Delaware Medicaid Dental Fee Schedule


If Medicaid Is The Secondary Payer Will Medicare Cross The Claim Over To Us

Impact of the CY 2022 Medicare Physician Fee Schedule Final Rule On PT And OT Assistants Services

Providers should submit secondary claims to AmeriHealth Caritas Delaware. We will accept TPL claims with the primary insurer EOB electronically or via paper. Please submit TPL claims within 60 days of the date on the EOB claim. We will be accepting claims directly from Medicare when we are the secondary payer.

West Dover Dental Llc

Since opening our doors in 2015, West Dover Dental, LLC. has been providing Delawareans and residents of the surrounding area with excellent dental care. We continue to grow thanks to our amazing patients spreading the word of how much they love their smiles! We understand that scheduling visits for you and your family can be difficult due to your varying dental needs. We specialize in all aspects of dentistry so we can be your one-stop-dental-care-shop for the whole family!

Medicaid Adult Dental Services

Correction Posted 10/06/2020

An announcement posted on the State of Delaware/DHSS website announcing Medicaid’s new adult benefit contained incorrect information regarding the age group for adult dental benefits.

This announcement indicated that beginning October 1, 2020 individual’s age 19-65 who are enrolled in managed care would receive their adult dental services through their managed care organization. This information is incorrect.

The adult dental benefit begins at age 21 not 19 as described in this announcement. Adults age 19-20 will continue to receive their dental benefits through the FFS program.

There is no age limit on who can receive adult dental services. Adults over the age of 65 may receive adult dental services.

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Lack Of Dental Coverage For Low

Thanks to Delawares 2014 Medicaid expansion, tens of thousands of low-income adults in Delaware were able to access preventive medical services. But one piece was missing: dental coverage.

The lack of affordable dental coverage results in real costs to peoples health and finances — and to the state.

A few years ago, Bear resident Jessica Favacchia was struggling to find a dentist for her mother, Janice, who has Alzheimers disease and lives in a nursing home.

Definitely caused her pain,” Jessica said. “And you can see that she now even still, she has very sensitive teeth so cold drinks and things like that, she winces. So she still has pain.

The federal government leaves it up to states to decide whether they will cover dental services for those on Medicaid. Delaware opts not to offer dental coverage. AmeriHealth has a Medicaid plan that offers dental. But that benefit only helps 957 Delawareans.

Poor oral health can take a toll financially and on a persons health.

Data from the Center for Health Care Strategies shows Delaware and just two other states, Tennessee and Alabama, dont provide dental coverage for low-income adults. Delawares decision impacts about 146,790 adults on Medicaid.

Christiana Care Health System has a dental clinic and an oral and maxillofacial surgery program that can see patients who present with emergency issues.

Werner adds that people with chronic diseases like diabetes who neglect their mouth can make their health conditions worse.

Delaware Medicaid Patients Now Receive Dental Coverage

DSS press release

Adult Medicaid patients in Delaware will automatically receive dental coverage as part of their health insurance plans beginning Oct. 1, according to the Delaware Department of Health and Social Services.

Medicaid patients ages 19 to 65 will now receive dental coverage through their plans and can access a list of providers from their managed-care organization. The benefits will cover services such as cleaning, fillings, exams, tooth extraction and sedation.

Each adult Medicaid patient will receive up to $1,000 of dental care annually, and they may qualify for an additional $1,500 per year in the case of an emergency.

“We know that low-income adults suffer disproportionately from dental disease and that poor oral health can increase risks for people with conditions like diabetes and heart disease, DHSS Secretary Molly Magarik said in a Sept. 29 news release. “This new benefit will go a long way toward improving the overall health of Medicaid recipients in Delaware.”

In August 2019, Gov. John Carney signed legislation giving adult Medicaid patients dental benefits. It was slated to take effect in April, but the implementation was pushed back due to the pandemic.

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Read Also: Is There Dental Coverage With Medicaid

Get Medicaid That Goes Beyond Care

Look to Highmark Health Options for Medicaid coverage and managed care. Even when youâre not sick, weâll help with your wellness goals and life goals. Choose coverage that goes beyond the basics so you can live your best life. Enroll today by calling the Delaware Health Benefits Manager at .

