The historic Medicaid rate increase passed last session is now in effect. For dentists already enrolled, not much will change except effective July 1, 2022, all claims filed with this date of service or after will be reimbursed at the new rates.

What if you’re not a provider yet? What do you need to know and how do you get started? To answer these questions and more, the MDA has been working with Amanda Fahrendorf, Lead Education and Training Specialist, Department of Social Services MO HealthNet Division (MHD) Education and Training Unit. Following is some basic information to get you started as you consider enrolling as a dental Medicaid provider.

MANAGED CARE VS FEE-FOR-SERVICE & WHY THE DIFFERENCE IS IMPORTANT

Providers often hear Managed Care (MC) and Fee For Service (FFS) when working with MO HealthNet. Here is what these terms mean:

• Managed Care (MC): In 2017, children, pregnant women, newborns and families were transitioned to the state’s three MC health plans (United HealthCare, Home State Health and HealthyBlue). The MC health plans are responsible for administering benefits and coverage on behalf of MO HealthNet to these populations. Note: A sub plan administered by Home State Health is Show Me Healthy Kids, specifically for instances of state custody, adoption subsidies and foster care.
• Fee-For-Service (FFS): The aged, blind, disabled and women with breast or cervical cancer remained in FFS. Providers will work with MO HealthNet directly when providing dental services to these individuals.

BECOMING A MEDICAID PROVIDER

All dentists who want to provide care to MO HealthNet participants must enroll with Missouri Medicaid Audit and Compliance (MMAC) first. Providers can choose to enroll as both FFS and MC providers or they can enroll as MC only. “Managed Care only” providers can provide care only to participants enrolled in MC health plans. Providers will be assigned a Provider ID once they complete the MMAC enrollment process. After receiving their Provider ID, providers can enroll with the MC health plans; each plan has its own credentialing process.

Note! Currently, there is an increase in Provider Enrollment applications due to the recent rate increases. MMAC is actively working with each MC health plan to expedite the enrollment process by requesting the plans begin reviewing enrollment applications prior to having the final approval from MMAC. Amanda will coordinate this process with the plans; therefore, once you have submitted an application to MMAC, email her at amanda.fahrendorf@dss.mo.gov and she will email the plan to request they review your application.

IF I ENROLL AS A PROVIDER, DO I HAVE TO ACCEPT ALL PATIENTS IN MY AREA WHO ARE ENROLLED IN MEDICAID?

No; this is a business decision for each provider. Some choose to see only children and others may want to take only a certain number of MO HealthNet participants, thereby leaving room for existing patients.

WHAT DOCUMENTATION & INFO DO I NEED FOR MMAC ENROLLMENT?

Provider Enrollment has created an Enrollment Guide to assist with the enrollment process. The guide outlines what documentation is required for each provider type and how to complete the Provider Enrollment Application. The Enrollment Guide includes information for all provider types, therefore dental providers should concentrate only on requirements for Clinics/Group or Dentist. Links to the guide, application and more can be found at modental.org/medicaid.

You should enroll as a clinic/group if you have more than one provider or plan on having additional providers in the future. Each individual provider will need to enroll separately; however, by enrolling as a clinic/group it will allow you to bill for all providers under one National Provider Identifier (NPI) number. Each provider must bill individually if not enrolled under a clinic/group.

HOW LONG WILL IT TAKE TO ENROLL WITH MMAC/MANAGED CARE PLANS?

MMAC Enrollment: The time frame for enrollment varies based on the time of year and number of applications. Dental applications, if they are complete when submitted, are processed quickly. Common mistakes that can cause processing delays:

• Not submitting all required documentation with the initial application.
• Not providing good contact information for additional documentation requests.
• Failing to sign the signature page, Business Organizational Structure (BOS) and Electronic Funds Transfer (EFT) forms.

Email Provider Enrollment for questions at mmac.providerenrollment@dss.mo.gov.

Managed Care Enrollment: Each MC health plan has its own application and credentialing process. Providers ordinarily reach out directly to the MC health plans to start the process. As noted above, MO HealthNet is facilitating the process at this time. Once you have submitted an application to MMAC, please email Amanda and she will email the plan requesting they review your application.

Amanda Fahrendorf works in the MO HealthNet Education and Training Unit. Contact her at 573-751-0352 or amanda.fahrendorf@dss.mo.gov. 

This article originally appeared in the Focus MDA magazine. Click here to view.