Last month we notified you that NHP will be instituting a specialty referral requirement for NHP Commonwealth Care and NHP MassHealth members for services rendered on or after January 1, 2012.  If an effort to ensure our provider network is ready to accomodate the required changes, NHP has decided to institute this requirement beginning with dates of service rendered on or after February 1, 2012.

As a reminder, specialty referrals will be required for all services/specialists except the following:

As of February 1, 2012, all referrals and most authorizations will only be accepted through NHPNet.  If you haven't done so already, we strongly encourage you and your staff to use this additional time to register for the portal at the following link: www.nhpnet.org. 

Please contact your Provider Relations representative or the NHP Customer Care Center with any questions.  

NHP Provider Service Center

Oral health is integral to a child's overall health and well-being. Although it is recommended that a child should visit a dentist at the eruption of the first tooth and no later than 12 months of age, the pediatrician is often the first clinician to examine a child's mouth.  During a well-child visit that includes an oral health screening to assess the oral cavity, you can detect whether a child is at moderate-to-high risk for dental caries disease, apply fluoride varnish as a preventive measure as necessary, and refer the child to a dentist for treatment. Fluoride varnish lowers caries-causing oral bacterial levels and repairs and strengthens teeth. It is the first weapon of defense against childhood caries disease.

Fluoride varnish is easy to apply in a medical setting, taking less than two minutes. Varnish is painted on the teeth with a brush and dries immediately upon contact with saliva. The child's teeth may appear yellow after the fluoride varnish application. This is normal and will disappear when the teeth are brushed the next day. The varnish can be applied in any setting and does not require dental equipment. It is safe and well tolerated by infants and children, including children with special health care needs.
 

MassHealth healthcare professionals, including physicians, physician assistants, nurse practitioners, registered nurses and licensed practical nurses can qualify to apply fluoride varnish after completing a MassHealth-approved training.  MassHealth-approved training programs for healthcare professionals are offered through web-based or office-based trainings, and CME credit is available.  The training can be taken at any time prior to providing services.  In the near future, medical assistants who complete the required training may apply fluoride varnish under the supervision of a physician.  Physicians will be notified through a transmittal letter when the program becomes effective for medical assistants.
 
Physicians should bill the CDT code D1206 (topical application of fluoride varnish; therapeutic application for moderate-to-high caries risk patients) using either the 837P electronic submission form or the CMS 1500 form. Reimbursement for the code is for children ages 6 months to 21 years who are MassHealth-eligible. The current rate of $26.00 per application includes the materials and supplies used in the process. 
 

For additional information, please visit www.mass.gov/masshealth/fluoridevarnish or contact Megan Mackin, Outreach Coordinator for DentaQuest/MassHealth, at 617-886-1728 or megan.mackin@dentaquest.com.