Integra Software

 

News

Dental*Partner's electronic billing is X12 5010 compliant for insurance/managed care billing and for direct billing of Medicaid claims to the State.

In addition, an EHR certified solution is now available for Dental*Partner users who are "eligible professionals", qualifying them to receive incentive payments from the State. See below.

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New York State Medicaid News for Dental & Orthodontic Providers

EHR Incentive Program

An EHR solution for Dental*Partner is now available that will qualify an eligible provider to receive EHR incentive payments of up to $63,750 from Medicaid over a 6 year period. First year payment (for adoption or implementation of EHR) is $21,250. 

While Dental*Partner itself is not EHR certified, Dental*Partner users may a utilize a custom EHR patient data export feature to feed their data to EHR certified systems we've identified. The Dental*Partner user would need to open an account with the 3rd party EHR company. At that point, you've "Adopted" certified EHR technology and could apply for the first year payment.

Summary of Offering and Costs 

We've identified two EHR certified web-based systems that we can recommend. 

1.     Company 1 is a well-respected dental services provider and their software is specifically for dental/orthodontic. 

2.     Company 2’s product is designed for medical but can be used by dental providers. Company 2 is supported by advertisements, thus does not charge. We include them mainly for the very limited costs you would have to incur to obtain incentive payments.

EHR Service

Integra

Company 1

Dental EHR

Company 2

Generic EHR

Access to DP's Custom Data Export for EHR Systems, guidance on completing your CMS registration and MEIPASS application, instructions and guidance for the data export, contact info for EHR companies.

$295.00

 

 

Setup fee

 

   $99.00

Free

Monthly fee for as long as you continue to use the EHR product.

   .

   $99.95

Free

Data Import Fee – One-time data import of patient data.

 

No charge. Included as part of setup fee.

 

Free

Support

 

No additional charges

No charges

Future Plans Regarding EHR

There are no plans to get Dental*Partner EHR certified as it would require extensive development of features that are rarely used by dental providers, yet are needed in order to obtain full EHR certification. This would add baggage to our product just for an incentive payment program that is temporary.

Rather, the long-range plan is to build into the Dental*Partner the key EHR features that our users find truly useful. Some of them are already in our product, such as the ability to provide a patient with patient history in digital format.

Information on the NY Medicaid EHR Incentive Program can be found at this link: https://www.emedny.org/meipass/index.aspx

Dental & Orthodontic Transition to Medicaid Managed Care program

While this is now old news, we are leaving this item posted as the transition to managed care is still on-going.

For Dental, this transition began on July 1, 2012; for Orthodontia, it took effect on October 1, 2012.

Effective with the transition dates, all MCO's (managed care organizations) that have contracts with NY State are required to cover dental and orthodontic services.

Key points for providers to note now that the transition is in effect:

  • For every office visit, you must check ePaces for the patient's eligibility to confirm coverage and which payor to bill.  (Patient's status & coverage may change during treatment.)

  • You will be able to identify that a patient is covered by Medicaid Managed Care if the MEVS/Eligibility Response returns that the coverage is “PCP Eligible.” The response will also include the Plan Name, address and the telephone number. 

  • If the patient is covered by Medicaid FFS, then PA's and services will continue to be processed and billed as before, even after the transition date. No change.

  • If the patient is eligible for Medicaid but is now in a managed care plan, PA's and billing must go through the MMC plan. 

  • To bill the MCO (managed care organization), you must be enrolled as an approved provider in the plan, unless you are continuing treatment for a patient that was initiated (i.e., decisive appointment occurred) prior to the transition date. In the latter case you can bill the MCO without being in the plan's network but still must bill at the MCO's rate.

  • Patients who are currently FFS and not in managed care will continue to be billed to Medicaid as FFS as long as they chose not to enroll in managed care. However, new Medicaid recipients will be required to enroll in a managed care plan.

  • Patients who, prior to the transition date, were in a managed care plan that provided dental - you should expect to continue billing the MCO as before unless notified by the MCO of a change.

  • Patients who, prior to the transition date, were in managed care but billed to Medicaid as FFS because the plan did not cover dental, will now have their services billed to the MCO since, presumably, the plan will now cover dental.

  • In Dental*Partner, if one of your Medicaid FFS patients transitions to a managed care plan, all you need to do is place a checkmark in the "Bill Services to Health Plan" checkbox on the patient form and select the health plan from the lookup right below the checkbox. After that, any visits/procedures you bill for that patient will be treated as claims to be paid by the managed care organization, which may be submitted  electronically or by generating an ADA Form.

Billing Providers - Annual Recertification is Required!

If you bill electronically, you must get recertified annually or your claims will be rejected. The certification process links the provider’s NPI to the Electronic Transmitter Identification Number (ETIN) under which electronic claims are submitted.

Click here for more information. Also see our Information Links at page bottom.

Emergency Services

Billing for patients eligible to receive 'Emergency Services Only'  is limited to specific procedure codes. Click here for a list of codes and information on billing for these services.