||Brief Description of Changes During the State of Emergency
||On March 21, 2020, Governor Ron DeSantis issued Executive Order 20-72, prohibiting hospitals, ambulatory surgical centers, office surgery centers, dental, orthodontic and endodontic offices, and other health care practitioners’ offices from providing non-essential elective medical procedures during the state of emergency. As a result, procedures that may have already been prior approved by the managed care plan must be postponed. In order to reduce the administrative burden for providers that already obtained approval for procedures postponed as a result of this executive order, the managed care plan must extend the approval period for affected authorizations for at least six months.
DentaQuest will extend all open authorizations that exist as of March 21, 2020 for an additional six (6) months.
||DentaQuest/Florida Medicaid will pay for medically necessary services provided to recipients diagnosed with COVID-19, regardless of whether the provider is located in-state or out-of-state. To be reimbursed for services rendered to eligible Florida Medicaid recipients, providers not already enrolled in Florida Medicaid (out-of-state or in-state) must complete a provisional (temporary) enrollment application. The process for provisional provider enrollment will be located at http://www.mymedicaid-florida.com by Thursday, March 19, 2020. In the event of workforce shortages in the State, practitioners that are not already enrolled in Florida can seek enrollment following the instructions above.
During this period, DentaQuest will reimburse non-participating provider for medically necessary services rendered to our Medicaid patients under Florida’s Medicaid Standard rates.
Out of Network medically necessary services will only be covered based on the coverage for the plan’s benefit.
Claims must be submitted on ADA approved claim forms (2012 or newer ADA claim form).
Claims should be sent to: DentaQuest - Claims
DentaQuest works directly with Emdeon (1-888-255-7293), Tesia 1-800-724-7240, EDI Health Group 1-800-576-6412, Secure EDI 1-877-466-9656 and Mercury Data Exchange 1-866-633-1090, for claim submissions to DentaQuest.
PO Box 2906
Milwaukee, WI 53201-2906
Fax to 1-262-834-3589
or Via Clearinghouse – Payer ID CX014
|Exceed Service Limits/Expand Coverage
- Exceed service limits to maintain the health and safety of recipients diagnosed with COVID-19 or when it is necessary to maintain a recipient safely in their home (inpatient, home health, etc.)
- Add coverage of the COVID-19 lab test codes
- Allow early refills of maintenance medication (excludes controlled substances)
- Eliminate restrictions on the use of mail order delivery of maintenance medications
- Allow recipients to request a 90-day supply of medications when that quantity is available at the pharmacy; recipients can also request a 90-day supply of their medications be delivered through mail order.
||DentaQuest covers Teledentistry. Please refer to the Florida Provider Office Reference Manual via DentaQuest’s website and/or the Provider Web Portal.
Expand telemedicine/telehealth services in the fee-for-service delivery system (remote patient monitoring, store and forward) for physicians, APRNs, physician assistants
Expand telemedicine coverage to:
- behavior analysis services
- therapy services
- specified behavioral health services
- early intervention services
|Provider Enrollment Flexibilities
- Enact provisional enrollment to quickly enroll providers currently enrolled in Medicaid
- Waive requirement that Medicaid providers be licensed in-state
||Postpone on-site or face-to-face provider site visits (including enrollment/credentialing requirements)
||Allow enrollees more time to request a fair hearing or health plan appeals
||Extending Medicaid recipient eligibility and extending time to complete application process