Apple Health (Medicaid) Provider Alert
Attention medical providers:
The Health Care Authority (HCA) sent a Provider Alert on December 10, 2020, to medical providers advising of a temporary billing procedure when submitting claims for fluoride treatments. This temporary billing procedure applied to clients age six and older or clients who are treated by a medical provider or a provider who is not Access to Baby and Child Dentistry (ABCD)-certified.
The notice instructed providers to bill HCA directly for fluoride treatments using CPT® code 99188 with modifier KZ for fluoride treatments. This policy is effective for claims with dates of service of January 1, 2020, through June 30, 2021.
Issue
HCA understands that this temporary billing procedure may have resulted in recoupment by the client’s managed care organization (MCO). If the date of service on the claim is more than a year old, enter a claim note indicating recoupment by the MCO and the date of recoupment.
Reprocess claim for payment
To have your claim reprocessed for payment by HCA, submit the claim by direct data entry in ProviderOne. For additional assistance, reference the ProviderOne Billing and Resource Guide.
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