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New Member
Nov 1, 2010
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  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.
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