Dental

Med-QUEST Dental Benefits

This page is for correspondence about statewide systems and policies surrounding the dental benefits program(s), not about individual patients, specific claims, or Medicaid enrollment.

The tabs and links below provide topics for your review, and introduce opportunities for you to share your ideas. Please do not include protected health information (PHI) in messages you send us.

We at the Department of Human Services value your insights. Like you, we are members of the community that want the residents of Hawaii to be healthy. We believe that we all benefit from teamwork and alignment between individuals, healthcare providers, and government systems.

Current Program Resources
New Topics
Dental Provider Q&A
Contact Us

LATEST PROVIDER MANUAL FOR DENTAL BENEFITS:

Chapter 14 - Dental Benefits - May 2025.pdf

https://medquest.hawaii.gov/content/dam/formsanddocuments/plans-and-providers/fee-for-service/Chapter%2014%20-%20Dental%20Benefits%20-%20May%202025.pdf

LATEST DENTAL PROVIDER FEE SCHEDULES:

2025 Medicaid Dental Fees - Effective 2025-05-01 - Final.xlsx

https://medquest.hawaii.gov/content/dam/formsanddocuments/resources/fee-for-srvices/2025%20Medicaid%20Dental%20Fees%20-%20Effective%202025-05-01%20-%20Final.pdf

NEED A DENTIST?

Are you a Medicaid-enrolled patient looking for a dentist? Or are you a dentist needing to refer a patient to a Medicaid dental provider? Community Case Management Corp. is a an agency here to help with finding a Medicaid dentist.

Welcome - Community Case Management Corp.

https://ccmchawaii.com

Phone: (808) 792-1070 / Toll-free: 1-888-792-1070

Fax: (808) 792-1062 / Toll-Free: 1-888-792-1062

Email: [email protected]

NEED HELP WITH A MEDICAID DENTAL CLAIM?

Medicaid dental claims are not processed or paid directly by Medicaid. All claims services occur through a private third-party agency, currently Hawaii Dental Service (HDS).

Patients or individuals: Call HDS Customer Relations 808-529-9248 / Toll-free 1-844-379-4325

Dentists: Call HDS Professional Relations 808-529-9222 / Toll-free 1-800-232-2533 Ext 222

Welcome to the New Topics section. Here, you’ll find a list of temporary and rotating topics designed to keep you informed about program updates, and opportunities for you to contribute your opinions. Click on any topic below to expand and explore. Your feedback will help shape future program changes and improvements. This section is updated regularly.

The day-to-day processing of dental benefits is conducted by a private contractor hired by The Department of Human Services. This contractor is currently Hawaii Dental Service (HDS).

If you wish to provide the Medicaid office any feedback on your experience with HDS for Medicaid-related claims, authorizations, or payments, please message us through the "Contact Us" tab. Privacy will be maintained. Names of commenters will not be shared with the private contractor.

Are you involved with the care or referral of Medicaid patients requiring advanced Oral Surgery or Oral Medicine? For example, patients with:

o Tumors or cysts requiring biopsy and/or resection

o Traumatic injury requiring surgery, repositioning, and stabilization

o Infections of the mouth requiring hospital admission and medical care

Med-QUEST (MQD) seeks feedback from the dental community. We are re-evaluating our systems surrounding the referral and coordination of care between dental homes and providers of advanced Oral Surgery/Oral Medicine. We would like to prevent patient care from being hindered due to:

o Uncertainty about where, who, or how to refer patients between medical and dental specialists

o Confusion about dental vs medical benefits, and associated paperwork

We would like to hear of any problems or experiences you have had with this topic, so we can design program improvements to begin in early 2026. Your comments will be for MQD internal use only. Please do not include any protected health information (Name/DOB/Medicaid ID #) in your initial email response. If you prefer to share your comments by phone, please email us your name and contact number and we will attempt to call you.

Please send us your comments through the "Contact Us" tab.

Thank you.

Are you a dental provider with ideas about new benefits for services to prevent disease? The Medicaid office invites your ideas about services that succeed in reducing the occurrence and costs associated with preventable diseases like caries and periodontitis. Hawaii's dental benefits programs are updated annually, and we are looking for new opportunities to prevent disease across our community.

Please send us your comments through the "Contact Us" tab.

Are you a dental provider with ideas about how to improve the oral health of individuals with special medical needs, including congenital anomalies? The Medicaid office invites your ideas about services that succeed in improving the health, and reducing the occurrence and costs of disease for these members of our community.

Please send us your comments through the "Contact Us" tab.

We expect to publish updates to Chapter 14 and the Fee Schedule once a year, between January and March. Special circumstances may call for an update outside of this cycle. Please check the "Current Program Resources" tab to view the most recent documents.

The dental benefit programs are intended to provide 100% financial coverage for many basic services related to oral health. Additional dental services may be requested and delivered to patients on a self-pay basis.

Providers must first inform patients of any covered procedures that reasonably address or satisfy their situations. After that, a provider may collect payment from a patient for a requested procedure without an available program benefit. This includes any service code not within the Medicaid dental program, and any benefit that has already been used by that patient, or has met frequency limits.

Some beneficiaries mistakenly expect that any dental service is “covered” or “free.” Medicaid dental providers must clearly communicate any out-of-pocket costs in advance, with a signed acknowledgement of financial cost. Failure to create a signed agreement will disqualify a dentist from collecting payment. See Chapter 14, section 7.

The goal of the Medicaid dental benefits programs is the HEALTH of the residents of Hawaii. "Health" is the status of living without disease or dysfunction. Some people have compromised health due to congenital conditions or unforeseeable accidents or medical events. This includes genetic and developmental disorders, or trauma. For others, health is naturally present - unless unhealthy decisions surrounding diet and lifestyle have resulted in chronic yet preventable disease. Dental caries and obesity are two forms of this type of preventable disease.

"Healthcare" is the business of paying medical/dental professionals to perform services on people. Many healthcare services are intended to manage disease, while some are intended to help prevent disease. The economy of healthcare is huge, and is growing quickly. Healthcare is a very expensive tool that a community has to try to be more healthy.

Rates of chronic preventable diseases are increasing, and limited community resources are being increasingly spent managing preventable disease. A lifetime of healthy choices surrounding diet and lifestyle - not increased healthcare spending - are a community’s best tool to living disease-free. When individuals make daily decisions that promote the well-being of themselves others around them, healthcare resources can be directed toward non-preventable conditions, and delivering prevention-oriented services.

An economy built around helping individuals avoid disease is in contrast to an economy that depends on individuals developing disease that requires a lifetime of expensive disease management.

The dental programs include federal requirements linked to funding and state-level requirements determined by Hawaii's lawmakers. When the details of the dental benefits call for program-level judgement, three of the strongest principles that guide decisions are:

1) The design of healthcare benefits will emphasize health maintenance and disease prevention, rather than only ongoing disease management.

2) Individuals with special healthcare needs arising from non-preventable conditions, including congenital disease, deserve high priority access to available resources.

3) Public funds will be used for services that meaningfully contribute to health. Waste, fraud, and abuse of resources will be minimized.

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