Effective December 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will implement an adult preventive dental benefit for its Healthy Connections Medicaid program.
Dentists who are enrolled in Medicaid will be able to seek reimbursement from the fee-for-service Healthy Connections program for preventive dental benefit services. These services are available to members age 21 and older who have full Healthy Connections benefits.
Covered services include diagnostics, extractions, fillings, and an annual cleaning, up to a maximum benefit of $750 per state fiscal year (July 1 through June 30), according to the health department. The $750 maximum benefit will be based on claim payments under the SCDHHS dental fee schedule.
SCDHHS requires a co-payment from adult members toward the cost of their preventive (nonemergent) care. Participating providers should collect a dental co-payment on each date of service for adult members. The co-payment amount is currently $3.40.
Medicaid members may not be denied services if they are unable to pay the co-payment at the time the services are rendered; however, this does not relieve members of the responsibility for the co-payment. It is the provider's responsibility to collect the co-payment from the beneficiary to receive full reimbursement for a service. The amount of the co-payment will be deducted from the provider's Medicaid payment.
For questions or concerns, contact the DentaQuest Provider Call Center at 888-307-6553.
