Updates to the SCDHHS Dental Services Program

FREQUENCY LIMITATION APPLICATION
With the transition to DentaQuest (DQ), the South Carolina Department of Health and
Human Services (SCDHHS) made changes to the frequencies allowed for certain dental
services. These changes were communicated in a Provider Bulletin dated October 15,
2010. Providers should review the latest version of the Dental Office Reference Manual
(ORM) to verify frequency limits and to check the web portal to determine if the
beneficiary has received the service within the frequency time period. Failure to follow
the frequency limits in the ORM may result in the denial of the claim. The ORM contains
SCDHHS policies applicable to the administration of the dental program. It is advised
that providers maintain a copy of the claims history in the patient record until the claim
has paid.

The ORM documents frequency limitations in the Benefit Limitations column of the
exhibits. Frequency limitations that are applied at the Provider level are indicated in the
Benefit Limitation column for each applicable procedure in the ORM. If no Provider
limitation appears in the Benefit Limitations column, the limitation for that procedure is
applied at the Beneficiary level.

CLARIFICATION ON ADULT DENTAL TREATMENT
Beneficiaries over the age of 21 may be eligible for dental services only if the services
are delivered in preparation for or during the course of treatment for one or more of
the following conditions: organ transplants; chemotherapy for cancer treatments;
radiation of the head and/or neck for cancer treatments; total joint replacement; heart
valve replacement; or treatment of trauma related injuries administered in a hospital or
outpatient facility.

EMERGENCY ORAL SURGICAL SERVICES:
Effective with dates of service on or after January 1, 2012, Oral Surgeons may bill CPT
codes for emergency oral surgical services for Beneficiaries age 21 and over. The listing
of covered CPT codes is available in the ORM, along with review and docur:nentation
reqUirements for individual CPT codes. Providers are required to indicate that services
were rendered as emergencies by checking field 24C on the CMS 1500 claim form or by
including the word "emergency" in the remarks field of a web submission. DQ will be working with the SCDHHS Division of Program Integrity to monitor utilization of these
oral surgery codes.

BROKEN APPOINTMENT TRACKING THROUGH DENTAQUEST PROVIDER WEB
PORTAL

Beginning January 1, 2012, DQ will offer the capability to record data through the
DentaQuest provider web portal on appointments for Healthy Connections beneficiaries
indicated as broken. Providers will be able to easily record the incident(s) along with the
reason cited for the broken appointment. Detailed and summary reports are also
available for providers use.

If you have questions regarding this functionality, contact DQ Customer Service at (888)
307-6553.

DQ will be hosting a series of web-based training sessions to review its provider web
portal and detail information outlined in this bulletin. The schedule of training
opportunities will be mailed to providers and will be posted on the DQ provider web
portal.

Report Fraud