Medicaid Monopoly
MCO is short for
What are Managed Care Organizations?
This specific, comprehensive orthodontic treatment code is used for the transitional dentition (mixed dentition) phase.
What is D8070?
The CT Team that owns their claims and preauths
What is CT Husky
What State(s) use D8070 & D8080 for COC transfers?
What is North Dakota?
How many different payor portals does the state have? (That we are in network with)
What is 4?
Coordination of Benefits means
What is Coordination of Benefits: Providers must bill 3rd party insurers before billing Medicaid?
If a Medicaid patient is in the middle of treatment when coverage changes or a plan is terminated, this is the process required to ensure payment for services already rendered.
What is a Claim Adjustment or Re-submission? (COC)
Age limit for Husky A/C/D?
What is 21
What State(s) have 1 payor portal?
What is Virginia, North Carolina, South Carolina, Arkansas, North Dakota, Connecticut, Vermont, and Wisconsin
How many different plans does the state have? (that we are in network with)
What is 12?
This crucial documentation, often requiring cephalometric films and diagnostic photos, must prove a functional, not cosmetic, necessity for Medicaid to pay for braces.
What is a Preauthorization?
Medicaid generally excludes payment for this type of Orthodontic treatment, focusing only on functional issues.
What is cosmetic?
Age limit Husky B
What is 19
What State(s) allow retro-billing? (back dating)
What is North Carolina?
What plan(s) support quarterly automatic billing for D8670?
What is UCCI CHIP?
This CDT code, often used for orthodontic retention, is sometimes bundled into the comprehensive treatment fee, meaning it cannot be billed separately to Medicaid
What is D8680
Difference between D8080 and D8090
What is dentition? (D8080 applies to adolescents (typically ages 11–19) with permanent dentition, while D8090 is used for comprehensive orthodontic treatment of the adult dentition)
Form required for orthodontic scoring
What is Salzmann
What State(s) allow D8670 & D8680 to be billed on the same DOS?
What is Virginia?
What plan(s) support monthly manual billing for D8670?
What is Highmark Wholecare?
To receive Medicaid coverage for orthodontic treatment, the patient must typically meet this specific, high-scoring criterion for functional impairment.
What is Medical Necessity?
If the patient's 3rd-party insurance does not cover orthodontia, can we bill the patient?
What is no?
8670 are reimbursed
What is monthly?
What State(s) allow 8 units of D8670, automatically approved with D8080?
What is Massachusetts?
What 2 plans does the patient have to complete orthodontic treatment by age 23?
What is Geisinger CHIP & AmeriHealth Caritas Medicaid?