Medicaid Dental Care

 
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Medicaid Related Assistance
Medicaid & Long-Term Care
 
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What you need to know

​​​​​​​​​​​​​​​Beginning January 1, 2024, dental services will be provided by the Member's health plan, Molina, Nebraska Total Care, or UnitedHealthcare. Nebraska Medicaid also proposed multiple changes to increase member access to dental care and reduce the administrative burden on dental providers. The following changes, including the ability to bill for the proposed services, are effective for services provided on or after January 1, 2024:

1. Removing the annual dental benefit maximum

The current policy limits adult members to $750 of dental care a year. This creates a barrier to care for new and high-need members who may need additional dental care. Removing the dental benefit maximum will improve member access to care and remove an administrative obstacle for dentists across the state.

2. Incremental Payments for Dentures

The current reimbursement policy for dentures only provides for payment once the process is complete. This can be a long and costly process; Nebraska Medicaid proposed to reimburse dentists over time for each step of the process. The following are service codes proposed by Nebraska Medicaid: 

PROPOSED INCREMENTAL PAYMENT SERVICE CODES
SERVICES
​SERVICE CODES
Complete denture - Maxillary
D5110
Complete denture – MandibularD5120
Immediate denture - MaxillaryD5130
Immediate denture - MandibularD5140
Maxillary partial denture - Resin baseD5211
Mandibular partial denture – Resin baseD5212
Maxillary partial denture – Cast metal framework
D5213
Mandibular partial denture – Cast metal frameworkD5214

3. Asymptomatic Wisdom Tooth Extraction

Nebraska Medicaid is bringing our coverage in closer alignment with commercial plans by proposing to cover the extraction of asymptomatic wisdom teeth based on the judgment of the provider. This change will help members and providers proactively prevent health issues and align with the current standard of practice for wisdom tooth extraction.​

4. Services Provided by Public Health Dental Hygienists

Public health dental hygienists will be reimbursed for select services they provide to Medicaid members. This will help improve dental access and dental health across Nebraska. The following service codes include existing and proposed codes for dental hygienists.

PUBLIC HEALTH DENTAL HYGIENIST SERVICE CODES
SERVICES
SERVICE CODES
Screening of a patient
D0190
Assessment of a patient
D0191
Prophylaxis-adult (age 14 and older)
D1110
Prophylaxis-child (age 13 and younger)
D1120
Topical fluoride varnish; therapeutic application for moderate to high caries risk patients    
D1206
Topical application of fluoride- excluding varnish 
D1208
Sealant - per tooth
D1351
Interim caries arresting medicament application – per tooth
D1354
Full mouth debridement to enable comprehensive evaluation and diagnosis       
D4355
Adjust complete denture - maxillary​​
D5410
​Adjust complete denture - mandibular​
​D5411
Adjust partial denture - maxillary

D5421
Adjust partial denture - mandibular

D5422
House/extended care facility call

D9410
Prescribing of mouthwashes and Fluoride. This service does not have an associated CDT code.
*

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5. Simplified Credentialing

Leading up to 2024, the MCOs are working with Nebraska Medicaid to streamline the provider credentialing process. Starting in 2025, there will be a single website for providers to credential with all three MCOs in one application. Until the website is live, the MCOs are working with providers to simplify the credentialing process to help relieve the administrative burden of the credentialing process.

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Information for Members

​Understanding the Upcoming Dental Changes

Beginning January 1, 2024, your dental services will be provided by your health plan (Molina, Nebraska Total Care, or UnitedHealthcare​).  Your health plan will send you new Medicaid cards and additional information on these changes.

Have questions about your benefits? Contact your health plan today:​​

Molina Healthcare
1-844-782-2018
Nebraska Total Care
1-844-813-6769
United Healthcare​
1-800-641-1902​

These changes are designed to make it easier to access and maintain your dental care regardless of where you are in the state.

Resources

​Frequently Asked​ Questions​

Frequently Asked Questions - Spanish

Information for Providers

​Credentialing with the Managed Care Organizations (MCOs)

​Nebraska Medicaid is asking dental providers to credential with all three MCOs.  During 2024, you will need to credential with each MCO individually.  The MCOs are working with providers and Nebraska Medicaid to simplify this process to help relieve the administrative burden on your offices.  Starting in 2025, there will be a single website for providers to credential with all three MCOs in one application.

If they have not already, dental representatives with each of the MCOs may be reaching out to providers to contract for dental services.  If you have any questions or would like to speak to the MCOs about contracting, please reach out to: ​

Molina Healthcare
1-800-508-6965
Nebraska Total Care
833-554-2292
United Healthcare​​​​
800-822-5353

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Resources for Community Partners, Tribes, and Providers ​

​Provider Credentialing One-Pager

Provider Credentialing One-Pager - Spanish

Frequently Asked Questions (FAQ)

Frequently Asked Questions (FAQ)​ - Spanish

Social Media Toolkit​​​​

Social Media Toolkit - Spanish​​​

​Provider bulletins 23-04, 23-07, and ​23-34​ provide additional information on the upcoming dental changes and can be found online at: https://dhhs.ne.gov/pages/Medicaid-Provider-Bulletins.aspx.

Before January 1, 2024, Dental benefits were provided by Medicaid's dental benefits manager, MCNA Dental. Historical information on the previous dental benefits manager​ can be found online at: https://dhhs.ne.gov/Pages/Medicaid-Dental-Benefits-Manager.aspx​​.

Questions?
Contact Nebraska Medicaid for more information