• SDN Site Updates

    Hey everyone! The site will be down for approximately 2 hours on Thursday, August 5th for site updates.

  • How To ACE Your Medical School Interview

    In this webinar hosted by SDN with experts from BeMo Academic Consulting, you will learn a simple five-step process to help you translate your interview invitation into an acceptance.

HighTechDentist

New Member
Nov 1, 2010
10
0
Status (Visible)
  1. Dentist
One of my practices does about 80% Medicaid and HMOs. We accept Medicaid, Horizon/Mercy, Americhoice, and Healthfirst aside from isnsurances and fee for services.

I'm trying to find online resources that will tell me each ones policy on what procedures require PreDetermination, and which ones do not. All allow for operative to be done without PreD, however that's where it ends.

Mercy allows me to perform Root Canals without preauthorization, but the other ones basically require that you do a pulpotomy, send out for Predetermintion, then reappoint the patient to complete the root canal. If you don't do this, they won't pay you! They are very strict. This is bad for the patient as well as the practice. Also Medicaid allows you to do scaling and root planing without PreD, the others require peril charting and preD prior to starting the procedure.

The problem is it is very grey, and it varies from procedure to procedure, as well as circumstance. My office manager is overwhelmed and just tells me "everything needs PreD"

Can anyone point me to some online resources so I can be sure of what procedures require PreD and which ones don't? I'm specifically looking for Medicaid, Mercy, Americhoice, and Health First. Thanks.
 
About the Ads
This thread is more than 9 years old.

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.