New York Medicaid Revises The Dental Manual

Recently the New York State Medicaid Program published an updated version of the Dental Manual as well as the fee schedule. We highlight some of those changes below and encourage all dental providers to analyze the revised documents.

On Site Visits – Be Prepared!

The Office of the Medicaid Inspector General (OMIG) performs periodic onsite visits, called Credential Verification Reviews (CVR), of a provider’s medical office. The stated goal of these visits is to analyze the extent to which providers are complying with Medicaid regulations. During a CVR, OMIG will inspect: 1) the provider and staff identification and credentialing; 2) physical attributes of the place of business; and 3) record-keeping procedures as well as procedures regarding submission of Medicaid claims.

An important feature of the CVRs is that they apply to all providers, not just dentists, who participate with the Medicaid program. Physicians, pharmacies, durable medical equipment companies as well as part time clinics should also be prepared for a possible CVR from OMIG.

OMIG representatives conducting the on-site visits are required to have a letter of introduction signed by the Inspector General along with photo identifications. While the Medicaid manual provides that “[e]very effort is made to conduct these visits in a professional and non-obtrusive manner,” one of our clients reported a less than pleasant experience with such an on-site visit as investigators showed up without IDs, were impatient while the doctor was with a patient, and were unpleasant during the inspection. We hope that this instance was an exception rather than the norm. Irrespective of the situation it will be beneficial to providers in the long term if they maintain a professional demeanor during the CVR. It is also a good idea for providers to verify the information provided by the inspectors before they initiate the CVR by either contacting the OMIG’s Dental Unit at 518-402-1837 or an alternate number provided by the inspectors.

Dental Vans – Update Enrollment Information

The Medicaid Manual noted that the use of dental vans has recently increased. Additional information from newly enrolling providers regarding plans to offer services via dental vans will be sought by Medicaid. For currently enrolled providers who obtained a van to offer mobile dental services, Medicaid is requesting that providers update the enrollment information.

Services Not Covered By Medicaid

Providers are reminded that not all dental services are covered by the NY State Medicaid Program. The following services are excluded:

  • dental implants and related services
  • fixed bridges (exceptions apply)
  • immediate full or partial dentures
  • dental work for cosmetic reasons or personal preference
  • crown lengthening
  • improper usage of panoramic X-rays (D0330) along with intraoral complete series X-rays (D0210)

Please refer to the dental manual for the full list of services not covered by Medicaid.

Managed Care

Many Medicaid recipients are switching to managed care plans. Medicaid reminds providers that it is inappropriate to bill Medicaid fee-for-service when the managed care plan covers the specific services.

If you have questions about NY State Medicaid participation, the revised dental manual or require other legal assistance, please contact us.