Oral Health Program: Medicaid and BadgerCare Plus for Dental Providers

Medicaid and BadgerCare Plus enrollment process

Enrolling is easier than you might think. You can see patients at your office or help them where they are. For example, be a provider at a nursing home, a charitable organization, or a nonprofit home healthcare agency. You can start small with a few families or patients at a time. You can use the Forward Health Portal to manage your Medicaid and BadgerCare Plus provider portal, and you can get paid by direct deposit while benefitting from online approval for many services.

Complete the following steps to become a Medicaid and/or BadgerCare Plus Provider in Wisconsin

1. Get National Provider Identification Number (NPI) Apply for NPI on the National Plan & Provider Enumeration System (NPPES) website. You will receive a confirmation email with your NPI, usually in minutes.
2. Enroll in Medicaid with a few short steps.
   • Know your NPI.
   • Gather your records of education, training, and experience.
   • Know your provider type and specialty taxonomy code.
     • Dental hygienist taxonomy code: 124Q00000X.
     • Dentist taxonomy codes are listed on page 11 of Forward Health Update No. 2008-148.
   • Complete the online application and allow 60 days for your Notice of Decision letter to arrive in the mail. The letter contains your login ID and PIN information.
   • Take note of the Automatic Tracking Number (ATN) that generates when you submit your application. You can use the ATN to track your application.
3. Request ForwardHealth Portal access. Set up an account using the Login ID and PIN provided in your Notice of Decision letter.

Medicaid and BadgerCare Plus revalidation

Once enrolled, you are required to revalidate your enrollment information every three years to continue your participation with Wisconsin Medicaid.

• Check your revalidation date.
• Revalidate your enrollment online.

Medicaid and BadgerCare Plus billing process

Learn how to bill Medicaid and BadgerCare Plus.

Avoid the most common billing errors

• Know service limitations and requirements
  • Fillings: provide narrative, if required
  • Include attachments on claim
    • Prior Authorization (PA), if required
      • Request a PA
      • Learn how to submit prior authorizations
    • X-rays as needed
  • Verify all procedure codes
  • Verify member identification number is correct by referring to the member ForwardHealth Identification Card
  • Verify and enter all other insurance coverage

 Members who live in Milwaukee, Ozaukee, Racine, Washington, and Waukesha counties may have their dental coverage managed through an HMO or SSI HMO. Providers select and participate in each HMO or SSI HMO as a billing provider in addition to enrolling as a Medicaid and/or BadgerCare Plus provider in Wisconsin. Contact each HMO or SSI HMO to learn more.

 If you have questions, contact dental professionals field representative  Lori Hock at Lori.Hock@wisconsin.gov or call  608-684-0470

ForwardHealth Provider Portal Dental Claims User Guide

This is an excellent guide, P-00970b (PDF) for all of your billing questions.

• Step-by-step directions for providers
• Submit dental claims on the ForwardHealth Portal

Options for submitting dental billing claims

1. Electronic Claims Submission is preferred and allows flexible submission methods.

Must use 837 Health Care Claims – Dental (837D) transaction.

• 837D transaction companion guide for dental claim submission software
• Provider Electronic Solutions (PES) claims submission software
  • Free download from ForwardHealth
  • HIPAA-compliant

1. Log in to the ForwardHealth Portal and click on the Claims tab at the top of the page. Click Submit Dental Claim.
   • Fill in the Dental Claim Panel
   • Fill in the Detail and Surfaces panels with dental procedure information.
   • Attach any applicable documents.
   • Double check and submit your claim.
   • Helpful tip: Claims can be copied and updated to expedite the billing process.

2. Paper Claims Submission must use ADA 2006 or ADA 2012 claim form.

   Paper Claim Form Preparation and Data Alignment Requirements

Dental Provider Handbook

• Dental Hygienist Allowable Services is a concise list of billing codes for dental hygienists.
• Section on Codes contains comprehensive list of all billing codes for dentists.

Review the ForwardHealth Online Handbook—Provider » BadgerCare Plus and Medicaid by clicking the links below.

• Physicians —Topic #501
• HealthCheck (EPSDT)—Topic #2237
• HealthCheck Agency / Dental / Dental Hygienist—Topic #4580
• HealthCheck Agency / Dental / Dental Hygienist—Topic #21257
• Dental Hygienist Allowable Codes—Topic #2807
• Dental Allowable Codes—Topic #2808
• Dental / Preventive Services—Topic #2872

ForwardHealth Max Fee Home

Learn about the Wisconsin BadgerCare Plus Maximum Allowable Fee Schedule.

• Begin using the Interactive Max Fee Search
• ForwardHealth Portal Maximum Allowable Fee Schedule User Guide, P-00957 (PDF)

Resources

• Become an in-state emergency provider with limited or full Medicaid enrollment.
• ForwardHealth Portal includes program information, fee schedules, and forms.
  • ForwardHealth Portal Helpdesk, 866-908-1363
  • ForwardHealth Provider Login: Bookmark this page for
    • Up-to-date information about programs covered under ForwardHealth.
    • Easy access to the Quick Links box.
• ForwardHealth Provider Services, 800-947-9627. Select option 4 for dental
• Find and contact your provider relations representative.
• ForwardHealth Updates announce changes in policy and coverage, prior authorization requirements, and claim submission requirements.   Search by topic—for example, reimbursement for interpretive services.

Trainings

• Submitting Prior Authorization
• Submitting Dental Claims Through the ForwardHealth Portal
• Managing Your Medicaid and BadgerCare Plus Provider Portal

ForwardHealth information to share with patients

 Use the ACCESS website to apply for Wisconsin Medicaid or BadgerCare Plus.

  ForwardHealth Search Tool—Find a Medicaid or BadgerCare Plus dental provider.

  ForwardHealth Program Resources—Learn what patients need to know about each ForwardHealth program. Includes details about benefits, contacts, and forms for programs like Medicaid, BadgerCare Plus, and SeniorCare.

ForwardHealth Member Service line 1-800-362-3002
Available Monday through Friday, 8 a.m.–6 p.m. (Central Time, with the exception of state-observed holidays). Members should call Member Service for enrollment and benefit information.
Dental Ombudsman: email Donna Gresen at Donna.Gresens@wisconsin.gov or call 1-800-947-9627, option 4

Medicaid HealthCheck Brochure, P-01007 (PDF) DHS publication: Brochure explaining a child's Medicaid benefit called HealthCheck.

Learn more about:

• Medicaid/BadgerCare and Quitting Tobacco University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI): Coverage for tobacco-dependence treatment applies to treatment provided by any Medicaid-certified Wisconsin physician, nurse practitioner or physician assistant.
• Medicaid/BadgerCare Plus Coverage and Topical Fluoride DHS: The most accepted mode of fluoride delivery in children under age 5 is fluoride varnish and can be applied up to four times a year for children at high risk of early childhood caries. In Wisconsin, coverage applies to fluoride varnish placement by a number of health professionals in a variety of practice settings.