General Resources
• Frequently Asked Questions
• AFMC Dental Provider Relations
• Dental Provider Manuals
• Benefit Plan Crosswalk for Dental Providers: Dental-specific Benefit Plans Crosswalk
• Presentation from July 19 Provider Webinar
• Webinar Recording from July 19 Presentation
• Webinar Slides from October 10 Presentation
• Webinar Recording from October 10 Presentation

Provider Enrollment
• Provider Enrollment

Billing
• AFMC/ Gainwell MMIS Billing Team Webpage
• DMS Provider Training Webpage
• Dental Procedure Code Linking Tables
• Dental Fee Schedules
• Quick Track Training series:
– Eligibility Verification Video
– Eligibility Verification Guide
•Submitting a Dental Claim Video
•Submitting a Dental Claim Guide

Prior Authorizations
•Acentra Prior Authorizations

Provider Questions
Email: [email protected]

What is happening with the Medicaid dental program in November?

Since 2018, the Arkansas Department of Human Services (DHS) has operated the Medicaid dental program by paying MCNA and Delta Dental a flat rate for each beneficiary eligible for dental services. MCNA and Delta Dental were then responsible for paying for the dental claims for their enrolled beneficiaries. Beginning November 1, the dental program will return to fee for service, meaning dental providers will bill Medicaid directly for the eligible dental services they provide. Clients will use their Medicaid ID to receive services, not their MCNA or Delta Dental cards.

Click here or the image below to download a flyer that can be printed and posted in your office to help educate clients about this change.

Why is this change occurring?

Arkansas Medicaid must ensure beneficiaries receive needed health services while serving as a good steward of taxpayer dollars. DHS analyzed statewide quality measures for dental care along with dental managed care expenditures and determined that a return to the fee for service model was the best way forward.

Reimbursement Rates

Does Medicaid anticipate an increase in reimbursement rates?

Medicaid reimbursement rates are the same as paid under Delta Dental and MCNA. At this time, there will be no rate increase in reimbursement rates. Current reimbursement rates can be viewed here. Medicaid continuously evaluates rates for all programs. DHS plans to immediately begin a comprehensive review of the entire dental program once the FFS transition has gone live and stabilized. To that end, DHS is already meeting with the Arkansas State Dental Association.

Will dental providers be able to participate in the Arkansas Diamond Deferred Compensation Plan?

Yes, Medicaid dental providers will be able to contribute a portion of their Medicaid income on a pre-tax basis, or post-tax ROTH basis, to the State of Arkansas Diamond Deferred Compensation 457(b) Plan as an element of their retirement planning. Plan information and enrollment packets are available on request via email or regular mail. Contact your Arkansas Diamond Plan representative (Cheryl Daughenbaugh or Brete Garland) with Stephens Inc. at [email protected] or 501-301-9900. You can also contact Robert Jones at 501-377-8112 or [email protected] to request an information packet or further inquiry.

Covered Services and Billing

What services are covered under Medicaid fee for service?

Medicaid’s fee for service program covers most of the services Delta Dental and MCNA cover, but some services are not covered. Current services covered by Medicaid fee for service can be viewed here. At this time, there will be no changes in the Medicaid covered services, but DHS plans to immediately begin a comprehensive review of the entire dental program once the FFS transition has gone live and stabilized.

Under the dental managed care program, providers were able to bill Medicaid for composite restorations. Will this be the same under the fee for service program?

Beginning Nov. 1, 2024, DHS will add the following dental procedure codes for use in the fee for service dental program. The codes will be reimbursed at the rate of the comparable codes and have the same limitations and requirements.

Added codes	Comparable codes
D2391	D2140
D2392	D2150
D2393	D2160
D2394	D2161
D2934	D2930

Until November 1, if a provider chooses to do posterior composites or porcelain/ceramic/esthetic coated primary tooth crowns, the claim must be billed under the comparable amalgam/stainless steel code. Reimbursement will be given at the amalgam/stainless steel reimbursement rate. DHS understands dental providers have questions about this billing practice, and we have consulted with our state Office of Medicaid Inspector General (OMIG). OMIG’s assurance that dental providers may perform dental procedures and bill the comparable reimbursement rate can be found here and here.

