HIP 2.0 Updates
HIP 2.0 Webinar Announced:
IDA will present a webinar for members on Thursday, March 26, 2015 at 8:00 PM Eastern TIme. The recorded webinar will also be made available in the online member center as soon as it has been edited and coverted. Be watching for additional information as it becomes available. To register, click here.
DentaQuest contract has been sent. Recently, DentaQuest sent their Provider Contract via postal mail to all IHCP enrolled dentists (not all dentists, as we stated earlier.) IDA had previously requested an ADA contract analysis of the DentaQuest contract; to request a copy of the analysis, contact Laurie Campbell at the IDA Central Office, Laurie@indental.org or 800-562-5646.
PLEASE NOTE: there are three different contract documents being circulated. There is a standard HIP contract, a combination HIP and Hoosier Care Connect contract (includes one passage to introduce the HCC fee schedule), and a Hoosier Care Connect amendment. As the combination contract and the amendment point out, Hoosier Care Connect reimburses at 100% of Medicaid fees, not the 130% HIP reimbursement. When enrolling with DentaQuest, providers may choose to enroll in HIP 2.0, Hoosier Care Connect, or both programs.
Download and read the ORM. Before signing the DentaQuest contract, it is suggested that you download and thoroughly read the Office Resource Manual (ORM) so you understand what you are agreeing to. The manual was not sent with the contract you received, but can be downloaded at the DentaQuest website. Scroll to the bottom of this page and look for HIP Office Reference Manual.
Extractions are covered. There has been a change in previously stated benefits. The original coverage for the HIP Plus plan included 4 restorations and 0 extratctions per year. That coverage has been updated and now includes any combination of 4 restorations/extractions per year for Hip Plus patients. Hip State Plan has no limitations on restorations or extractions.
You may charge for noncovered services. There is a provision in the HIP 2.0 program that does allow you to charge your usual fees for any noncovered services or over the limit services as long as the patient voluntarily accepts the charges, understands why he is being charged, and signs a waiver attesting to this prior to the services being rendered. The signed waiver must be kept in the patient chart. IDA has created a patient waiver that you can use for this purpose, which is available for download in the online Member Center (login required).
Check eligibility every time. You should check benefits eligibility of every HIP patient at every visit. The correct source of information is the HP Web Interchange. It is suggested that you print a copy of the eligibility information and retain it in the patient's chart. In a few cases, the information available at Web Interchange does not coincide with the information avaialbe through DentaQuest. We have been informed by DentaQuest that in theses situations, you should include a copy of the Web Interchange print out when you submit your claim to DentaQuest and your claim will be paid.
Copay information has been updated. As a reminder, all HIP State Plan Basic patients must be charged a $4 per service copay (not per visit). You should collect the copay at the time of service; it will be deducted from your reimbursement remittance.
Here is what we've learned recently regarding HIP 2.0:
It is important to verify eligibility for each patient at each visit. HIP eligibility can be verified at the IHCP Web Interchange. We have been informed that online eligibility is up to date and should take precedence over any printed material the patient brings into the office.
As of Monday, February 23, approval for the DentaQuest provider manual has still not been received from the State. If you wish to review the provider manual before signing a contract with DQ, keep in mind that the provider enrollment deadline has been extended to April 30.
If the HIP member plan requires a copay, you should collect the copay at the time of service and retain the funds. The correct copays will be automatically deducted from your reimbursement check. You may not deny services based on the patient’s inability to cover the copayment, but it is permissible to bill the patient for any uncovered copayments.
Please note, there has been a recent correction to the originally announced copay fees. Dental copays for State Plan Basic patients are $4 per service, not $4 per day as was originally announced by the State. You can download the Medicaid Bulletin with full details from the IDA website.
There is a provision allowing providers to bill the patient for any noncovered services and services beyond the coverage limit. You may charge your regular fees, but you must get (and document) consent from the patient prior to treatment. You must maintain documentation in the patient’s file, but you do not need to submit any documentation to DentaQuest. The criteria for the consent is rather specific. IDA is in the process of creating a form that you can use for this purpose; we hope to release it to members soon. In the meantime, you must have a signed statement which outlines that the patient understands he/she is accepting financial responsibility for the service, how much the service will cost, why the patient is being charged, and a full description of the services.
Providers should bill DentaQuest their usual and customary fees and take the write off as was done in the past. In the rare instance that your fees are lower than the reimbursed fee, and you bill your usual (lower) fee, you will get reimbursed at the lower rate. It is advisable to verify reimbursement rates prior to filing claims. While DentaQuest has not yet released reimbursement rates, we have been informed that HIP plans will be reimbursed at 130% of Medicaid fees. Medicaid rates can be verified online.
