Dental Office Reference Manual Updates for October 2018

PROVIDER ALERT

The South Carolina Department of Health and Human Services (SCDHHS) encourages all dental providers to review the latest updates on the SCDHHS Dental Office Reference Manual (ORM) effective on or after Oct. 1, 2018. The following existing policies have been updated:

1. Criteria for authorization of services delivered in an outpatient setting: operating room (OR) and ambulatory surgical center (ASC). 

To review this update please reference sections 3.03; 4.16; C.04 and exhibits A-C (Adjunctive Services cover page) of the Dental ORM.

2. Criteria for services delivered under general anesthesia/IV sedation in the dental office. 

To review this update please reference section C.09 of the Dental ORM. 

3. Criteria for services delivered in conjunction with behavioral management services. 

To review this update please reference section C.10 of the Dental ORM.

4. Update of the medical procedure codes rendered by oral surgeons. 

To review this update please refer to exhibits A-C (Medical Services) of the SCDHHS Dental ORM. 

5. Services requiring inpatient stay. 

DentaQuest will NOT process any authorizations and will deny all claims filed for services that require inpatient stay. The authorizations for these services will only be issued by KEPRO or the beneficiary's managed care organization (MCO). Reimbursement for these services are included in the medical payment paid to the hospital. To review this update please refer to sections 3.04 and 4.17 of the Dental ORM.

For all updates, please reference the Dental ORM dated Oct. 1, 2018, and accessible on the DentaQuest web portal at https://govservices.dentaquest.com/. For questions regarding the Dental ORM updates, 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.

Tags: 
Report Fraud