What electronic payor ID is needed for submitting claims?

Use payor ID 716007869 to submit all claims to Arkansas Medicaid. In the 837D Companion Guide, this number can be found in loop ISA – Interchange Control Header and loop 1000B – Receiver Name.

There have been questions around the use of a 5-digit code. For clarification, the 5-digit code is used by a clearinghouse to identify the payor in the clearinghouse system.

Where should paper claims be mailed to?

• Regular Claims Address: P.O. Box 8034 Little Rock, AR 72203
• Crossover Claims Address: P.O. Box 34440 Little Rock, AR 72203
  • Crossover claims are claims in which Medicare is primary and Medicaid pays secondary for clients that are dually enrolled in Medicare and Medicaid.

How should I upload claim attachments?

You will upload claim attachments on the portal when submitting the claim. No electronic attachment ID is required.

You can also mail paper attachments with paper claims.

Will D1354 (Application of caries arresting medicament – per tooth) be covered under the fee for service program?

No, this code is not currently covered under fee for service. However, DHS plans to immediately begin a comprehensive review of the entire dental program once the FFS transition has gone live and stabilized.

What is the dental cleaning frequency under fee for service? 

The frequency is a minimum of 6 months and a day between cleanings.

Under dental managed care, the cleaning frequency was different. Do providers need to reschedule beneficiary cleanings?

If the beneficiary was enrolled in dental managed care and the beneficiary’s next cleaning follows the dental managed care frequency, beneficiary appointments for cleanings do not need to be rescheduled. All subsequent beneficiary cleanings should follow the fee for service cleaning frequency (see prior question regarding fee for service cleaning frequency).

Will the $500 annual service limit for adult beneficiaries be based on a fiscal year or calendar year?

Annual benefit limits are based on a state fiscal year (July 1-June 30), not a calendar year.

The annual $500 benefit limit for adults operates on a state fiscal year. Do the twice-a-year benefit limits for cleanings operate on a state fiscal year too?

No, the limit on cleanings operates as a rolling 6 months. For example, if the first cleaning after the Nov. 1 transition is Nov.12, the next cleaning would be after May 13 (or 6 months and a day). If a cleaning occurs on January 1, the next cleaning would be after July 2 (or 6 months and a day).  

What version of the American Dental Association claim form should I use when submitting a paper claim?

You must use this version of the ADA claim form (also known as ADA-J430 in the dental provider manual).

Which claims should I submit to Delta Dental/MCNA, and which should I submit to Medicaid?

All claims for dates of service before Nov. 1should be sent to the dental managed care organization (Delta Dental or MCNA) in which the beneficiary was enrolled on the date of service. For clients enrolled in a DMO, only claims for dates of service on or after Nov. 1 should be submitted to Medicaid.

Beneficiaries’ dental service history is not showing up in the Medicaid provider portal. Where can this information be found?

DHS has decided that all services provided while beneficiaries were enrolled in Delta Dental or MCNA will not be applied against Medicaid benefit limits. As a result, any services processed by Delta Dental or MCNA will not appear in the provider portal under a beneficiary’s benefit limit history. This change will be implemented November 14, 2024, and will be retroactive to dates of service on or after November 1, 2024. After the change is implemented, our system will reprocess for payment any claims denied for this reason.

How will I know if a beneficiary has Medicaid Dental coverage?

Please see this job aid to determine beneficiary Medicaid Dental coverage.

Prior Authorizations

What services require a prior authorization (PA) under fee for service?

Medicaid covered services and those that require a PA are listed here.

In anticipation of the transition to dental fee for service, where should I submit my prior authorization requests?

For Beneficiaries Enrolled in Delta Dental or MCNA, you’ll use the following schedule and instructions:

Now through October 18, 2024	Send to Delta Dental or MCNA
October 19, 2024, and beyond	Enter in Acentra portal

Any PAs approved by Acentra for dental managed care beneficiaries on or after October 19, 2024, will need to have a Date of Service (DOS) on or after November 1, 2024.

