E-News May 21, 2015

Update on third party issues

WVDA continues its efforts to resolve dentists’ concerns with various third party payers and administrators. This past week demonstrates some of those efforts.

Executive Director Richard Stevens met May 19 with Delta Dental officials to discuss its reimbursement to dentists. Stevens contended that fees can be increased without increasing premiums to policyholders, based on Delta’s filings with the WV Insurance Commission. He was informed that Delta will review reimbursement and claims experience during the third quarter of this year (July, August and Sept.) then make a decision on what increases can be made.

Dr. Carol Buffington, WVDA representative to WV Medicaid, and Stevens met with agency officials and representatives of the managed care organizations, May 20. Reimbursement being “put on hold” was discussed. According to agency officials some dentists did not send copies of their WV licenses to the agency in a timely manner, resulting in their not being paid for services. The submission of a copy of license is required by federal Medicaid before the agency can authorize payments. Dentists are reminded to send the agency a copy of their license as soon as it is received from the Board of Dentistry to avoid being “put on hold” and not paid.

Apparently, Scion Dental has different terminology (CDT numbers) for fluoride than the ADA publishes in the CDT manual. This will be corrected, according to Richard Grooms, Provider Relations Field Representative for Scion. His Cell number is 304-860-5153, and email: [email protected]

Considerable discussion centered on the Web portal. Dr. Buffington said considerable time is being spent by staff on the telephone to verify eligibility when the Web portal is down. Chief Information Officer Edward Dolly said their monitoring of the Web portal does not reveal it be down for any great periods of time. Dentists having problems with the Web portal may call Mr. Dolly 304-558-5906 or email him at: [email protected]

Coventry Director of Network Management Michelle Coon informed WVDA that it will begin paying for selected preventive services to pregnant women over 21 years of age beginning June 1. Dentists may call her 304-348-2017 or email: [email protected]

The issue of treating emergencies was discussed with Christy Donohue of The Health Plan, which requires prior authorization for more than two
extractions. Dr. Buffington and Stevens said patients in pain with abscess cannot wait for a prior authorization. Dentists having this problem can call her 304-720-4923 or email: [email protected]

Lastly…Medicare enroll or opt-out. WVDA obtained a “Q&A” from Kathy Boehm, Provider Outreach, for Palmetto GBA, which is the Medicare
administrator for WV, Virginia, North Carolina and South Carolina. The “Q&A” is published in the forthcoming issue of WVDA News. Dentists
may call Kathy at 804-440-8366 for additional questions.

WVDA office will be closed May 25 for Memorial holiday.