Banner Message: Dear Dental and OB/GYN Providers: (Fee-For-Service [FFS] and CMO Network Providers)
This banner message is intended to clarify the Department of Community Health (DCH), Medicaid Division, GA Medicaid eligible pregnant women dental benefit policy. There are reports that some dentists, including OB/GYN providers, will not see or refer pregnant women for dental services. GA Medicaid eligible pregnant women are entitled to dental services during the duration of their pregnancy whether serviced by a Fee-For-Service (FFS) provider or through one of the Care Management Organizations (CMOs). These are additional benefits above and beyond the standard dental benefits available to adult members. The dental benefits ordinarily end on the day the member delivers; however, some pregnant women (depending on her Medicaid eligibility category) may be entitled to continue receiving regular adult dental benefits following delivery.
It is customary for GA Medicaid members who become pregnant after being enrolled in the eligibility classification of Low-income Medicaid (LIM) or Aged, Blind, or Disabled (ABD) to remain in their original aid category (LIM or ABD) and become entitled to pregnancy dental benefits. Therefore, Dental and OB/GYN providers will not notice a change to their pregnant member’s Medicaid eligibility category (e.g. LIM, ABD) when viewing the member’s eligibility profile via the Georgia Medicaid Management Information System (GAMMIS). In most situations, women with existing Medicaid eligibility should not be directed to the Department of Family and Children Services (DFCS) to have their eligibility changed to Pregnant Woman Medicaid. Instead, the pregnant women should be advised to report their pregnant status and expected due date (EDD) to DFCS if they have not already done so.
Also, pregnant women serviced under the Health Check program – under the age of 21 years of age, are entitled to receive covered dental benefits as part of their Medicaid Health Check services. These covered dental benefits include:
• Oral exam and prophylaxis (cleaning)
• X-rays
• Fillings, extractions and other treatments as medically needed.
The CMOs (Amerigroup, Peach State and WellCare) and the CMOs contracted dental vendors i.e., Dental Quest (Amerigroup and Peach State Health Plan) and Avesis (WellCare) will follow the same above FFS policy.
PAYMENT INFORMATION
All dental providers who render dental services to eligible FFS and CMO pregnant members must submit a completed and signed DMA 635 form, Attestation of Pregnancy, along with the pregnant woman’s claim or CMO encounter in order to receive payment. The Attestation of Pregnancy form serves to validate the current pregnancy for the purpose of determining whether the member is eligible to obtain certain Medicaid dental service benefits. For the CMOs, the pregnancy affidavit form allows for processing of payment of the pregnancy-only coverage claims despite the pregnant member’s plan not having that coverage. DentaQuest follows the same above payment process as FFS Medicaid.
The DMA 635 form can be found in the Part II, Policies and Procedures for Dental Services Policies and Procedures Manual, Appendix B-2, located at www.mmis.georgia.gov under Provider Manuals in the Provider Information hyperlink. Also, the DentaQuest provider portal has published the DMA 635 form under its “Documents” page. To log in to the DentaQuest portal, please visit the following DentaQuest link: https://govservices.dentaquest.com/. Additionally, this form is also found in the DentaQuest Provider Handbook under the Appendices section. If needed, the link to the Amerigroup DentaQuest Provider Handbook is: http://www.dentaquest.com/state-plans/regions/georgia/dentist-page/
The Avesis link for their information is: https://www.avesis.com (WellCare members).
CONTACT INFORMATION
The following contacts are for the CMO Plans and FFS – GA Medicaid if you need further information or clarification of their policy regarding pregnant women dental services benefits:
• FFS MEDICAID: Contact Nancy Moore, Dental Services Program Specialist, at nmoore@dch.ga.gov or 404-657-7884
• WELLCARE – Contact:
WellCare Provider Services Line
1-866-231-1821
https://www.wellcare.com/georgia
Dental Providers who are treating WellCare members can contact:
Avesis Dental GA Medicaid Provider Service Center:
1-800-231-0979
https://www.avesis.com
• AMERIGROUP - Contact:
Amerigroup Community Care Contact Information:
Provider Services: 1-800-454-3730
• Peach State Health Plan - Contact:
Provider Services: 1-800.516.0124
Both AMERIGROUP and Peach State Health Plan contract with DentaQuest:
Contact Information:
Provider Services: 1-800-516-0124
http://www.dentaquest.com/state-plans/regions/georgia/dentist-page/
Email Claims questions: denclaims@dentaquest.com
Additional DentaQuest Contact Information:
Fax numbers:
Claims/payment issues: 1-262-241-7379
Claims to be processed: 1-262-834-3589
All others: 1-262-834-3450
Claims Mailing Address:
DentaQuest
P.O. Box 2906
Milwaukee, WI 53201-2906
Thank you for your continued participation in the GA Medicaid program.
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