Sni.l2!· Le Provider Bulletin - California

2!·sni.lleCALIFORNIA!MEDI· CAL HAS DENTAL COVEREDProviderBulletinFEBRUARY 2020Volume 36, Number 02THIS ISSUEpg 1New Resources for NationalChildren’s Dental Health Monthpg 2Beneft Reminder: Aid Codes2C, L6, and L7 underMedi-Cal Dentalpg 2Management of Patients’ DentalFear and Anxiety Resourcespg 32020 Medi-Cal DentalPayment Schedule Changespg 4Need to access your Medi-CalDental information? TheProvider Website Applicationmakes it quick and easy!pg 4Reminder: Outdated Versions ofTreatment AuthorizationRequest (TAR)/Claim Forms NoLonger Acceptedpg 5Reminder: Criteria Requirementsfor General Anesthesia andIntravenous SedationTRAINING SEMINARSTo reserve a spot online or to viewa complete list of training seminars,to go the Provider Training SeminarSchedule.New Resources forNational Children’s DentalHealth MonthThis February, celebrate National Children’s Dental HealthMonth with new Smile, California materials for the children inyour community. You can download the new children’s oralhealth lesson packages and pledge certifcates here. Thesepackages include age-appropriate activities and worksheetsdesigned to help children understand the importance ofgood oral health and regular dental check-ups. The Smile,California pledge certifcates are designed to promote andstrengthen children’s commitment to healthy dental habits.Once you’ve downloaded the lesson packages and pledgecertifcates, share how you’re using them in your practiceby posting photos on Facebook or Instagram using thehashtags: #SmileCalifornia and #NCDHM. Posting withthese hashtags gives you the chance to be featured on theSmile, California Facebook or Instagram and connects youwith other Medi-Cal dental providers celebrating NationalChildren’s Dental Health Month.PROVIDER ENROLLMENTASSISTANCE LINESpeak with an EnrollmentSpecialist. Go here for moreinformation.Available every Wednesday8am - 4pmContinued on pg 2www.denti-cal.ca.govPO BOX 15609, Sacramento, CA 95852-0509 (800) 423-0507Copyright 2018 State of CaliforniaProvider Bulletin, February 2020 1

Benefit Reminder: Aid Codes 2C, L6, and L7under Medi-Cal DentalEfective October 1, 2019, as announced in Provider Bulletin Volume 35, Number 35, aidcode 2C was changed from a non-dental beneft aid code to a full scope beneft aid codewith no share of cost.Additionally, as part of the Afordable Care Act expansion, efective October 1, 2019, aidcode L6 was added as a full scope aid code with no share of cost, and aid code L7 wasadded as a restricted/limited aid code with no share of cost.The aid code descriptions are as follows:AidCodeBeneftsSOC Program/Description2CFull ScopeNoL6Full ScopeNoL7Restricted orlimited beneftsNoCCHIP above 266% - 322% FPL, age 0 19Disabled/Blind 19 through to 65 at or below 128% FPLCitizenDisabled/Blind 19 up to 65 at or below 128% FPLundocumentedTo treat these members, dental providers must be enrolled in Medi-Cal and must confrmthe children are transitioned into Medi-Cal by viewing their eligibility status. Providerscan verify eligibility through the Medi-Cal website or the Automated Eligibility VerifcationSystem (AEVS). For more information on member eligibility, please refer to the Medi-CalDental Provider Handbook, Section 4 - Treating Benefciaries, pages 4-3 through 4-5.Medi-Cal Dental providers must bill the Medi-Cal program for dental services according tothe criteria outlined in the Provider Handbook, Section 5 - Manual of Criteria and Scheduleof Maximum Allowances.Don’t miss out on serving these members by getting your name on the Patient Referral List!Sign up by clicking here, complete the form and send it in. If you have any questions aboutMedi-Cal Dental, please call the Telephone Service Center at (800) 423-0507.Management of Patients’ Dental Fear andAnxiety ResourcesThe Department of Health Care Services encourages Medi-Cal patients to utilize theircovered dental beneft. However, some patients do not access this beneft due to fear andanxiety over dental treatment.The American Dental Education Association (ADEA), currently ofers a free AmericanDental Association (ADA) accredited Continuing Education webinar titled UnderstandingContinued on pg 3www.denti-cal.ca.govProvider Bulletin, February 2020 2

and Managing Dental Fear and Anxiety (1 credit hour). Providers do not have to be amember of the ADEA or the ADA but are required to create a free login to access thewebinar. The course is available as a recording with a PowerPoint presentation referenceguide. During the webinar recording, Dr. Cameron Randall ofers a psychologicalperspective on the role that pain, fear and anxiety can play in oral health as well asassociated non-pharmacological management strategies.This helpful resource for providers can be accessed viders can also refer patients to view the Dental Visits tab on SmileCalifornia.org, wherethey can learn fve quick tips about overcoming anxiety and what to expect during the visit.2020 Medi-Cal DentalPayment Schedule ChangesThe Medi-Cal Dental payment schedule will be adjusted at various times throughout the2020 calendar year. Below is a complete list of the 2020 payment schedule changes.Please note: Providers who receive payments via Electronic Funds Transfer (EFT) may notreceive payment until the following Monday.2020 Medi-Cal Dental Payment Schedule ChangesAdjusted ForWeek OfPayment Issue DateMartin Luther King Jr. DayPresident’s DayCaesar Chavez HolidayMemorial DayLabor DayColumbus DayVeteran’s DayThanksgiving HolidayJanuary 20, 2020February 17, 2020March 30, 2020May 25, 2020September 7, 2020October 12, 2020November 9, 2020November 23, 2020January 24, 2020February 21, 2020April 3, 2020May 29, 2020September 11, 2020October 16, 2020November 13, 2020November 27, 2020Please check the Medi-Cal Dental website for future notifcations. For questions, please callthe Telephone Service Center at (800) 423-0507.Continued on pg 4www.denti-cal.ca.govProvider Bulletin, February 2020 3

