DentaQuest is honored to be the
third-party administrator for the South Carolina Healthy Connections dental
program. Our administrative duties officially began on August 2, 2010.
DentaQuest understands that the
transition to the Healthy Connections dental program has been challenging for
many of you. Our top priority is to solve the issues you are facing as quickly
as possible. If
you are experiencing any challenges...Contact our South
Carolina customer call center at 1-888-307-6553. Please note that some issues may require
further investigation and therefore cannot be resolved at the time of your
initial call. You will receive a follow up call with a resolution or
status update within 24 hours. If you require further resolution, please ask to
speak to Yves Mary Durand, Call
Center Supervisor. If you have not received satisfactory resolution after
speaking with a supervisor, please contact Ellen Rattey, DentaQuest's South Carolina Vice President of
Operations, directly at 1-803-758-0552.
DentaQuest
and SCDHHS value your input. Many of you
have expressed concern with benefit limitations. To ensure that you can determine appropriate
courses of treatment for Healthy Connections beneficiaries, the following
benefit limitations are being adjusted. These changes are being implemented in
DentaQuest's processing system and will be effective for dates of service on or
after October 15, 2010.Examination
Codes:
Frequency limitations on D0140
will be 1 per 6 months per provider. The frequency limitation on D0150 will remain 1 per 36 months,
but be applied per provider instead of
per beneficiary. Restorative
Codes: The
limitation will remain at 36 months; however, this limitation applies only
to the same restoration on the same tooth and surface by the same billing
provider. A restoration involving
different surfaces is allowable within the 36-month timeframe, as are
restorative services rendered by another billing provider. Extraction Codes: Single tooth extractions under D7140 and D7210
will notrequire x-rays
or narratives of medical necessity for adult members, only an indication
in the "notes" field that the service was rendered as an emergency. Claims filed for more than one
extraction still require documentation to support medical necessity. Adult members are only eligible for
emergency services. "Emergency" always needs to be indicated on
claims filed for adults.
The
implementation of the Healthy Connections dental program has been very
challenging, and we appreciate your patience as we resolve these issues. Beginning next week, we will provide regular
weekly updates to keep you informed of the progress we're making and provide
you with the information you need. We
are committed to the success of the program, and solving your issues is our top
priority. |
