Colorado Summit. Updates for Providers in the Colorado Medicaid Dental Program. This issue of the Colorado Summit will cover the following:

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1 Colorado Summit Updates for Providers in the Colorado Medicaid Dental Program Vol. 6 October 2015 This issue of the Colorado Summit will cover the following: Provider Revalidation Dental Hygiene Providers DentaQuest Launches Preventistry SM Program Collaboration with Medical Community Aims to Increase Oral Health Prevention DentaQuest Out and About Colorado Pay for Performance Update Periodontal Treatment Reminder Provider Revalidation Reminder Colorado Medicaid Provider Revalidation & Enrollment Began September 15, 2015 New federal regulations established by the Centers for Medicare and Medicaid Services (CMS) require enhanced screening and revalidation for all Medicare, Medicaid, and CHP+ providers. All Colorado providers who want to continue, or begin, providing services to Medicaid and CHP+ members after March 31, 2016, will be required to be validated and enrolled under new federal enrollment screening criteria. To meet these new requirements, Colorado providers must revalidate using the new Online Provider Enrollment (OPE) tool. The Department of Health Care Policy and Financing (the Department) asks that providers complete your revalidation during your assigned revalidation and enrollment wave. Visit the provider resources page for more specific information at or at Providers who fail to revalidate and enroll by March 31, 2016 may have their claims suspended or denied. Dental Hygiene Providers As a reminder to all Colorado Medicaid Registered Dental Hygienists (RDHs), please review section Direct Access/Independent Dental Hygiene Providers of the Office Reference Manual (ORM) for the current list of allowable CDT codes for reimbursement. RDHs are responsible for knowing the Prior Authorization Request

2 (PAR) requirements and benefit limitations for the various Medicaid client groups with dental benefits. Please call your Provider Relations Representative if you need additional clarification regarding RDH billing guidance. Additional resources for Providers are available to help define periodontal stages and clinical conditions and classifications for: Healthy, Gingivitis, Slight Periodontitis, Moderate Periodontitis, Advanced Periodontitis, and Aggressive/Refractory Periodontitis. Some of the clinical indicators should include: Pocket Depth, Bleeding On Probing (BOP), Six-Point Probing, Bone loss, Graded Tooth Mobility, Graded Furcation, Clinical Attachment Loss (CAL), and the appropriate CDT codes for: Assessment, Active Therapy, and Ongoing Maintenance. Treatment and billing must be within the Colorado Department of Regulatory Agency rules regarding scope of practice and can be found on line by visiting, DentaQuest Launches the Preventistry SM Program in Colorado DentaQuest is proud to announce the launch of their Preventistry SM Program, in partnership with the Colorado Department of Health Care Policy and Financing. Preventistry is a unique program designed to help providers increase the number of children in their practice receiving sealants and topical fluoride applications. In the coming month, each Colorado Medicaid provider will receive a Preventistry program toolkit in the mail. These kits will include all of the information you need to implement this important program within your practice, and greatly improve the oral health of your clients enrolled in the Colorado Medicaid Dental Program. If you would like more information on this program, or do not receive your toolkit, please call Nancy Greene, DentaQuest Outreach and Education Coordinator at Collaboration with Medical Community Aims to Increase Oral Health Prevention In an effort to increase Early Periodic Screening and Diagnostic Treatment (EPSDT) dental services for children, DentaQuest has launched the Primary Care Provider Integration Program. This program makes it easy for Primary Care Providers (PCPs) to encourage their pediatric patients and their parents or guardians to be seen on a regular basis for preventive and diagnostic dental services. Medical offices are provided with dental referral prescription pads (50 tear-off pages) that can be given out during medical visits encouraging parents or guardians to make a dental appointment for their child. Because families with young children are more likely to visit their PCP office, this program reinforces the message that oral health care is important, and impacts overall health and well-being. DentaQuest is also distributing these tear-off pads to WIC Clinics, Head Start programs, Nurse Family Partnership staff and many other community partners in an effort to increase referrals. If your office notices an increase in parents or guardians wanting to schedule an appointment for their infant, please be reminded that this is in accordance with American Academy of Pediatrics (AAP) and American Academy of Pediatric Dentistry (AAPD) recommendations that a child have their first dental visit by age 1. If you work closely with a Primary Care Provider, or other health care professionals that would benefit from having these prescription pads, please call Nancy Greene, DentaQuest Outreach and Education Coordinator at

