MCO Billing
101
MCNA, DentaQuest, TMHP
Medicaid and Chip
DO NOT PASS GO:
Ask these 3 questions before seeing the patient:
1. Are they eligible for the date of service?
2. Do you k...
This date needs
to be the date of
service.
This is where you
will find the last date
of history on file.
TMHP Eligibility
DentaQuest Eligibility and
History
MCNA Verification and History
Common Mistakes we see:
•N20 (Nitrous Oxide) is NOT a covered benefit
under the Chip program.
•Use code 1208 (fluoride)
•N...
Most Common Procedures for
Preauthorization:
The following procedures are the most common and require pre op and/or
post o...
Procedures that Require X-
Rays:
– Extractions (Roots need to be visible)
– Root Canal Build Up (Pre and Post X-Rays)
– Sp...
Billing
• When charging out a patient, make sure to only
charge out treatment completed. Confirm with
the doctor or the as...
Step by step billing/
charging out
Step by step billing/ charging
out
Once treatment is set
to complete, it will be
on the ledger. Mark
the INS button on the...
Step by step billing/ charging
out
Double click on the
claim to have it
open.
Click the
submit button
then click
batch
Step by step billing/ charging
out
Under Batch Processor in the Office Manager, you
will find your batched claim. Highligh...
Step by step billing/ charging
out
Make sure use the drop down box
and select Adobe PDF or Cute
PDF (which ever your offic...
Exporting X-Rays to PDF
X-
Exporting X-Rays to PDF
Go to the patients chart
Exporting X-Rays to PDF
Click PRINT
Here is where you
select the Pano or
the BW’s/ PA’s
Click on Image, and double click
a...
Exporting X-Rays to PDF
Once you hit the print button, make
sure to select Adobe PDF or Cute PDF
then click OK.
Select the...
Exporting X-Rays to PDF
When saving the x-ray
save it under the patients
name and the tooth
number of the x-ray
being subm...
Zipping Your Claims for
IssueTrak
Zipping Your Claims for
IssueTrak
On your Billing computer,
you will find a folder labeled
Zip Claims, double click to
ope...
Zipping Your Claims for
IssueTrak
Once the claims
have been zipped, a
folder will appear
with today’s date.
*Double check ...
IssueTrak
• Training on IssueTrak can be found in your
Operations Manual in the Non-Dentrix
section.
Things to Remember:
• Send only ONE date of service per IssueTrak ticket
– There is a 25MB limit for attachments.
– If sen...
QUESTIONS??
MCO Billing 101
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MCO Billing 101

  1. 1. MCO Billing 101 MCNA, DentaQuest, TMHP Medicaid and Chip
  2. 2. DO NOT PASS GO: Ask these 3 questions before seeing the patient: 1. Are they eligible for the date of service? 2. Do you know who their MCO is?(MCNA, TMHP, DentaQuest) 3. Is your office their Main Dental Home? If you answered YES to ALL 3 questions, then you can proceed with seeing the patient in your office If you answered NO to ANY of these questions, DO NOT continue. Find out if the patient is eligible, who their MCO is, or make sure you call to ensure that your office is their main dental home.
  3. 3. This date needs to be the date of service. This is where you will find the last date of history on file. TMHP Eligibility
  4. 4. DentaQuest Eligibility and History
  5. 5. MCNA Verification and History
  6. 6. Common Mistakes we see: •N20 (Nitrous Oxide) is NOT a covered benefit under the Chip program. •Use code 1208 (fluoride) •Narratives for Limited visits. –When seeing patient for a limited visit NO TREATMENT CAN BE DONE!!! •Treatment being billed that needs a preauthorization. •NOT verifying history
  7. 7. Most Common Procedures for Preauthorization: The following procedures are the most common and require pre op and/or post op x-rays as well. • Root Canals • Rubber Dam for RCT • Crowns • Build Up • Extractions – All wisdom teeth extractions need a preauthorization regardless of code. • SRP • FMD • Periodontal maintenance • All Prothodontic codes
  8. 8. Procedures that Require X- Rays: – Extractions (Roots need to be visible) – Root Canal Build Up (Pre and Post X-Rays) – Space Maintainers – Inlay/Onlay – Sedative Filling – Pulpal Therapy – Periodontal Scaling and Root Planning (SRP, NSP) – Periodontal Maintenance – Full Mouth Debridement (FMD) – Dentures and Partial Dentures
  9. 9. Billing • When charging out a patient, make sure to only charge out treatment completed. Confirm with the doctor or the assisting RDA. • Check that all patient information was entered correctly. (patient name, sub. ID, DOB, etc…) • Include all necessary x-rays and narratives. • Submit your claims on a daily basis!! • Under Chip, verify maximum allowed. ($564 max per year)
  10. 10. Step by step billing/ charging out
  11. 11. Step by step billing/ charging out Once treatment is set to complete, it will be on the ledger. Mark the INS button on the top to create claim. The claim will generate and be batched.
  12. 12. Step by step billing/ charging out Double click on the claim to have it open. Click the submit button then click batch
  13. 13. Step by step billing/ charging out Under Batch Processor in the Office Manager, you will find your batched claim. Highlight your claim with the blue line, and select Print Preview. Once you print preview, go to file print report.
  14. 14. Step by step billing/ charging out Make sure use the drop down box and select Adobe PDF or Cute PDF (which ever your office has) Click Ok, The save as box will appear. Save the PDF document as the patients name. Save all documents under a folder named claims in the P drive.
  15. 15. Exporting X-Rays to PDF X-
  16. 16. Exporting X-Rays to PDF Go to the patients chart
  17. 17. Exporting X-Rays to PDF Click PRINT Here is where you select the Pano or the BW’s/ PA’s Click on Image, and double click anywhere on the black area.
  18. 18. Exporting X-Rays to PDF Once you hit the print button, make sure to select Adobe PDF or Cute PDF then click OK. Select the x-rays you want to print. Once all of the x- rays needed are selected, click PRINT.
  19. 19. Exporting X-Rays to PDF When saving the x-ray save it under the patients name and the tooth number of the x-ray being submitted. X-rays should be saved in the same “claims” folder on the P drive.
  20. 20. Zipping Your Claims for IssueTrak
  21. 21. Zipping Your Claims for IssueTrak On your Billing computer, you will find a folder labeled Zip Claims, double click to open. Once Zip Claims is open, click on the Mb2 logo. This will “zip” all the documents that were saved into the claims folder in the P drive.
  22. 22. Zipping Your Claims for IssueTrak Once the claims have been zipped, a folder will appear with today’s date. *Double check to ensure there are documents in the zip file before attaching to IssueTrak.*
  23. 23. IssueTrak • Training on IssueTrak can be found in your Operations Manual in the Non-Dentrix section.
  24. 24. Things to Remember: • Send only ONE date of service per IssueTrak ticket – There is a 25MB limit for attachments. – If sending a different date, give an explanation as to why this claim is in a certain batch • When zipping a file, make sure that only claims and x- rays are being zipped. • Before submitting your claims, double check date of birth and subscriber ID is correct. • Pre-authorizations is the office responsibility! DO NOT do treatment if you haven’t received the approval!! • SUBMIT CLAIMS ON A DAILY BASIS!!!! THEY ARE DUE BY 10 AM THE NEXT BUSINESS DAY!
  25. 25. QUESTIONS??

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