°Deficit Reduction Act¡± is federal legislation which went into effect January 1, 2007.  The Act states that any ¡°entity¡± (private, governmental, non – profit, business, provider etc) performing or supplying any service AND/OR goods under Title XIX totaling $5.0 million or more in the most recent federal fiscal year (October 1 through September 30) must complete this form including an Affidavit where the entity attests that it has read and understands the Deficit Reduction Act.  The Deficit Reduction Act requires an employer who meets the $5.0 million threshold to establish written policies for all employees or any agent of the entity describing the False Claims Act detailing policies and procedures for detecting and preventing waste, fraud and abuse.  This description is a synopsis, for more complete and additional information, please sees Policy Bulletin 2007-4 available at www.ctdssmap.com.

 

If I enroll with EDS now, can I start treating patients right away? 

 

Yes, dentists and Public Health Dental Hygienists who wish to provide services to HUSKY A and B, Title XIX fee for service and SAGA clients MUST be enrolled with EDS in order to submit claims for reimbursement for services provided on or after September 1, 2008.  The Department of Social Services will retroactively enroll providers for all enrollment applications processed after September 1, 2008, in order to allow you to provide and submit claims for services provided to clients beginning September 1, 2008.

 

Where can I find the dental fee schedule?

 

There is one fee schedule in effect for children under the age of twenty one and one for adults. The fee schedule can be viewed on Electronic Data Systems¡¯ (¡°EDS¡±) website www.dssmap.com under ¡°Provider¡±, scroll down to ¡°Provider Fee Schedule Download¡° and click on the link.  This action will bring you to a new page, scroll down to ¡°Dental¡± and click on ¡°04/01/2008¡± located in the second column.  This will display the current dental fee schedule for adults and children.  The fee schedule lists the rate for a client under the age of 21.  The fee for a client 21 years of age and older is 52% of the fee listed on the fee schedule.

Medicaid Dental DSS Contact Information:

Kenneth Lambert, DDS, Dental Consultant                                          860-424–5158                           kenneth.lambert@ct.gov

Theresa Rugens, Health Programs Supervisor                           860-424–5156                           theresa.rugens@ct.gov

Lisa Jameson, Administrative Assistant                                             860–424–5212                           lisa.jameson@ct.gov

Donna Balaski, DMD, Health Administrator                                    860-424–5342                           donna.balaski@ct.gov

 

 

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Connecticut Dental Carve Out Contact Information:

 

BeneCare Contact Information

Provider Relations and Services                 888 - 445 - 6665

 

Client Services                                       866 - 420 - 2924

 

Network Development Manager                      Michael Massarelli

Office Phone                                 860 - 507 - 2303

Cell Phone                                    860 - 978 - 0855 

Pre - determination Requests

BeneCare Dental Plans

CT Prior Authorization Request

P. O. Box 40109

Philadelphia, PA 19106-0109

 

EMDEON payer ID            CKCT1 (Note, in order to access EDS

electronically (for claims submission or payment) you MUST have completed the ¡°Trading Partner¡± Agreement with EDS/EDI.)

 

Paper Claims                        EDS

P.O. Box 2971

Hartford, CT 06104

 

 

BeneCare will be providing many outreach services to all clients.  One of the services is to offer assistance with scheduling an appointment.  A BeneCare Customer Service Representative may assist a client and contact your office to help setup an appointment for the client.