For Beneficiaries Enrolled in Fee for Service Medicaid, enter the PA request in the Acentra portal.

How long does it take for a PA to be processed?

Acentra Health must process all prior authorization requests within 72 hours of receiving all necessary documentation. If a PA request is sent back to the requesting provider for additional information, the dental provider will have 15 calendar days to provide the necessary documentation. If no clinical information has been received within 15 calendar days, the review will be administratively denied. Insufficient clinical information reviews will be forwarded to a Dental Peer Reviewer for medical necessity review.

Can a prior authorization request for a service be submitted after the service has been provided?

Nearly all PA requests should be submitted before a service is provided with some exceptions (e.g., emergencies, child sedation). DHS understands retroactive PA requests have been allowed in the past. DHS will allow retroactive PA requests in November and December 2024 for dates of service no more than 90 days before the submission. Beginning in 2025, all PA requests (with limited exceptions of retroactive eligibility, emergencies, and child sedation) must be submitted prior to providing the service.

Where can I find more information about the process for submitting prior authorization requests for dental services?

FAQs about the dental prior authorization process and other resources can be found on the Acentra website: https://ar.acentra.com/dental-services/.

What diagnosis code should I enter in my PA request?

If you know the correct diagnosis code, enter it in the field. If you do not know the correct diagnosis code, you may enter R69. The Medicaid fee for service dental program will be moving toward requiring more specific ICD-10 codes in the coming months. Information on ICD-10 diagnosis codes can be found here.

What if I have an active PA dated prior to November 1, 2024?

If you have an active PA dated prior to November 1, 2024, DHS will honor it. Delta Dental and MCNA have transferred their PAs to Arkansas Medicaid’s MMIS system for reference in processing claims.

I have an expired PA.  What should I do?

Please submit a new PA.

For Beneficiaries Enrolled in Delta Dental or MCNA, use the following schedule and instructions:

Now through October 18, 2024	Send to Delta Dental or MCNA
October 19, 2024, and beyond	Enter in Acentra portal

For Beneficiaries Enrolled in Fee for Service Medicaid, enter the PA request in the Acentra portal.

How will orthodontic treatment already under way be paid for?

If banding has occurred (if the appliances have been installed) on or before November 1, 2024, Delta Dental and MCNA will pay out the remaining sum. If banding has not occurred (if the appliances have not been installed), FFS will pay an upfront sum for the services.

Will the payouts for approved orthodontic treatment be paid up front when treatment starts, or will the payments be made in installments?

Medicaid pays for orthodontic treatment as an upfront sum for clients who are in Medicaid fee for service when the orthodontic treatment begins.

Will patients who have already received orthodontic treatment under Managed Care be eligible for additional orthodontic services?

No. Medicaid fee-for-service policies do not allow for more than one orthodontic treatment to be reimbursed per a beneficiary’s lifetime. Treatment received under managed care will count toward a beneficiary’s lifetime limits.

How should dental providers bill for limited orthodontic treatment as those specific procedure codes are not currently included in the Medicaid fee schedule?

Dental providers should bill for limited orthodontic treatment under code D8999. The more specific limited orthodontic treatment codes will be part of DHS’s comprehensive reviewof the entire dental program. DHS understands dental providers may have concerns about billing the more general code, and we have consulted with our state Office of Medicaid Inspector General (OMIG). OMIG’s assurance that dental providers may bill for limited orthodontic treatment using the D8999 code can be found here.

What scoresheet will be used for orthodontia?

Please use the HLD Scoring sheet available in Section II.226.00 of the provider manual. The link to Section II is here. The link to the HLD Scoring sheet is here.

How will dentures already under way be paid for?

Delta Dental and MCNA will pay all claims for dentures with a seat date (the date the dentures are delivered to the patient) before Nov. 1. Medicaid will pay claims for dentures initiated before Nov. 1 with a seat date on or after Nov. 1, 2024.

DHS will pay the Delta Dental/MCNA rate for all dentures started while beneficiaries were enrolled in DMO. These cases will be identified as follows:

• For beneficiaries enrolled in MCNA, those with an MCNA-approved PA for dentures.
• For beneficiaries enrolled in Delta Dental, those with dentures seated in November or December who were enrolled in Delta Dental in October.

