dental billing tips, claim submission, and research...
TRANSCRIPT
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Indiana Health Coverage Programs
DXC Technology
Dental Billing Tips, Claim
Submission, and
Research Tools
October 2017
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Agenda
• Billing tips
• Billing on the provider Portal
• Billing secondary claims
• Research and resubmission
• Helpful tools
• Questions
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Billing Tips
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indianamedicaid.com
How to keep Informed
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Member Eligibility – Payers
• Traditional Medicaid─ Claims are processed by DXC Technology
• Hoosier Care Connect, Hoosier Healthwise and HIP
members ─ Managed Health Services: Claims are processed by Envolve
─ MDwise: Claims are processed by DentaQuest
─ Anthem: Claims are processed by DentaQuest
─ CareSource: Claims are processed by CareSource
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Member Eligibility
The following fee-for-service (FFS) benefit packages do not cover dental services:• Family planning
• Qualified Medicare Beneficiary (QMB) - ONLY
• Special Low Income Medicare Beneficiary (SLMB) - ONLY
• Qualified Individual (QI)
• Presumptive Eligibility for Pregnant Women
• Emergency services only – Package E (limited services)
If the member is enrolled in managed care, dental claims will be the responsibility of the member’s managed care entity (MCE)• Contact the appropriate entity for billing instructions and/or payer
contractor
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What’s the difference?
QMB ALSO
QMB ONLY
Qualified Medicare Beneficiary
The IHCP pays member’s Medicare, Part B premium and ALSO the member has full Medicaid benefits
The IHCP pays the member’s Medicare Part B premiums and coinsurance/deductable ONLY. If Medicare does not allow the charge, the IHCP does not allow the charge.
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Periodontal Root Planing and Scaling
Document
date of
service by
each
quadrant
billed on the
current claim
Member ID (RID)
Periodontal scaling and root planing requires documentation
10/29/2017
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Periodontal Maintenance
HCPCS code D4910
Billing guidance and restrictions – Providers are not allowed to bill for HCPCS code D1120 – Prophylaxis, child or D1110 – Prophylaxis, adult for members receiving periodontal maintenance
− There must be at least six months between a DOS billed for periodontal maintenance and prophylaxis for individuals under the age of 21 or for institutional members
− There must be at least 12 months between a DOS billed for periodontal maintenance and prophylaxis for individuals aged 21 and older
Guidelines are for services delivered under the
fee-for-service (FFS) delivery system
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Billing Dental Claims on the
Provider Healthcare Portal
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What to Know
• Fields marked with an asterisk (*) are required
• Claims must be submitted in a single session − There is no option to save and come back later to complete the claim
• Error notifications will highlight information that is not
completed − This information must be completed before the claim can be submitted
When is the primary EOB required for Other Insurance (TPL)?
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Billing Claims on the
Provider Healthcare Portal – Header
v
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Billing Claims on the
Provider Healthcare Portal – Header
• “Include Other Insurance” leads you to Step 2.
If no prior insurance payment, do not check box
– click “Continue” to go to Step 3
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Billing Claims on the
Provider Healthcare Portal – Detail
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Billing Claims on the
Provider Healthcare Portal – Detail
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Billing Claims on the
Provider Healthcare Portal – Detail
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Billing Claims on the
Provider Healthcare Portal – Detail
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Billing Claims on the
Provider Healthcare Portal – Detail
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Billing Claims on the
Provider Healthcare Portal – Detail
• After you choose “Add,” the service detail collapses
• Add additional lines by clicking “Click to add service
detail” until all services are entered
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Billing Claims on the
Provider Healthcare Portal – Attachments
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Billing Claims on the
Provider Healthcare Portal – Notes
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Billing Claims on the
Provider Healthcare Portal – Confirm
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Confirmation – Status – Claim ID
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Billing Secondary Claims on the
Provider Healthcare Portal
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Secondary Claims on the
Provider Healthcare Portal – Header
• “Include Other Insurance” leads you to step 2
• Check the box
• Click “Continue” to go to step 2
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When is the primary EOB Not Needed for
Other Insurance (TPL)?
When is the primary EOB required for
Other Insurance (TPL)?
• When the TPL has denied the service as noncovered
• When TPL has applied the entire amount to the copay, co-insurance, or deductible
• The primary insurance COVERS the service and has
PAID on the claim
• Actual dollars were received
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Billing Secondary Claims on the Provider
Healthcare Portal – Header
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Billing Secondary Claims on the Provider
Healthcare Portal – Header
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Billing Secondary Claims on the Provider
Healthcare Portal – Detail
• Each detail line must include the amount paid for that
particular code on the detail line
• Click the detail number under the “#” column to expand
the “Other Insurance for service detail” window
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Billing Secondary Claims on the Provider
Healthcare Portal – Detail
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Billing Secondary Claims on the Provider
Healthcare Portal – Detail
• Once you choose “Add” and “Save,” the Service Detail
collapses again
• Add insurance payment to EACH detail that has been
paid by the primary carrier
• When finished, submit the claim
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Claim Research and Resubmission
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Searching for Claims
OR
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Searching Claims
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Claim Search Results
Click the plus sign (+) to expand
information
Click Claim ID to view the claim
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Claim Search Detail Expanded
Expanding the window lets you see more of the claim
information without completely opening additional screens
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• Claim status
• Claim Explanation of Benefits
(EOB) information
• Claim Adjustment Reason
Codes
• Claim attachments
• Claim notes
• Copy denied claims for
correction
• Edit/void paid claims
Claim
Viewing by
Claim ID
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Correcting and Resubmitting Denied
Claims
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Copying Denied Claims
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Corrections to Paid Claims
Click on Claim ID to view the claim
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Corrections to Paid Claims – Void
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Confirmation
of Void
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Corrections to Paid Claims – Edit
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After making
desired
changes, click
“Resubmit”
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Helpful Tools
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Helpful Tools
• IHCP website at indianamedicaid.com
– IHCP Provider Reference Modules
– Medical Policy Manual
• Customer Assistance available 8am-6pm EST Monday –
Friday
– 1-800-457-4584
• IHCP Provider Relations Field Consultants
– See the Provider Relations Field Consultants page at
indianamedicaid.com
• Secure Correspondence via the Provider Healthcare
Portal
• Written Correspondence
– DXC Technology Provider Written Correspondence
P.O. Box 7263
Indianapolis, In 46207-7263
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QuestionsFollowing this session please review your schedule for the next session you
are registered to attend