Medicaid CONTINUED FROM PREVIOUS PAGE
Why are some services not covered by MO HealthNet? The Limited Adult Dental Benefit was approved in 2016, which allows partici- pants who are over 21, not blind, pregnant or residing in a nursing home to access dental benefits. Many health care professionals were involved in deciding what services should be included while considering the constraints of the budget. For example, some providers feel that D0120 is an essential service, but it is not part of the Limited Adult Dental Benefit at this time.
Can I provide a non-covered service to a participant? Yes. Providers can provide non- covered services, however; they can’t bill MO HealthNet. Billing for non-covered services may result in an overpayment, which is con- sidered improper billing.
Example: Many providers feel providing Silver diamine fluoride SDF (D1354) is a best prac- tice to help slow decay for patients, regard- less of age. But MO HealthNet covers this service only for participants ages 1-5.
Can I bill a participant for a non-covered ser- vice? Yes. Providers may bill a MO HealthNet participant for a non-covered service only if the participant signed a written statement, prior to receiving the service, indicating their understanding that MO HealthNet does not cover the service and that the participant ac- cepts financial responsibility for the service. The statement must include the date of service, the service for which the participant has accepted financial responsibility, the par- ticipant’s signature and the date signed. This should be maintained by the provider in the patient record. MO HealthNet has a resource for this, Participant Liability (Balance Billing) Hot Tip.
MO HealthNet provides a wealth of training and resources to educate providers about what services are covered. Providers are en- couraged to visit The MO HealthNet Educa- tion and Training page to enroll in trainings and access resources.
MO HealthNet is collaborating with the MDA, the Missouri Coalition of Oral Health
22 focus | NOV/DEC 2022 | ISSUE 6
and the Department of Health and Senior Services to increase access to care for all MO HealthNet participants—through increased provide enrollment. This collaboration will allow us to streamline our processes as well as provide resources and training to help providers be successful while they serve Missouri’s most vulnerable citizens.
REFERENCES
LINKS TO THE FOLLOWING RESOURCES REFERENCED IN THIS ARTICLE ALSO CAN BE FOUND AT
MODENTAL.ORG/MEDICAID.
1. Provide Resource Guide
dss.mo.gov/mhd/providers/ pdf/provider-resource-guide.pdf
2. eMOMED
emomed.com 3. Dental Benefit Table
dss.mo.gov/mhd/providers/ education/docs/Dental.pdf
4. Dental Provider Manual
manuals.momed.com/ collections/collection_den/print.pdf
5. Education & Training Page
dss.mo.gov/mhd/ providers/education/files/dental-policy-and-billing- resources.pdf
6. Participant Liability (Balance Billing)
dss.mo.gov/ mhd/providers/pages/
hot-tips-2020.htm#200610- participant-liability
Amanda Fahrendorf works in the MO HealthNet Education and Training Unit. Contact her at 573-751-0352 or amanda.
fahrendorf@dss.mo.gov. Visit
modental.org/medicaid for links to various resources and guides, useful phone numbers, emails and more.
modental.org/join-renew
ONLINE March 31 – Final Dues Deadline
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