Need to access your Medi-Cal Dentalinformation? The Provider WebsiteApplication makes it quick and easy!Save time by accessing your Medi-Cal Dental information with the Provider WebsiteApplication. You and your staf can securely login to view: Claim Status and History Treatment Authorization Request Status and History Weekly Check Amounts Monthly Payment Totals and Year-to-Date PaymentsThe Provider Website Application is even mobile friendly, so you can stay updated on thego. Need help getting started? Check out the Provider Website Application User Guide forstep-by-step instructions on how to create an account.Reminder: Outdated Versions of TreatmentAuthorization Request (TAR)/Claim FormsNo Longer AcceptedMedi-Cal Dental is decommissioning outdated versions of the Treatment AuthorizationRequest (TAR)/Claim form. As a reminder, efective January 30, 20202020, providers must usea current version of the TAR/Claim form when submitting to Medi-Cal Dental. The currentTAR/Claim form numbers and revision dates are: DC-202 (R 08/13) and (R 10/19) - for flling in by hand DC-209 (R 07/13) and (R 10/19) - for pin-fed printers DC-217 (R 9/13) and (R 10/19) - for laser printersProviders can confrm that they are using the most current version by checking the revisiondate at the bottom of the form. If you have outdated TAR/Claim forms in your dental ofce,please recycle the old forms and reorder new ones.To order current TAR/Claim forms, please complete and fax the Forms Reorder Request tothe number on the form. Providers can fnd the Forms Reorder Request on the Medi-CalDental website here.For information on how to complete the TAR/Claim form, please refer to the ProviderHandbook Section 6 - Forms, pages 6-6 and 6-7. For questions about the TAR/Claim formdecommissioning efort, please contact the Telephone Service Center at (800) 423-0507.Continued on pg 5www.denti-cal.ca.govProvider Bulletin, February 2020 4

Reminder: Criteria Requirements forGeneral Anesthesiaand Intravenous SedationEfective November 1, 2015, criteria and guidelines were developed by the Department ofHealth Care Services (DHCS) for Intravenous Conscious Sedation/Analgesia (proceduresD9241/D9242) and Deep Sedation/General Anesthesia (procedures D9220/D9221). Thesepolicies are currently in efect across all delivery systems in medical and dental programs.Providers rendering general anesthesia (GA) and intravenous (IV) sedation servicesare required to submit Treatment Authorization Requests (TARs). The TARs should besubmitted with documentation justifying the medical necessity for the IV Sedation/GA.Please note, the submission and criteria requirements outlined in the Manual of Criteria(MOC) will not be updated until the implementation of CDT-19 occurs. Providers arerequired to abide by the updated requirements outlined in Provider BulletinVolume 31, Number 21 along with the attached fowchart to be used in conjunction with theDental GA/IV Sedation policy.The fowchart was developed to aid and ensure that providers are submitting appropriatedocumentation to justify medical necessity of the IV Sedation or GA. Each case requiring IVSedation/GA is unique and should be evaluated as such. Although standard forms may beused to document the medical necessity for IV Sedation/GA, it is imperative that providerssubmit additional documentation that is specifc to the case. If a dental treatment plan isavailable, it should be included with the justifcation for the IV Sedation/GA.For more information, please call the Telephone Service Center at (800) 423-0507.www.denti-cal.ca.govProvider Bulletin, February 2020 5

i.'HCSCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESTreatment Authorization Request (TAR) submitted for Intravenous Sedation or GeneralAnesthesiaDocumentationprovided mustsupport/justifythe need for theconsideration ofusing IV Sedationor GA.Effective communicativetechniques and the abilityfor immobilization failedor was not feasible basedon the medical needs ofthe patient.Documentationprovided mustsupport/justify theneed for theconsideration of usingIV Sedation or GA.Health Care .Services#1/2 Local Anesthesia/conscious sedation(oral/inhalation) was not feasible#1/2 Local Anesthesia/conscious sedation(oral/inhalation) failed#3ICIIUQr,.I 01p rijl'll'! 1U U ol#4Requires extensive dentalrestorative treatment orsurgical treatment thatcannot be rendered underlocal anesthesia orconscious sedation.Submitted documentationoutlines the extensivetreatment or surgicaltreatment plan based onradiographs or visual exam(if unable to obtainradiographs) of thereferring Dentist.#5#6Patient has acute situationalanxiety due to immaturecognitive functioning.Patient isuncooperative due tocertain physical ormentalcompromisingconditions.Submitted documentationindicates the patient isuncooperative due tocognitive immaturitywhereby they are unableto follow commands fromprovider rendering theneeded dental/surgicalinterventions.Documentationprovided mustsupport/justify theneed for theconsideration ofusing IV Sedationor GA.When a provider determines that a beneficiary meets one of the criteria of 3-6, it is not automatically considered to be documentation that conscious sedation orIV sedation was not feasible; rather the submitted documentation of the criteria that was met must be clearly stated in the patient’s records and the submitteddocumentation requesting GA must clearly demonstrate the need for this covered benefit.April 2017