News and Views

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Spring 2022 Newsletter

Friday, April 1, 2022 | Posted in GEHA Connection Dental Network Provider Newsletter

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Medicare Advantage plans offer expanded coverage, but verify benefits first

Regular dental care is an important part of maintaining good health. One of the main perks of a Medicare Advantage plan is that many plans offer dental coverage.

Traditional Medicare only covers dental procedures while in the hospital. Medicare Part A does not cover routine dental care, such as cleanings, X-rays and fillings. Because of high out-of-pocket expenses, patients enrolled in traditional Medicare often go without the services they need. Medicare Advantage (Part C) is an all-in-one alternative to traditional Medicare. Medicare Advantage is a bundled plan that includes Parts A, B and usually, D. Medicare Advantage offers extra benefits that traditional Medicare does not, such as dental, vision, hearing and more. Patients that have Medicare Advantage plans may pay additional premiums for coverage.

MEDICARE PLANS INCLUDE:

• Part A (Inpatient hospital coverage)
• Part B (Outpatient medical coverage)
• Part C (Medicare Advantage)
• Part D (Prescription drug coverage)

Medicare Advantage plans include a variety of dental benefits. Please note you will be reimbursed by the payor the member has selected, not by Medicare directly.

It is crucial to verify benefits and eligibility with each payor prior to performing services. Contact the payor directly for your participation status within each of their network plans or products.

For a full listing of Medicare Advantage payors and plans offered by each, please visit the Resource Center at connectiondental.com.

Look in the Resources box on the right, then scroll near the bottom to the Connection Dental Network Payor List.

Since these plans follow Medicare/Medicare Advantage guidelines, you need to comply with related requests sent by GEHA Connection Dental Network, including annual fraud, waste and abuse training and quarterly directory updates. Both tasks can be completed at connectiondental.com within the Provider Portal. You will receive a prompt to complete your training when required.

Clarification on FEDVIP Dental First Payor information

When a provider participates in both FEHB and FEDVIP, the lesser of the contractual plan allowances will prevail. For example, when the FEHB allowance would result in lesser out-of-pocket expenses for the enrollee than the FEDVIP plan allowance, the FEDVIP enrollee should not be disadvantaged and the FEHB allowance should be applied.

Check out our News & Views

DENTAL PROVIDERS PLAY A KEY ROLE IN IMPROVING OVERALL HEALTH EQUITY

Disparities among economic security, healthy housing, availability of nutrient-dense food, opportunities for exercise and efforts to provide social security for all can create an increase of oral health diseases among the marginalized groups, leading to oral health inequities.

The federal initiative Healthy People 2030 plays an important role in oral health, including reducing untreated dental disease, increasing water fluoridation, expanding access to dental insurance and improving access to care and enhancing the public health infrastructure. Paying attention to the importance of these SDoH can lead to improved policy and research that boosts oral health for everyone.

Read the full News & Views article on connectiondental.com

Be sure to check out the “What’s New References” in the Resources section on our web Resource Center at connectiondental.com to stay up to date on new and revised payor notices, provider manual and state specific policies and procedures. We encourage you to check the Resource Center on a regular basis to see updates as they occur. Here is a recap of the new or updated documents that are important to you as a GEHA Connection Dental Network provider:

UHC Healthnet	12.7.2021	New document added
Kansas City Life Referral Guidelines	12.13.2021	New document added
Aetna 2022 Medicare Quick Reference Guide	12.14.2021	New document added
GEHA CD Cred Recred QAP Legal Policies	1.14.2022	Updated document
Humana Medicare Advantage Dental Office Handbook 2022	1.14.2022	Updated document
Humana Provider Communication 2022	1.14.2022	Updated document
Guardian Appeals New Jersey	1.14.2022	Updated document
Guardian Claim Info New Jersey	1.14.2022	Updated document
Provider Manual	1.29.2022	Updated document
Illinois State Specific P&P	1.31.2022	Updated document
Principal Claim Appeal UM Procedures New Jersey 2022	1.31.2022	Updated document