Requirements to Dental Service Providers. If a PIHP subcontracts with a dental benefits administrator, the participating dentist has the right to appeal to both the PIHP and Department, according to the Department’s provider appeal requirements. This right to appeal is in addition to that of the provider’s right to appeal. PIHPs must pay at a minimum the Medicaid fee-for-service rates for dental services. Providers rendering services must be paid at a minimum the Medicaid fee-for-service rates.
Requirements to Dental Service Providers. If an HMO subcontracts with a dental benefits administrator, the participating dentist has the right to appeal to both the HMO and Department, according to the Department’s provider appeal requirements. This right to appeal is in addition to that of the provider’s right to appeal. HMOs must pay at a minimum the Medicaid fee-for-service rates for dental services. Providers rendering services must be paid at a minimum the Medicaid fee-for-service rates. HMOs must ensure their contracted Dental Benefits Administrator is compliant with the appeal rights and service coverage decisions required in this contract.
Requirements to Dental Service Providers. If a HMO subcontracts with a dental benefits administrator, the dental benefits administrator has the right to appeal to both the HMO and Department, according to the Department's provider appeal requirements. This right to appeal is in addition to that of the provider’s right to appeal. HMOs must pay at a minimum the Medicaid fee-for-service rates for dental services. Providers rendering services must be paid at a minimum the Medicaid fee-for-service rates. Responsibility for Payment of Orthodontic and Prosthodontic Treatment When There is an Eligibility Status Change During the Course of Treatment Who pays for completion of orthodontic and prosthodontic treatment* when there is an enrollment status change First HMO Second HMO FFS Person converts from one status to another: 1. FFS to the HMO covering dental. N/A X 2a. HMO covering dental to the HMO not covering dental, and person’s residence remains within 50 miles of the person’s residence when in the first HMO. X 2b. HMO covering dental to the HMO not covering dental, and person’s residence changes to greater than 50 miles of the person’s residence when in the first HMO. X 3a. HMO covering dental to the same or another HMO covering dental and the person’s residence remains within 50 miles of the residence when in the first HMO. X 3b. HMO covering dental to the same or another HMO covering dental and the person’s residence changes to greater than 50 miles of the residence when in the first HMO. X
Requirements to Dental Service Providers. If a PIHP subcontracts with a dental benefits administrator, the participating dentist has the right to appeal to both the PIHP and Department, according to the Department’s provider appeal requirements. This right to appeal is in addition to that of the provider’s right to appeal. PIHPs must pay at a minimum the Medicaid fee-for-service rates for dental services. Providers rendering services must be paid at a minimum the Medicaid fee-for-service rates. Responsibility for Payment of Orthodontic and Prosthodontic Treatment When There is an Eligibility Status Change During the Course of Treatment Who pays for completion of orthodontic and prosthodontic treatment* when there is an enrollment status change First PIHP Second PIHP FFS Person converts from one status to another: 1. FFS to the PIHP covering dental. N/A X 2a. PIHP covering dental to a PIHP not covering dental, and residence remains within 50 miles of the person’s residence when in the first PIHP. X 2b. PIHP covering dental to an PIHP not covering dental, and person’s residence changes to greater than 50 miles of the person’s residence when in the first PIHP. X 3a. PIHP covering dental to the same or another PIHP covering dental and the person’s residence remains within 50 miles of the person’s residence when in the first PIHP. X 3b. PIHP covering dental to the same PIHP or another PIHP covering dental and the person’s residence changes to greater than 50 miles of the residence when in the first PIHP. X
