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mbrzezinski
#21 Posted : Thursday, April 27, 2017 4:22:48 PM(UTC)
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mbrzezinski

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Hi Guest!

There is a new rule general dentistry can enroll in 855I here is a snip from the CMS website

CMS 855i- allows you to enroll to be reimbursed for the covered services furnished to Medicare beneficiaries, order and certify certain items or services, and prescribe Part D drugs.

Please note: If you are using the CMS 855i to enroll in Medicare to be reimbursed for covered services furnished to Medicare beneficiaries, select from either the Maxillofacial Surgery, Oral Surgery (dentist only), if applicable or select Undefined Physician type and write in "General Dentist"

Hope this helps!
Guest
#22 Posted : Monday, May 8, 2017 7:17:58 PM(UTC)
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Originally Posted by: mbrzezinski Go to Quoted Post
Hi Guest!

There is a new rule general dentistry can enroll in 855I here is a snip from the CMS website

CMS 855i- allows you to enroll to be reimbursed for the covered services furnished to Medicare beneficiaries, order and certify certain items or services, and prescribe Part D drugs.

Please note: If you are using the CMS 855i to enroll in Medicare to be reimbursed for covered services furnished to Medicare beneficiaries, select from either the Maxillofacial Surgery, Oral Surgery (dentist only), if applicable or select Undefined Physician type and write in "General Dentist"

Hope this helps!


Hi,

I appreciate your response, but this information is actually not accurate. Noridian (our MAC for Medicare) has refused to process our 855I since our doctor is a general dentist. I did select "Undefined Physician" and type General Dentist, and this was rejected. Also, the rep at Noridian said we could not submit a new app as an oral surgeon, since our doctor's credentials did not indicate she was an oral surgeon.

I argued with a few Noridian reps, and they've all said the same thing. I even pointed this out on their website, and asked if one of them could tell me where in their PIM manual it says dentists cannot contract with Medicare; they couldn't tell me, but still refused to allow our application. Ended up submitting an 855-O instead.

It would be really great if anyone who has had success with the 855-I (after the 855-O became available) for a general (non-OS) dentist can give me some hope. From what I can tell, the 855-I stopped being available to general dentists after the 855-O came out last summer.

BTW, I come from a medical billing background and have never had these issues with MDs, DOs, NPs, etc. getting their 855-I processed, so I know my way around the application pretty well.

Edited by user Monday, May 8, 2017 7:20:17 PM(UTC)  | Reason: ps

Guest
#23 Posted : Friday, May 12, 2017 2:55:24 PM(UTC)
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I just got the official denial from Noridian:

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Dear ,

We received your Medicare enrollment application(s) on March 22, 2017. We are rejecting your application(s) for the following reason(s):

The following were incomplete and requested to complete the Medicare application:
· Provider is a General Dentist and is unable to enroll as a paid medicare provider but can enroll as an O/R doctor. Asked if they wanted both applications returned or if they wanted to submit an 855O paper application to work with the received 855I application and return the 855R application as not needed. Was asked to do neither at the time of the phone call made April 10, 2017 at 3:41pm. I informed the contact this would serve as her RFI notification and an answer was due May 9, 2017.




So I guess that answers my question!

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courtneydsnow on 5/15/2017(UTC)
courtneydsnow
#24 Posted : Monday, May 15, 2017 2:08:57 PM(UTC)
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Thank you for sharing the outcome!
Guest
#25 Posted : Wednesday, January 10, 2018 11:02:06 AM(UTC)
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Courtney,

Could you send me a Medicaid link for Oklahoma like the one you sent for Texas?

Thank you!
courtneydsnow
#26 Posted : Wednesday, January 10, 2018 11:25:19 AM(UTC)
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Hi Guest!

No problem, here it is!

http://www.okhca.org/providers.aspx?id=105
Guest
#27 Posted : Thursday, February 1, 2018 1:15:43 PM(UTC)
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We are a general dental practice in Colorado. We are wondering if a patient can bill medicare on their own for services in our office that would be considered medical in nature. We have opted out as a medicare provider so I know we can not submit a claim ourselves. I am not worried about if the claim would be paid or not. Just can the patient submit a claim on their own or not?

Thanks
Shawna
courtneydsnow
#28 Posted : Thursday, February 1, 2018 5:37:04 PM(UTC)
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Hi Shawna!

Great question. If you are opted out of Medicare, then you should have your patients with Medicare sign a private contract for any services Medicare would have otherwise covered. That private contract states that neither the patient nor the provider will file a claim for the services, and it will all be cash pay.

Hope this helps!
Danielle
#29 Posted : Monday, February 5, 2018 8:52:46 AM(UTC)
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We have a patient who has to have medically necessary extractions prior to radiation that should be covered by Medicare. Does anyone know what the Medicare codes for this would be or where I can find these codes?

Thanks,
Danielle

Edited by user Monday, February 5, 2018 8:54:38 AM(UTC)  | Reason: Added more details

courtneydsnow
#30 Posted : Monday, February 5, 2018 10:43:11 AM(UTC)
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Hi Danielle!

Great question. There is not a specific CPT code for extractions, so you can either use the "D" codes on the claim (many insurers these days will process "D" codes when they are medically necessary services), or you can try the CPT codes below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures

Hope this helps!
Guest
#31 Posted : Friday, June 1, 2018 2:41:13 AM(UTC)
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Thanks to Courtneysnow, I've been following the thread and learning so much about dental eligibility. I am also looking to get an advice about Medicaid eligibility Utah at https://www.utahseniorplanning.com I heard that their staffs are really nice especially Valarie, the Account Manager, who's professional and gives me detailed information on my every query.
courtneydsnow
#32 Posted : Monday, June 4, 2018 11:11:35 AM(UTC)
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You're welcome!
bren
#33 Posted : Tuesday, September 25, 2018 1:50:47 PM(UTC)
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can you send me provider enrollment information for you for Arizona:)

thanks!
courtneydsnow
#34 Posted : Tuesday, September 25, 2018 2:03:09 PM(UTC)
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Hi bren!

Just to clairfy, are you looking for enrollment information for Medicare and/or Medicaid?
If Medicare - for sleep appliances or something else?
Guest - Bee
#35 Posted : Wednesday, June 19, 2019 11:44:26 AM(UTC)
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Hello Courtney,

We are a group practice based in Minnesota and are looking at getting credentialed with Medicare in hopes of being able to send claims for 'medical' procedures like Alveoloplasty or Biopsies done in our clinic. Normally, we'd bill the medical insurance for our Medicaid-only patients for these services but have never billed for our Medicare + Medicaid patients due to opting out with Medicare for claims. To clarify, we've opted in for the Rx purposes but not for billing/claims purposes.

However, I've read through this thread and, according to the links you posted, it seems that Medicare may not actually pay for these medical services?


I guess this is what I am wondering: is it worth it to credential/opt-in with Medicare just so we can bill and get a denial (if they indeed do not cover these services) and then bill to Medical side of Medicaid for possible payment? Or would Medicare actually pay us for services like those listed above if we opt-in with them? Please let me know as there seems to be little information about billing Medicare for Dental Clinics.

Thank you in advance for your reply!
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