Providing you with information about our plans and information that can benefit you and your practice is an important part of our commitment to you.
Our semi-annual newsletter is your key source for staying up-to-date on what’s happening with HMSA dental.
This Just In
Provider Fee Schedules, Benefit Matrices for our PPO and ACA plans, and a current List of Dental Codes Requiring Prior Authorization are now available. Your Type 1 NPI (individual and unique to provider) is required for access. Click here to view, download, or print a copy of the documents mentioned above. CDTs and Dental Manuals for the upcoming year will be posted mid-December.
To avoid impacting payment of claims, please note that, effective July 1, 2022, changes were made when servicing FEP Basic and Standard Option members. Paper claims should now be mailed to: HMSA Dental P.O. Box 69436, Harrisburg, PA 17106-9436 (same as PPO claim submissions). Dental providers also have the option of submitting claims electronically through clearinghouses or the Speed eClaim process. As a reminder, members with FEP Basic and Standard Option plans have access to HMSA Dental providers in our PPO network. Learn more.
Precertification is now required for anesthesia (which is covered under the medical plan benefit) linked to a dental procedure under Private Business (PB) plans and QUEST Integration (QI) plans. For prior authorization in an outpatient setting with anesthesia, include both CPT codes 00170 and 41899 on the request submitted to HMSA.
Deep sedation or general anesthesia may be medically necessary to render dental services in patients with special medical challenges. This policy helps ensure patient safety and reserves these services for patients and situations that warrant the risk.
For more information on the criteria, guidelines, and documentation required, please refer to the Deep Sedation and General Anesthesia for Dental Services policy.
Jan. 1, 2022 marked the start of a limited HMSA Dental Medicare Advantage network. This network was developed to improve the quality and efficiency of services to our members and further enhance the network management experience for our participating dentists. Learn more about Medicare Advantage Participation here and if needed, contact your Dental Network Manager or email us to verify your participation status with this network.
The American Heart Association continues to recommend viridans group streptococcal (VGS) infective endocarditis (IE) prophylaxis only for categories of patients at highest risk for adverse outcome while emphasizing the critical role of good oral health and regular access to dental care for all. Read the full study.
Email us any questions or requests at HMSAdentalPR@usablelife.com.
Access the current dental manual and guidelines, CDT guides, and training materials.
Learn more about Medicare Advantage participation.