Dental. I H C P A n n u a l S e m i n a r

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1 Dental I H C P A n n u a l S e m i n a r

2 CareSource & Scion Dental CareSource has partnered with Scion Dental to enhance efficiency and consistency of our Dental Management Services. Scion handles: Claims payment Prior Authorization Electronic Funds Transfer (EFT) Portal issues CareSource handles: Member related concerns such as claim issues, covered services and patient eligibility Contracting with dental health partners 2

3 Routine Dental Care Coverage Overview Hoosier Healthwise Office Visits/Hospital Package A Package C Package P Prior Authorization Needed? Dental Care Yes Yes Yes Prior authorization needed for dental care in hospitals and ambulatory surgery centers Healthy Indiana Plan (HIP) Specialty Services Dental Care HIP Plus Yes, periodic exams covered every 6 months; no limit on filings or extractions HIP Basic No HIP Maternity HIP State Plan Prior Authorization Yes, periodic exams covered every 6 months Plus Yes, periodic exams covered every 6 months Basic Yes, periodic exams covered every 6 months Yes, for dental care in hospitals and ambulatory surgery centers 3

4 Verifying Eligibility Verify eligibility before every visit. Use the Scion Provider Portal or CareSource Provider Portal to verify eligibility. Upon logging into the CareSource Provider Portal, dental providers will be able to view member eligibility with: 24 months of history Member span information Multiple member look-up (up to 500) 4

5 Dental Services That Require Prior Authorization Orthodontia treatment Complete dentures and partial dentures Frenulectomy/frenulotomy Periodontal treatment All unspecified and miscellaneous dental codes CareSource follows the Indiana Administrative Code Rule for Medicaid Services definition of medically necessary services for coverage determinations (405 IAC ). *For the dental services listed above that require prior authorization, CareSource utilizes the dental criterion defined in the Dental Services Provider Reference Module located at 5

6 Scion Dental Provider Portal CareSource now offers a Dental Provider Web Portal. Just log in to the CareSource Provider Portal, click on the Dental Provider Login link under the Providers heading, and register to use the Portal. The portal can also be accessed at 6

7 Scion Dental Provider Portal Functions Some of the time-saving functions of the Dental Provider Web Portal include: View member service history, covered benefits and fee schedules Create a member eligibility calendar and view real-time eligibility for multiple members View authorization guidelines and required documentation prior to submitting authorizations`` Submit authorizations with attachments for faster determinations For member eligibility verification and dental history (including the specific tooth and four surface areas to all dental procedure codes), you may also visit the CareSource Provider Portal at 7

8 Scion Dental Portal Questions? Contact the web portal team at for issues related to Portal access. 8

9 Dental Claims Online: Dental health partners may submit claims online at Electronic Data Interchange (EDI) Payer ID = INCS1 Paper: CareSource Attn: Claims Department P.O. Box 3607 Da yton, OH Contact CareSource Health Partner Services at for any questions regarding paper claim submissions. 9

10 Electronic Funds Transfer (EFT) We encourage our dental health partners to enroll in Scion Dental s Electronic Funds Transfer (EFT) to enjoy efficient and reliable claim payments. Visit to enroll for EFT payments (registration on the Dental Portal is required). 10

11 Prior Authorization Online: Dental health partners may submit prior authorizations online at Paper: CareSource IN: Authorizations P.O. Box 745 Milwaukee, WI, Contact CareSource Health Partner Services at for any questions regarding prior authorizations. 11

12 How to Reach Us Provider Services Hours Monday to Friday 8 a.m. to 8 p.m. (EST) Member Services Hours Monday to Friday 8 a.m. to 8 p.m. (EST) 12

13 DENISE EDICK ENGAGEMENT SPECIALIST MELISSA KAMEN TONYA THOMPSON SUSAN SCHURMAN TROY MCKINLEY PAULA DRYE Manager, Health Partnerships ASSIGNED COUNTIES / HEALTH SYSTEMS IU Health and Suburban Health Organization Engagement Specialist Assignments Counties: Benton, Cass, Fulton, Jasper, Lake, LaPorte, Marshall, Newton, Porter, Pulaski, Starke, White Health Systems: Franciscan & Beacon Health Systems Counties: Adams, Allen, DeKalb, Elkhart, Huntington, Kosciusko, LaGrange, Miami, Noble, St. Joseph, Steuben, Wabash, Wells, Whitley Health Systems: Parkview, Lutheran & SJRMC Counties: Bartholomew, Blackford, Decatur, Delaware, Fayette, Franklin, Grant, Henry, Jay, Madison, Randolph, Rush, Union, Wayne Health Systems: Community Health Network Counties: Boone, Hamilton, Hendricks, Johnson, Marion, Hancock, Morgan and Shelby AMY WILLIAMS amy.williams@caresource.com BONNIE WAELDE bonnie.waelde@caresource.com VACANT ANGELINA WARREN angelina.warren@caresource.com 13 Counties: Brown, Carroll, Clay, Clinton, Fountain, Howard, Monroe, Montgomery, Owen, Parke, Putnam, Tippecanoe, Tipton, Vermillion, Vigo, Warren Health System: American Health Network & Eskanazi Health Counties: Daviess, Dubois, Gibson, Greene, Knox, Lawrence, Martin, Perry, Pike, Posey, Spencer, Sullivan, Vanderburgh, Warrick Health System: Deaconess & St. Vincent Health Counties: Clark, Crawford, Dearborn, Floyd, Harrison, Jackson, Jefferson, Jennings, Ohio, Orange, Ripley, Scott, Switzerland, Washington Health System: KentuckyOne & Norton Health Statewide Behavioral Health CONTRACTING MANAGERS HOSPITALS / LARGE HEALTH SYSTEMS MANDY BRATTON mandy.bratton@caresource.com TENISE HILL tenise.hill@caresource.com

14 Thank You! 14 IN-P-0281; Date Issued: 10/17/17 Date Approved: 9/18/17

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