Can I continue to use the lab of my choice for things like dentures and crowns?

Dental providers can select the labs they wish to use for all services, EXCEPT for the creation of dentures for adult beneficiaries. Medicaid contracts with Green Dental to create all dentures for beneficiaries enrolled in the dental fee for service program.

What is the process for submitting a prior authorization request and billing claims for adult dentures?

For adult dentures where a PA is required (partial dentures), submit:
1. PA request to Acentra and in the “servicing provider” field, you must enter Green Dental.
2. Dental Lab Request Form to Green Dental

For adult dentures where PA is NOT required (full dentures), submit:
1. Dental Lab Request Form to Green Dental

Medicaid will pay Green Dental for adult dentures fabrication. Dental providers should bill Medicaid only for diagnostic cast (D0470) and evaluation (D0140). Please refer to this Quick Training Guide for the step-by-step process.

What is the process for submitting a prior authorization request and billing claims for children’s dentures?

Dental providers may use the lab of their choice for children’s dentures. Please, submit
1. PA to Acentra and
2. Any documentation your selected lab requires to that lab

Dental providers bill Medicaid for appropriate dentures codes (D5110, D5120, D5211 or D5212)

How will other multi-visit treatments (e.g., crowns) already under way be paid for?

Delta Dental and MCNA will pay all claims for multi-visit treatments with a seat date (the date the crowns or other prosthetic appliances are delivered to the patient) before Nov. 1. Medicaid will pay claims for all other multi-visit treatment initiated before Nov. 1 with a seat date on or after Nov. 1, 2024.

Will Medicaid pay for immediate Dentures?

At this time, immediate dentures are not a Medicaid covered service. DHS plans to immediately begin a comprehensive review of the entire dental program once the FFS transition has gone live and stabilized.

Payment

How often will payment be remitted to providers?

Claims are paid weekly with the financial cycle occurring on the weekend. The check date is the following Thursday.

How will Dental providers be supported during this transition? 

DHS will provide job aids and instructional videos to help with Medicaid billing and prior authorization processing. DHS will also provide beneficiary-friendly fliers and posters you can print out for your office. AFMC provider representatives will be visiting dental offices in person before November 1, 2024, to discuss the transition, provide job aids, Prior Authorization information, and contact information for the Provider Relations team and the MMIS billing team. AFMC will also be able to answer any specific questions providers may have.  

Where can I find information about how to file Medicaid dental claims?

Click here for a job aid that details how to file a claim.

I received information about Medicaid combining Delta Dental and MCNA. Is this accurate?

Medicaid is not combining Delta Dental and MCNA. The Dental Managed Care Program is ending, and we are returning our Dental Program to Medicaid fee-for-service. This means Medicaid clients will no longer be enrolled in Delta Dental or MCNA. Instead, Medicaid clients will use their Medicaid ID for Dental services, and Dental providers will bill Medicaid directly for services for Medicaid clients.

What information is being sent to beneficiaries?

Enrollees in Delta Dental and MCNA will receive a letter before mid-October explaining the change. Click here to read the letter.

Other Questions

How can I ask a question that is not included in this set of FAQs?

If you have other questions, please contact the below resources:

Entity	Contact Information
Gainwell Provider Assistance	Phone: (501) 376-2211
AFMC Provider Relations	Email PR Outreach Specialists map
MMIS Billing Team	Phone: 501-906-7566 Billing Specialist map AFMC/ Gainwell MMIS Billing Team Webpage
Acentra Health	Webpage Email Health Portal
Prime Therapeutics	Webpage
AR DHS – Division of Medical Services (DMS)	Email Webpage Phone: 501-302-6230 Toll Free: 855-703-2891 Mailing Address: DHS Division of Medical Services Dental Care Unit P.O. Box 1437, Slot S410 Little Rock, AR  72203-1437

Who should I contact if I’m not receiving e-blast communication for AR Medicaid dental updates? 

Please reach out to AFMC Provider Relations – [email protected].