800 Delaware Avenue, Wilmington, DE 19801

Highmark Health Options is an independent licensee of the Blue Cross Blue Shield Association, an association of independent Blue Cross Blue Shield Plans.

Real Support For The Challenges Of Real Life

Highmark Health Options Community Support can connect you with local programs, resources, and support to help you navigate your health care choices.

Find help based on your unique needs and location. Our free, anonymous search feature can help you with care, education, food, housing, legal, money, work, and more. Start by entering your ZIP code.

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Dental Coverage For Low

Program provides new benefit for adults who receive Medicaid

NEW CASTLE – Adult Delawareans who receive Medicaid will automatically get dental coverage as part of their plan starting Oct. 1.

Governor John Carney signed legislation establishing the Medicaid adult dental benefit in August 2019. Implementation was originally scheduled for April 2020, but was delayed by the coronavirus pandemic.

Beginning Oct. 1, individuals ages 19-65 who are enrolled in a managed care Medicaid plan will receive their adult dental services through that plan and can obtain a list of providers from their managed care organization. About 200,000 of the 235,000 Medicaid clients in Delaware are served by one of two managed care organizations, Highmark Health Options Blue Cross Blue Shield Delaware and AmeriHealth Caritas Delaware.

Adults who are enrolled in fee-for-service Medicaid will receive their adult dental services through that program and may obtain a list of providers from the Department of Health and Social Services’ Division of Medicaid and Medical Assistance by contacting the Delaware Health Benefits Manager at 1-800-996-9969.

The benefit will cover a wide variety of services, including exams, cleanings, fillings, sedation, and regular tooth extractions. It will cover $1,000 of dental care per year an additional $1,500 per year may be available for qualifying emergency or supplemental care when medically necessary.

How Will I Be Notified Of My Credentialing Status

WASTE WATCH UPDATE: Ohio Medicaid Money Misspent

There are three ways to verify eligibility and benefits: AmeriHealth Caritas Delaware Provider Services at 1-855-707-5818, use the automated real time eligibility service and follow the prompts for Member Eligibility. Go through the secure provider portal, or contact Delaware Enterprise System at .

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Delaware Medicaid For Adults And Children

  • Choose from a large network of doctors, hospitals and specialists, including vision service providers.
  • Visit conveniently located pharmacies to get your necessary prescriptions and medications.
  • Access tools and programs to help you maintain a healthy lifestyle and manage your health conditions.
  • A large network of doctors, hospitals and specialists, including vision service providers.
  • Strong care management solutions and responsive member services.
  • Comprehensive prescription drug coverage.
  • A broad range of preventive health screenings and tests.
  • Detailed health and wellness programs and tools.

Medicaid Adult Dental Benefit

  • Resources
  • Update 10/12/2020

    Several updates have been made to the Adult Dental Fee Schedule. These updates include coverage of D1206 and D1208 . A provider may bill one or the other of these fluoride codes 1x every 12 months. Additionally, clarification was made to the note on D0120.

    Senate Substitute 1 for Senate Bill 92, enacted in 2019, directs the Division of Medicaid and Medical Assistance to establish an adult dental benefit. Adult dental coverage is optional for state Medicaid programs, but most offer at least an emergency dental benefit. It has been a long-standing priority of DMMA to offer preventive and restorative dental treatment for our adult population to address negative health outcomes associated with the lack of oral health care. The benefit will enable Medicaid-enrolled adults to receive up to $1,000 of dental care per year. An additional $1,500 may be available for qualifying emergency or supplemental care when medically necessary.

    Unfortunately, we will be unable to meet the April 1, 2020, implementation date included in the legislation. We are working closely with the Centers for Medicare and Medicaid Services, but estimate an additional six months will be needed to receive all the necessary federal approvals and complete the subsequent administrative tasks necessary to begin the program. The projected implementation date is now October 1, 2020. The full benefit will be available upon the implementation of the program.

    Recommended Reading: Medicare And Medicaid In Florida

    Are There Pharmacy Copay’s

    AmeriHealth Caritas Delaware charges copays for DSHP member’s prescription drugs filled at the pharmacy. The copay is based on the cost of each prescription. The most that members will pay for prescription copays each calendar month is $15.00 total. Once a member meets the $15.00 copay maximum for the calendar month, there will be zero copays for drugs filled for the rest of the calendar month. The copay maximum will start over on the first of each month. If a generic drug costs less than $1.00, the member will pay the lesser cost of the drug.

