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How do the new enhanced Medicaid rates compare to commercial insurance companies?

Although we cannot get into details of any specific insurance plan, if you review the enhanced rates for the pilot to one of your contracted insurance plans, you will see they are quite comparable. The WDA thinks it’s important to note that with pilot reimbursement rates that fall similarly in line with commercial contracted rates,… Continue Reading How do the new enhanced Medicaid rates compare to commercial insurance companies?

If I become a Certified Medicaid Provider, must I then abide by the new ACA rules for Section 1557 that state I must provider a language translator to Medicaid patients if they ask for one?

Yes, you would then have to abide by this new regulation IF, and only IF, the patient asks for a language translator then you must accommodate the request. However, the ADA and the WDA have worked to make this requirement as easy to implement as reasonably possible. You can find additional information on 1557 via… Continue Reading If I become a Certified Medicaid Provider, must I then abide by the new ACA rules for Section 1557 that state I must provider a language translator to Medicaid patients if they ask for one?

Is the process of filing claims and getting paid by Medicaid still as cumbersome as it has been in the past?

Since the state developed ForwardHealth and the Medicaid portal, the process of becoming a Certified Medicaid provider and filing claims became more seamless. Everything you need to know about being a Medicaid provider, claims, coverage benefits and reimbursements is all located online and in one place now. The creation of the Dental Unit has also… Continue Reading Is the process of filing claims and getting paid by Medicaid still as cumbersome as it has been in the past?

If I am a Certified Medicaid Provider and my practice is in one of the pilot counties, can I treat kids and emergency adults from outside the county and still get paid the enhanced rate?

Yes. You can treat any Medicaid patient from any county in Wisconsin and the state must still pay you the enhanced rate since your practice is inside a pilot county. This is also one data parameter that we requested to be tracked since it will be good to know how far Medicaid recipients will travel… Continue Reading If I am a Certified Medicaid Provider and my practice is in one of the pilot counties, can I treat kids and emergency adults from outside the county and still get paid the enhanced rate?

Is there any mandate for the state to collect data on the pilot counties and make that public?

Although our original proposal dictated what data parameters to collect and when, the Governor did veto that out of the bill. However, the Department of Health Services, Oral Health Program obtained grant funding from HRSA to do data collection on the pilot. DHS will be contracting with UW Population Health Institute to collect and publish… Continue Reading Is there any mandate for the state to collect data on the pilot counties and make that public?

Do the HMOs have to pay the dentists the enhanced rates too or is that adjusted differently?

Yes, the HMOs in Racine county must pay the dentists the same enhanced rate that any fee-for-service provider outside of Racine county (and in a pilot county) would get as well. Please contact the HMO you are contracted with to see how this is passed onto the dentist.

If I sign up to be a Certified Medicaid Provider to participate in this pilot, does that mean I have to take every Medicaid patient that calls my office? How will I control being overwhelmed?

No, it does not mean you must open your doors to every Medicaid patient that calls your office. You can still limit your participation however you wish as long as you are not discriminating against any of the protected classes. You can also contact the dental unit at ForwardHealth and ask that they take your… Continue Reading If I sign up to be a Certified Medicaid Provider to participate in this pilot, does that mean I have to take every Medicaid patient that calls my office? How will I control being overwhelmed?

What happens when the state runs out of money that is allocated to the pilot? Do the enhanced rates just stop then?

It is our hopes that the state does in fact run out of the $13.7 million allocated because that would mean more children are being seen, more emergency adults are being seen and more dentists are signing up to be Certified Medicaid Providers. The state cannot stop reimbursing at the enhanced rates even if the… Continue Reading What happens when the state runs out of money that is allocated to the pilot? Do the enhanced rates just stop then?

If I have multiple practices, one in a pilot county and one outside the pilot county, do both offices get the enhanced reimbursement rate since the offices have the same doctors who are Certified Medicaid Providers?

No. Only the office within the pilot county will get the enhanced rate. The office outside of the pilot county will still get the usual reimbursement rate. If you have two (or more) offices, one in the pilot county and one outside the pilot county, you need to contact ForwardHealth Dental Unit and speak with… Continue Reading If I have multiple practices, one in a pilot county and one outside the pilot county, do both offices get the enhanced reimbursement rate since the offices have the same doctors who are Certified Medicaid Providers?

If I am already a Medicaid Provider must I do something different to get these enhanced reimbursement rates since I am in one of the pilot counties?

No. If you are already enrolled as a Certified Medicaid Provider with the state, then you do not need to do anything to obtain the enhanced rates. Submit your dental claims as usual.