Dental Application
Dental Policies
Dental Coordinator
Dental Fees
Dental Prior Authorization
Dental Payment
Dental
Claims Inquiries
Dental
Eligibility
Dental
Application
Currently, all dental services are
provided under the fee-for-service program, which covers dental
services for Hawaii Medicaid recipients. (Previously dental services
were part of the managed care program.) If you would like to be
a dental provider or if you are already a provider and want to report
changes you can use the Medicaid
Provider Application/Change Request Form (DHS1139) and appropriate
attachment forms (DHS 1139A,
1139B,
1139C,
1139D,
1139E,
1139F,
1139G
and 1139H).
New Applicants:
You should submit
a new application if you:
- Opened a new private practice
- Were a Managed Care Provider
- Are reactivating a Medicaid Provider number which was terminated
more than one year ago.
- If you are establishing a payee (pay to) other than your
own social security number . A separate application must be
submitted on behalf of the payee entity (e.g. XYZ, Inc or
LLC).
Instructions
are provided for form DHS1139; however, here are some additional
“pointers” to get you started:
- Parts A, B, C & E. should be completed:
- If you are providing regular services
to individuals under age 21, please complete Part D also.
- Submit the following documents with your
application:
- Copy of dentists current Hawaii dental
license card;
- IRS Form W-9.
- For dental specialists (i.e. Pediatric,
Endodontic, Oral Surgery) - documents certifying completion
of specialty training.
Current Applicants:
To modify Information on existing
Applications:
You should submit an application if
you need to add a location, close a location, change ownership
or make any other adjustments on your existing application:
- If you are adding or closing service
locations, check the appropriate boxes and complete Part A.
- The "Instructions for Existing Providers"
outlines requirements for all other changes.
- Please refer to the “Instructions
for Existing Providers” for additional information that
you may be required to submit such as your current Hawaii
license, W-9, Federal DEA, etc.,
Dental Memos:
Policy # |
Description |
Issue Date |
ACS
M09-14 |
Drugs Prescribed
by Dentists for QUEST or QExA Recipients |
06-16-09 |
ACS
M07-16 |
Dental
Procedures Codes |
08/27/07 |
ACS M07-15 |
Transition
of Dental Claims Processing and all the attachments (1-4) |
08/27/07 |
|
Adult
Dental Benefits (Preventive/Restorative and Dentures)
rendered in a Federally Qualified Health Center (FQHC) |
Effective December 1, 2006 |
ACS
M06-20 |
Adult
Dental Benefits (Preventive/Restorative and Dentures) |
Effective
December 1, 2006 |
ACS
M06-06 |
National
Provider Identifier (NPI) Information |
05/8/06
|
ACS
M04-14 |
Acceptance
of Claim Form ADA 2002 |
12/22/04 |
ACS
M04-08 |
Dental
Coverage for Adults |
08/16/04 |
ACS
M03-22 |
Claims
Filing Instructions for Dental Procedure Codes D0230,
D4210, D240, D7310, D7320 |
11/20/03 |
ACS
M03-12 |
Clarification
of Coverage of Dental Sedation |
10/1/03 |
M02-16 |
Sign Language Interpreter Services |
08/12/02 |
M02-14
|
Coverage
of Elective Tooth Extractions |
07/3/02 |
- Hawaii Revised Statutes
- 17-1735: General Provisions For
Fee For Service Medical Assistance
- 17-1737: Scope and Contents of the
Fee for Service Medicaid Assistance Program
- 17-1739: Authorization, Payment and
Claims in the Fee-For-Service Medical Assistance Program
- 17-1739.1: Authorization, Payment
and Claims in the Fee-For-Service Medical Assistance Program
for Non-Institutional Services. .
Dental Coordinator
CCMC (Community Case Management Corporation) is contracted by HDS to help recipients find a dentist.
Dentists may call CCMC at:
Oahu: (808) 792-1070 or Toll-free (888) 792-1070
Dental Fees
Click here for the Oahu Dental Fee Schedule.
Click here for the new increased Neighbor Island Dental Fee Schedule.
Dental Prior Authorization
Some dental procedures require prior authorization. All hospital prior authorizations must be submitted to HDS on paper using the Request for Dental Authorization form.
All non-hospital prior authorizations (including orthodontic prior authorizations) can be submitted electronically or on the standard ADA claim form. For further information, please contact HDS Medicaid at:
HDS Medicaid Customer Service
Oahu: 529-9345; Neighbor Islands: 1-855-819-9117
Dental Payment
Effective January 16, 2013 HDS is the Third Party Administrator (TPA) for Hawaii Medicaid�s dental program. HDS has partnered with Community Case Management Corp.
(CCMC), who will continue to handle the outreach services to Medicaid patients.
HDS Medicaid has a dedicated mailing address, customer service number and website for eligibility and electronic claims processing.
HDS Medicaid Customer Service:
Tel: (808) 529-9345, or Toll-free (855) 819-9117
Fax: (808) 529-9333, or Toll-free (855) 819-9118
HDS Medicaid DenTel Automated Voice Response System (for eligibility and fax back only):
(808) 529-9346 or Toll-free (855) 819-9119
Mail Medicaid Claims to:
HDS Medicaid
700 Bishop St Ste 750
Honolulu, HI 96813
HDS Medicaid Web Portal (eligibility, claims submission, claim information):
https://hdsmedicaid.org
Professional Relations Department:
(808) 529-9222 or Toll-free (800) 232-2533 ext. 222
Dental Claims Inquiries
HDS Medicaid Customer Service. Oahu: 529-9345; Neighbor Islands: 1-855-819-9117
HDS Medicaid: 700 Bishop Street Suite 750, Honolulu, HI 96813
Dental Eligibility
To check a patient�s Medicaid eligibility providers may use any of the following resources:
-
HDS Medicaid Customer Service.
Oahu: 529-9345; Neighbor Islands: 1-855-819-9117
-
HDS DenTel Automated Voice Response System.
Oahu: 529-9346; Neighbor Islands: 1-855-819-9119
-
HDS Medicaid Web Portal at https://hdsmedicaid.org
-
Call AVRS (Automated Voice Response System)
1-800-882-4608
-
Log on to Medicaid On-line:https://hiweb.statemedicaid.us
-
Call Med-QUEST Customer Service Section.
Oahu: 524-3370; Neighbor Islands: 1-800-316-8005
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