Correction regarding HIP State Plan Basic copayments for Dental Services (read more...)
Here is the latest (02/16/15) information regarding dental benefits contained in the State of Indiana's HIP 2.0 program:
Some patients may arrive in your office with the understanding that they now have benefits under HIP 2.0, based on a mailing they received from the State. Be cautious! The benefits some patients are expecting are contingent on their making a contribution into a "power account" making them eligible for HIP Plus. Go online and confirm each patient's eligibility before beginning treatment. Otherwise, the care you provide may not be eligible for reimbursement.
HIP Plus Benefits are very modest:
evaluations and cleanings (2 per person per benefit year)
bitewing x-rays (4 x-rays per person per benefit year)
comprehensive x-rays (1 complete set every 5 years)
minor restorative services, such as fillings (4 per person per benefit year)
major restorative services, such as crowns (1 per person per benefit year)
We have received updated information from the State confirming that procedures that are not covered by HIP Plus, or that exceed the limited benefits above, may be provided by the dentist on a fee-for-service basis, provided certain conditions are met. The dentist must inform the patient of the cost prior to performing the service and maintain documentation in the patient's file that clearly demonstrates that the patient voluntarily chose to receive the service, knowing it was not covered by the IHCP.
Extractions are not covered in the HIP Plus plan. The Committee is communicating its concern about the absence of this basic benefit to the State.
The State has also confirmed that dentists may not charge IHCP members for missed appointments and no reimbursement is available for "no show" appointments.
In addition to the modest benefits in HIP Plus, some patients who qualify under the "Unique Population" status (medically frail, pregnant, Native Americans, low income parents, 19-20 year olds, recipients of transitional assistance) are eligible for dental benefits under various plans. While these plans include expanded benefits, many require prior authorization that may present problems for patients who present in pain. The Committee is working with the State to obtain more reasonable "prior authorization" guidelines.
On Friday, the State announced that Hoosier Healthwise contracts scheduled to expire at the end of 2015 will be renewed, with no changes to dental benefits for Hoosier Healthwise patients. This means that the Hoosier Healthwise dental program will continue to be managed by HP through 2016, at which time contracts for HIP 2.0, Hoosier Care Connect and Hoosier Healthwise are all scheduled for renewal. It appears the State is laying groundwork for transitioning management of the entire IHCP dental program to DentaQuest, if they feel the HIP 2.0 program is successful.
HIP 2.0 Contact Information:
FSSA has set up a Rapid Response team that can be reached at HIP2.email@example.com.
Customer Service/ Member Services:
855.453.5286 – DentaQuest Provider Services
888.291.3762 – Anthem
844.231.8310 – MDwise
855.343.4271 – MHS
A list of covered procedures under HIP Plus, HIP State Plan Plus, and HIP State Plan Basic can be found in the Quick Reference Guide for Dental Providers.
02/06/2015 - On Thursday, February 5, 2015, Indiana Health Coverage Programs (IHCP) released provider bulletin BT201508 which a reference guide to the dental benefits covered under the HIP plan options as well asinformation about the grace periods for establishing the DentaQuest provider network and honoring existing authorizationsfor dental services for current IHCP members transitioning to HIP. (read more...)
02/03/2015 - The recent roll out of HIP 2.0 Plus has generated a lot of questions that we do not yet have answers for. To address some of these concerns, Jim Gavin of FSSA has presented the following quick HIP reference guide for dental providers. We will continue to provide new information as we receive it. (read more...)
01/31/2015 - All dentists currently enrolled in any Indiana Health Coverage Program will be able to provide treatment to properly enrolled HIP 2.0 Plus patients beginning February 1, 2015. Currently enrolled dentists are not required to register with DentaQuest until May 1, 2015. (read more...)
01/29/2015 - The federal government issued a waiver allowing for the expansion of the Healthy Indiana Plan (HIP)effective February 1, 2015. This HIP expansion will allow 350,000 low income Hoosiers to enroll in a state-sponsored health plan. HIP 2.0 Basic Plan will have no dental coverage. HIP 2.0 Plus plan requires a premium contribution from participants and includes expanded benefits including dental and vision coverage. (read more...)
The IDA does not encourage or discourage participation in any managed care contract. Participation is a decision each individual dentist should make in consultation with his or her attorney, accountant and/or practice management advisor.