Hospital billing changes for dental services provided to managed care clients, effective 1/1/2020

Having trouble viewing this email? View it as a Web page.

Health Care Authority (HCA) logo

Apple Health (Medicaid) Provider Alert

This billing change applies only to clients enrolled in an agency-contracted managed care organization (MCO).

Effective dates of service on and after January 1, 2020, hospital charges for dental services must be billed directly to the client’s MCO. This includes inpatient, outpatient, emergency department, and ambulatory surgery centers. Do not bill the Health Care Authority (HCA) through fee-for-service for these charges.

The following fees will still be billed directly to HCA through fee-for-service:

  • Dental professional fees billed using CDT codes;
  • Dental and/or oral surgeon professional fees using a CPT code and the provider taxonomy starts with a 12.