Adult Emergency Dental Service
Dental claims for adult extractions with a date of service on or after April 1, 2014 must include the word “EMERGENCY” on the claim form in field 35 (comments section). Additionally, pre-payment review is required for more than four (4) extractions per member per date of service. Providers are required to document the medical necessity for the emergency services in the patient’s medical record and submit this documentation along with the claim to DentaQuest, who will review the submitted documentation prior to paying for the service(s). Prior authorization is optional.
SCDHHS will be monitoring the utilization of extractions in adult beneficiaries to ensure that services are being rendered in emergency situations only.
Please refer any questions or concerns regarding this bulletin to the DentaQuest Provider Call Center at 888-307-6553. Thank you for your continued support of the South Carolina Healthy Connections Medicaid Program.