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2016-46: Covered Dental Benefits at FQHCs

Date: 09/12/16

Federally Qualified Health Clinics are the backbone of community-based, patient-directed primary care all across Louisiana. And dental health is an important part of physical health. That’s why Louisiana Healthcare Connections provides adult dental benefits at FQHCs as a value-add for our members.

ADULT DENTAL BENEFIT DETAILS:

  • Adult members (age 21+) are covered for two dental encounters each calendar year, regardless of what services are performed within those encounters.
  • The adult dental benefit applies only to members age 21+. Dental services for younger members are covered by the Medicaid dental benefit provided by MCNA.
  • FQHC dental providers can submit a claim for a dental encounter, as long as it includes a valid D code in the service lines, up to two per year per member.
    • In certain situations, some dental encounter claims may have been denied in the past. We are reviewing previously denied dental claims and will issue payment where appropriate.
    • Effective October 17, 2016, configuration changes will be in place to prevent such denials from recurring.
  • When performing a crown, a third encounter will be permitted to complete the procedure. A valid crown code must appear in the claim service line.

Thank you for providing dental care for our members − your patients.