UARTERLY ENTAL. Welcome to the New Dental Newsletter ACS FIELD REPRESENTATIVE VISITS

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1 Volume 1, Issue 1 April 200 ENTAL UARTERLY Welcome to the New Dental Newsletter Inside This Issue Introduction and Welcome ACS Field Representative Support and Visits Online Remittance Advices Medifax and Mevsnet.com Services Dental Claim Form 3 Maternal Dental Care Services Dental Claim Forms and Fee Schedules Common Dental Billing Problems WINASAP In an effort to improve communications and service to Wyoming dentists who participate in the Medicaid dental program, ACS, Medicaid, and the Dental Health office of the State Health Department are producing this quarterly newsletter. Hopefully, some of your questions and concerns can be addressed and changes in the program can be explained. Recently, the legislature appropriated additional money for the Medicaid dental program and earmarked it for fee increases. The Dental Health office is currently revising the Medicaid fee schedule which will be available July 1, 200. Additionally, we are currently reviewing the administration of the program and will be soliciting the advice and opinions of providing dentists. We look forward to hearing from you. Please feel free to contact the Dental Health office with your input. Grant Christensen, DDS Dental Programs Administrator ACS FIELD REPRESENTATIVE VISITS During the summer of 200, the ACS Field Representatives will be making individual visits to all actively enrolled dental providers in the state of Wyoming. The visits will give the providers an opportunity to ask questions regarding claims, payment, and any issues they may have regarding EqualityCare billing, in a face-to-face setting. The Field Representatives will go over claim denial rates, EqualityCare income from the current and previous year, and how to improve billing. Providers will receive phone calls from the Field Representatives in order to make appointments for the visits. Please have all pertinent information ready on the date the visit is scheduled; for example, any specific claims questions or issues, Remittance Advice s, etc.

2 ONLINE REMITTANCE ADVICES EqualityCare remittance advices are available online. In order to retrieve these, providers must be enrolled with ACS EDI Gateway, and receive a Trading Partner Identification Number from ACS EDI Gateway. The enrollment forms are available at Please follow the directions on this website. MEDIFAX AND MEVSNET.COM EqualityCare has an agreement with two vendors under which providers can check EqualityCare eligibility: Medifax provides a full-service swipe card reader for point-of-service transactions. There is a cost for the swipe card reader, plus a monthly cost, in addition to a transaction fee. Please call for more information. Mevsnet.com provides an Internet-based verification for EqualityCare, EqualityCare for Children and other Wyoming Department of Health programs. There is a monthly cost plus a transaction fee. Please call for more information. Automated Voice Response (AVR) System provides a service to the EqualityCare provider community by allowing direct access to the following information: Client eligibility status; Service limitations; Third party liability insurance company and policy number; Payment data; EqualityCare number and information; If you have a touch-tone telephone, ACS, Inc.'s Voice Response System provides a synthesized voice response to eligibility related inquires. You can access the system using the Client Identification Number and date of birth or Social Security Number and date of birth. Complete instructions are provided over the telephone. The AVR telephone number is or (307) Providers may also fax their eligibility questions on multiple clients to ACS. Please list the client's name, Client Identification Number or Social Security Number, and date of service you are inquiring eligibility for. This can be faxed to the attention of the Provider Relations Unit at (307) ACS will have up to 10 days to complete your request and have it returned to you. Page 2

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4 MATERNAL DENTAL CARE SERVICES We would like to thank all the dentists who participated in the Maternal Dental Care Services project. As you know, this was a pilot project undertaken to determine the value of eliminating dental infections as a part of decreasing the delivery of low birth weight babies in Wyoming. We have found that there are many unmet dental needs among this population and demand for services has far exceeded the budget allocated for the project. The funding for this project is close to being expended. Therefore, we have asked that no new treatment be started, no new patients be accepted under this project, and that the public health nurses discontinue referrals to dentists. The results of this project will be presented to Medicaid to prove the need for comprehensive dental care for all families, including pregnant women. DENTAL CLAIM FORMS AND FEE SCHEDULES The 2002 ADA dental claim form and 200 fee schedules are available on the Wyoming EqualityCare website, The claim form is available to download under the section titled forms. The fee schedules will be under the section titled publications. Please see enclosed 2002 ADA dental claim form for more detailed information. COMMON DENTAL BILLING PROBLEMS The following is a list of the top 5 dental billing errors EqualityCare providers experience: 1. Prophylaxis and fluoride treatments - these can be billed more than once every six months if medically necessary. Providers will need to attach the documentation of medical necessity to the claim form. Do not write notes on the actual claim form. 2. Make sure to always bill EqualityCare your usual and customary charges. 3. Make sure to always use 5-digit procedure/cdt codes.. Make sure your 9-digit EqualityCare provider number is on every claim in Box 9 of the claim form. If you are a group, make sure the group number and treating provider numbers are both on the claim. 5. Make sure the client s 10-digit EqualityCare number is on every claim in Box 23 of the claim form. Page

5 ARE YOU USING WINASAP 2003? ACS offers free software, WINASAP 2003, for providers wishing to send billing electronically. There are many benefits of our WINASAP 2003 software: Free software, training, and installation; Free claims submission 2 hours a day, 7 days a week; Free technical support from EDI Support Unit; Continued assistance from your Field Representative; HIPAA ready electronic claims portal WINASAP 2003 claims cannot be transmitted via DSL or Broadband connection. Providers must be enrolled with ACS EDI Gateway in order to bill claims electronically. In order to enroll with ACS EDI Gateway and obtain the WINASAP 2003 software, please go to com, or contact ACS EDI Gateway at for more information. ACS, Inc. P.O. Box 667 Cheyenne, WY Phone: (800) In Cheyenne: (307) Fax: (307) We re On the Web! acs-inc.com