Dental Program Information
You may reach the Medicaid Dental Program during normal business hours at (803) 898-2568. The fax number for the program area is (803) 255-8221. All program personnel will be happy to answer any questions you may have on program policy, claims filing and related information.
What's Covered
Dental services are defined as any covered diagnostic, preventive, therapeutic, rehabilitative or corrective procedure. For a comprehensive listing of covered procedures and specific guidelines, go to Chapter 400 of the provider manual.
Adult dental services (beneficiaries over the age of 21) are limited to Emergency Dental Services only. Those services are defined as those necessary to:
- Repair traumatic injury
- Relieve acute severe pain
- Control an acute infectious process; or,
- Emergency services necessary due to a catastrophic medical condition (i.e. cancer, organ transplant, chemotherapy, etc)
Allowable emergency services are limited to those listed in the Medicaid Dental Provider Manual. Chapter 200 of manual.
Eligibility
Medicaid beneficiaries from birth through the month of their 21st birthday and Mentally Retarded/Related Disabilities (MR/RD) Waiver beneficiaries are eligible for covered dental services.
Beneficiaries with pay category 55 ( Family Planning Waiver) or 92 (Silver Card) are not eligible for dental services. Chapter 200 of manual.
Waivers
Beneficiaries over the age of 21 years old who are enrolled in the MR/RD
(Mentally Retarded/ Related Disabilities) Waiver program may receive the same covered dental services as those beneficiaries less than 21 years of age. To apply for this waiver, the beneficiary must contact the Department of Disabilities and Special Needs office in the
county in which they reside.
Go to the DDSN county office listings to find the appropriate county.
Broken/Cancelled/Missed Appointments
The Centers for Medicare and Medicaid Services (CMS) prohibit billing Medicaid beneficiaries for broken, missed or cancelled appointments. Medicaid programs are State designed and administered with Federal policy established by CMS. Federal requirements mandate that providers who participate in the Medicaid program must accept the payment of the agency as payment in full. Providers cannot bill for scheduling appointments or holding appointment blocks. According to the CMS Program Issuance transmittal Notice MCD-43-94, broken or missed appointments are considered part of the overall cost of doing business.
If a provider has a non-compliant Medicaid patient, particularly with BROKEN, MISSED OR CANCELLED APPOINTMENTS, they can contact the Family Support Services worker at their local health department. For more information about FSS, go to page 200-6 of the manual.
Orthodontics
Orthodontic Services are not a covered service by Medicaid. However, the Children's Rehabilitative Service (CRS), through DHEC, offers orthodontic services for Medicaid beneficiaries that have severe craniofacial anomalies such as cleft lip and cleft palate and syndrome's that affect dental and skeletal functional development. Referral to the program must come from a physician, dentist or other dental specialist. All orthodontic referrals must be made to the local county health department to the attention of the Children's Rehabilitative Service's (CRS) coordinator.
For more information regarding the CRS program, call the dental program area at (803) 898-2568.
Links
- Fraud and Abuse:
Email: fraudres@scdhhs.gov
Hotline Phone Number (1-888-364-3224).
- DHEC Family Support Services (FSS)
Staff (Broken, cancelled or missed appointments):
Click on A to Z Subject Listing, Family Support Services.
- Department of Disabilities and Special Needs (MR/RD Waiver):
Website: www.state.sc.us/ddsn.
Telephone, fax and e-mail addresses in Appendix of manual.
- Family Connections of SC:
Phone Number: (803) 252-0914
Website: www.familyconnectionsc.org.
- HIPAA Call Center for web-tool users:
Website: www.scmedicaidprovider.org or call 1-888-289-0709
- Eligibility information for beneficiaries:
1-888-549-0820
- DHEC (Children's Rehabilitative Service):
Click on A to Z Subject Listing, Children's Services.
- South Carolina Dental Association:
Phone number: (803) 750-2277 Website: www.scda.org. The website has a list of public assistance dental clinics.
- South Carolina State Board of Dentistry:
Phone Number: (803) 896-4599
The SC Department of Labor, and Licensing and Regulation website: www.llr.state.sc.us.
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