dental billing tips, claim submission, and research tools billing... · dental billing tips, claim...

Indiana Health Coverage Programs

DXC Technology

Dental Billing Tips, Claim

Submission, and

Research Tools

October 2017

2

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