3 DentaQuest Out and About KINDness Gala, September 18, 2015 DentaQuest Diamond Sponsor DentaQuest was proud to be a part of this special event that celebrated the many individuals, sponsors, corporations and volunteers who support Kids In Need of Dentistry. Kids In Need of Dentistry s mission is to increase the health and happiness of Colorado s children in need by eliminating dental disease through treatment and education. DentaQuest was honored to be a part of the special evening. Pictured above from L to R: Richard Spencer (Southeastern Colorado PR Representative), Lisa Larkin-Allen (Northern Denver Metro PR Representative), Betsy Holman (Colorado Outreach Representative), and Nancy Greene (Outreach Coordinator). Colorado Pay for Performance Update DentaQuest has processed the first payments and will continue on a monthly basis moving forward. As a reminder for providers, the Take 5 Program payments will be made by DentaQuest via paper checks that will be mailed to the billing entities on behalf of the rendering providers. DentaQuest wants to ensure that all providers are compensated appropriately based on whether or not the program s metric(s) were met. Due to the complexity of the federal reporting requirements associated with data that is being reviewed, providers not receiving payment in the first check run may receive payment in a future run. DentaQuest has posted individualized reports that outline each provider s payments and progress on the provider portal. These reports will be updated monthly. Instructions on how to locate provider reports are on the next page. Please contact your PR representative if there are any questions or concerns, thank you.

4 How to find your Pay for Performance ( Take 5 ) Reports on the Provider Web Portal Step 1: Step 2: Log into the Provider web portal On the Home page click on the Link called Related Documents located on the right hand side of your screen (under the picture and hyperlink for the Event Calendar ) This link will take you to the Document List page Step 3: At this Document List page, choose Pay for Performance (Take 5) from the File Detail Category drop down box, and then click the Search button located at the bottom center of the screen.

5 If you need additional assistance with your Pay for Performance (Take 5) report, please contact your Provider Relations Representative or call DentaQuest Provider Services at Periodontal Treatment Reminder Colorado Medicaid Dental Providers are asked to please review the Criteria for Periodontal Treatment in Section of the current Colorado Medicaid DentaQuest Office Reference Manual. This criteria, as published previously, must be met for all Colorado Medicaid members, including DIDD members Criteria for Periodontal Treatment (as outlined in the current ORM) Complete periodontal charting indicating abnormal pocket depths in multiple sites, PSR is not acceptable American Academy of Periodontology (AAP) Case Type should be included in the charting Radiographs Periapicals or Bitewings preferred Additionally at least one of the following must be present: o Radiographic evidence of root surface calculus. o Radiographic evidence of noticeable loss of bone support (2.5 mm or greater from the CEJ) Maximum of two (2) quadrants per date of service is allowed except in a hospital/asc setting Not allowed if there is a history of gingivectomy (D4211 and/or D4212) provided in the past 12 months in the same quadrant Prophylaxis (D1110 and/or D1120) is not paid on the same day as periodontal scaling and root planning (D4341 and/or D4342). Periodontal scaling is a treatment procedure involving instrumentation of the crown and root surfaces of the teeth to remove plaque, calculus, and stains from these surfaces. It is performed on patients with periodontal disease and is therapeutic, not prophylactic, in nature. Periodontal scaling may precede root planing, which is the definitive, meticulous treatment procedure to remove cementum and/or dentin that is rough and may be permeated by calculus, or contaminated with toxins or microorganisms. Periodontal scaling and root planing are arduous and time consuming. They may need to be repeated and may require local anesthetic. Some of the clinical indicators should include: Pocket Depth, Bleeding On Probing (BOP), Six-Point Probing, Bone loss, Graded Tooth Mobility, Graded Furcation, Clinical Attachment Loss (CAL), and the appropriate CDT codes for: Assessment, Active Therapy, and Ongoing Maintenance. The ORM can be found on the Provider s web portal, as well as on the DentaQuest Colorado Provider s webpage under the DentaQuest Resources header. For additional assistance, please contact your Provider Relations Representative.