Colorado Summit. Updates for Providers in the Health First Colorado Dental Program Vol July New Provider Portal

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1 Colorado Summit Updates for Providers in the Health First Colorado Dental Program Vol July 2018 This issue of the Colorado Summit will cover the following: Testimonial New DentaQuest Provider Portal Receiving payment for claims with HCPF when eligibility shows in HCPF Portal, but not the DentaQuest Portal Diabetes and the Dental Clinician Sealant Champion Provider Training Opportunity New Provider Portal In August 2018, DentaQuest is launching our new provider portal for Colorado. The provider portal offers a variety of resources to make day-today functionality easy and effective. Our enhanced interface includes an intuitive landing page customized task starters. These task starters provide access to key functions including claims processing and information on member eligibility. Important notifications will display on the landing page, and live chat will be available for quick answers to questions. DentaQuest, with Richard Spencer as our representative, has made a world of difference in our experience with Medicaid. Using the clearly written criteria, I can confidently screen patients for orthodontic treatment and successfully ascertain whether or not they will qualify for Medicaid coverage. Approvals for care arrive in a timely manner and payment is provided also in a timely manner. Medicaid also provides an avenue for our cleft and craniofacial deformity patients to receive truly life changing care within our team environment. The switch to DentaQuest is a good example of government and a private contractor working together to serve the citizens of this State. Mark J. Bentele, DDS, MS

2 The portal will offer other additional benefits, including streamlined claims management with single and batch upload ability, as well as enhanced search options for information on member eligibility, explanation of benefits, and pre-authorizations. We are revolutionizing oral health by making preventive dental care easy and effective. Our portal is just the beginning of how we are transforming the way we provide quality access to members. The new provider portal will be launched in two separate groups with the following registration dates: Group 1 Registration Dates: 8/13 8/24 Group 2 Registration Dates: 8/27 9/7 The registration groups will be split by counties associated with the tax ID of the primary location. We will be sending out a fax blast informing you of which group your office belongs in. The DentaQuest Colorado Provider Relation Representatives will be holding in-person trainings along with scheduled webinars educating you on the new provider portal. You will find the training dates and locations on our website as well as an upcoming fax blast. Please reach out to your provider relations representative with any questions: Central & Northeastern Colorado Lisa Larkin-Allen Lisa.Larkin-Allen@dentaquest.com Western Colorado Christie Robson Christie.Robson@dentaquest.com Central & Southeastern Colorado Richard Spencer Richard.Spencer@dentaquest.com Receiving payment for claims when eligibility shows in the HCPF Portal, but not the DentaQuest Portal While Health First Colorado (Colorado s Medicaid Program) makes every effort to send timely and accurate eligibility information to DentaQuest, the DentaQuest portal may not always reflect accurate eligibility information. The Health First Colorado Portal is the system of record and must be used to verify eligibility. Please see Section 1.04 of the ORM for details. If a provider checks the Health First Colorado portal on the date of service and copies down the guarantee number or takes a screen shot of the member s active eligibility, this can be submitted with an appeal if the claim is denied for eligibility.

3 If the denied claim is appealed with a guarantee number or screen shot showing the member was eligible on the DOS in the HCPF portal, DentaQuest will reverse the eligibility denial. On the rare occasion the member s eligibility has never been sent to DentaQuest, the appeal will be processed when the member s eligibility is sent from Health First Colorado to DentaQuest. At that time, the appeal will be processed. Diabetes and the Dental Clinician Diabetes affects over 9% of Colorado s population and the American Diabetes Association estimates that an additional 35% of Coloradans show signs of prediabetes. The complications associated with diabetes are diverse and affect the whole body, including the mouth. With the addition of D0411 (HbA1c testing) to the 2018 CDT codes, management of diabetic patients is more accessible than ever. Members with diabetes and pre-diabetes have unique oral health issues and may require additional treatment protocol. Dental professionals are able to contribute to the overall health of patients by implementing successful diabetic screening and referral protocols. Identifying pre-diabetes or diabetes through these screenings can help patients avoid or manage the often severe health consequences that can accompany this chronic condition. An understanding of basic diabetic risk factors provides a foundation for identifying patients with undiagnosed diabetes, those with diabetes that may be poorly controlled, and prevention of diabetic emergencies in the dental office. Type II Diabetes Risk Factors Obesity Age 45 or older Family history of diabetes High blood pressure High cholesterol Heart Attack/Stroke Sedentary lifestyle History of gestational diabetes African American, Hispanic/Latino, Asian American, American Indian, Alaskan Native, Pacific Islander, or Hawaiian Native descent Depression Polycystic Ovary Syndrome Acanthosis Nigricans Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). In the coming months, DentaQuest will be sending out information on the prevalence, costs and health consequences of diabetes, the importance of and information regarding the new testing code D0411, and your role in supporting the diabetic patient in the dental office. We encourage you to review the information and to understand how this new code might benefit your patients.

4 Sealant Champion DentaQuest would like to introduce our Health First Colorado Sealant Champions for the quarter, Dr. Mark Montano and Dr. Melissa Talbot! Dr. Montano and Dr. Talbot are not only family, they are twins that own a practice together in the Fountain area, and will be opening a second location in Falcon. While working in their practice they have done an amazing job making sure sealants are placed whenever clinically possible. Dr. Montano has a sealant utilization rate of 63% and Dr. Talbot has a sealant utilization rate of 59%. These rates are outstanding; the Health First Colorado average rate of sealants is less than 20%. We applaud their dedicated to the Health First Colorado children. Please join us in thanking Dr. Mark Montano and Dr. Melissa Talbot for all of their hard work. Provider Training Opportunity Adverse Childhood Experiences: Foundation for Trauma Informed Care For Dental Professionals (2.0 CE) August 31, 2018, 10:00 AM 12:00 PM Penrose House 1661 Mesa Avenue, Colorado Springs

5 This training session examines the science behind the Adverse Childhood Experiences (ACE) Study and its relationship to an individual's overall health and well-being. It demonstrates the intricacies between ACEs and an individual's propensity for developing chronic disease including cardiovascular, liver and respiratory diseases. This session also exposes the strength of ACEs as a social determinant to better understand and treat your patient s physical and mental health. Objectives: Upon completion of this 1.5 hours training, participants will be able to: 1. Understand the basic biology of the effects of childhood trauma on neurodevelopment. 2. Understand that Adverse Childhood Experiences (ACEs) are common and highly interrelated. 3. Understand dose-response related to many health and social problems and the collective impact of cumulative stress. 4. Understand life-long effects of ACE s and relationship of ACE score to health, mental/behavioral health and social problems. 5. Understand the intergenerational aspects of ACEs. 6. Explore the concept of Trauma Informed Care. This training is led by Kathy Orr, RN BSN, Executive Director of Peaceful Households and an ACE Interface Master Trainer. Two CE credits will be awarded upon completion of the training. Learn more and register her:e ( Participants: Continuing education credits issued for participation in the CE activity may not apply toward license renewal in all licensing jurisdictions. It is the responsibility of each participant to verify the CE requirements of his/her licensing or regulatory agency. Colorado Dental Association is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it ply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at