    What Is Delaware Medicaid

    Ctdssmap Provider Login

    Delaware Medicaid is a cooperative effort between Delaware’s state government and the United States federal government. The program provides health coverage for low-income residents of Delaware as well as elderly or disabled residents who don’t have enough income to pay for necessary medical services.

    Recommended Reading: Does Florida Medicaid Cover Eye Exams

    Expanding Medicaid Dental Coverage Means Finding More Dentists To Handle The Work

    Theres growing recognition, even among states that provide limited Medicaid benefits, that poor oral health contributes to a broad range of chronic problems, from depression and diabetes to unemployment.

    If you dont have a good smile, you oftentimes dont have a job, said Dr. Lisa Piercey, who leads the Tennessee Department of Health.

    More states have added dental benefits to their Medicaid coverage for low-income residents in recent years. Idaho started coverage in 2018 and Delaware began in late 2020. But Tennessee and Alabama dont provide dental coverage to adults not even for painful emergencies.

    Now Tennessees Republican governor, Bill Lee, who has resisted using federal money for Medicaid coverage under Obamacare, has proposed expanding dental benefits to all adults on Medicaid. The new coverage would extend to more than 600,000 people at roughly $75 million a year, according to Stephen Smith, director of Tennessees Medicaid program, known as TennCare.

    State lawmakers still have to sign off on the plan, so leaders are pitching the dental coverage as a way to improve overall health and possibly save money from reducing other types of expensive treatment.

    We also know that we have a lot of visits to the emergency room, Smith said.

    But adding so many new patients at once presents a workforce problem.

    You could not have a practice that you have more than 35%, 40% of your patients Medicaid patients youd go broke, she said.

    Cds Webinar Explores New Medicaid Dental Coverage For Adults

    Delawares Medicaid director heralded the rollout of the states new adult dental coverage, and said his department is exploring ways to expand it while noting theres room to improve it, at a CDS webinar on Jan. 19.

    Stephen Groff, the director of the Division of Medicaid and Medical Services spoke at Oral health care at any age, the most recent event in CDSs Lunchtime Learning series.

    I have been very happy with both the provider enrollment and the uptake in the program, said Groff. We did have concerns about the availability of services, especially in the pandemic.

    Since the benefit launched in October after a six-month delay Groff says that more than 4,300 Delawareans have used it, accounting for almost $2 million in dental work.

    The benefit provides $1,000 per year per person in dental coverage, which applies to procedures including cleanings, fillings, exams, x-rays, oral surgery and sedation. An extra $1,500 per year is available to cover emergency care. Originally, a $3 copay was required per trip, but it was suspended indefinitely due to the Covid pandemic.

    The benefit may continue to evolve. Said Groff: DMMA is explor options for how we might be able to expand, notably by covering dentures.

    We know that there is room for improvement, and certainly to hear what your experience has been and if you have experienced any barriers or challenges, he said.

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    Division Of Medicaid & Medical Assistance Medicaid Managed Care Rfp

    The State of Delaware Department of Health and Social Services , Division of Medicaid and Medical Assistance has released a Request for Proposal RFP # HSS-22-008, to seek Professional Services for Managed Care Medicaid Service Delivery. The release date was December 15, 2021, with responses due March 15, 2022 by 1:00pm.

    The proposed schedule of events subject to the RFP is outlined below:

    Public Notice:

    RFP Designated Contact

    As provided in Section IV.B.15, RFP Question and Answer Process, all questions related to this RFP must be submitted in the Q/A section of the project listing in the Bonfire Procurement Portal. Address all other RFP communications to the person listed below communications made to other State of Delaware personnel or attempting to ask questions by phone or in person will not be allowed or recognized as valid and may disqualify the bidder. Bidders should rely only on written statements issued by the RFP Designated Contact or responses posted under the project listing in Bonfire.

    DHSS/DMMA Contact:

    Contracts, Management and Procurement Contact:Chevis FennellPurchasing Services Administrator

    To ensure that communications are received and answered in a timely manner, please use electronic mail .


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