Dental Manual Updates

PROVIDER ALERT

The South Carolina Department of Health and Human Services (SCDHHS) is issuing the following dental policy updates, effective July 1, 2018.

1. Request for Reconsideration: SCDHHS and DentaQuest will refer to the former claim appeals process as the request for reconsideration process. The process itself remains the same and no changes or additional actions are required from providers. DentaQuest will reference the request for reconsideration in future communications. 

The updated policy reflecting the above change is detailed in section 4.14 and 6.01 of the SCDHHS Dental Office Reference Manual (ORM) available at: https://www.scdhhs.gov/sites/default/files/SC%20Healthy%20Connections%20ORM%2004.%2001.18.pdf.

2. Expedited Prior Authorization: SCDHHS will require a change in the entry request for an expedited prior authorization (PA). The request for an expedited PA should indicate the urgent need and the provider must enter the full word "EXPEDITE" in the "Notes" field on the ADA Claim Form (field #35 or field #24C on the CMS 1500 Claim Form). Providers may only file an expedited PA via fax at (800) 521-1735 or email at DQSCEmergency@DentaQuest.com

PA requests made in urgent situations will be reviewed and the medical necessity determination will be made within 72 hours of receipt. There are no PAs required for emergency services. 

The updated policy reflecting these changes is detailed in section 3.01 (C) of the SCDHHS Dental Office Reference Manual (ORM) available at: https://www.scdhhs.gov/sites/default/files/SC%20Healthy%20Connections%20ORM%2004.%2001.18.pdf.

3. Charge Limitations for Covered Services: SCDHHS is clarifying its policy on charge limitations for covered services. Please refer to section 4.11 of the Dental Office Reference Manual (ORM) accessible at: https://www.scdhhs.gov/sites/default/files/SC%20Healthy%20Connections%20ORM%2004.%2001.18.pdf.

For questions regarding this alert, please contact the DentaQuest Provider Service Center at (888) 307- 6553.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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