ACECCE Member Services Toolkit Installment 3

The Illinois Medicaid program covers dental benefits for all enrollees, including but not limited to diagnostic and restorative services. Details about specific covered services for children and adults can be found in the Department of Healthcare and Family Service’s (HFS) Dental Office Reference Manual (pdf), posted on the HFS website with other Chapter 200 installments of the Provider Handbooks. The manual also includes information on services that require prior authorization.

Like other covered services for ACE and CCE members, dental benefits are available on a fee for service basis from providers enrolled in the Medicaid program. DentaQuest administers dental benefits on behalf of HFS.

To locate a dental provider for ACE and CCE members, you can either use the DentaQuest Find a Dentist search tool on their website, or you can call DentaQuest Customer Service at 1-888-286-2447.

If you use the online search tool, first select Illinois. Then you will be able to search by state and plan.

If you choose the Select a State and Health Plan Group option, make sure to select Illinois from the state drop down list, and to select IL Illinois All Kids/Medicaid Dental from the plan drop down list.

Unless you are helping your member connect with a dentist who has provided care to that member in the past, you will probably want to search for providers who are accepting new patients.

Once you have made these selections, you’ll be able to search for providers by geographic area as well as by additional provider criteria such as language and gender.

Remember that although ACEs and CCEs are fundamentally changing the way members access health care, services are still reimbursed through the fee for service system. As such, the member’s HFS-assigned Recipient Identification Number (RIN) and medical card are essential tools for accessing and coordinating covered services.

In the event your organization fields questions from dental providers about how to handle ACE and CCE clients, it may be helpful to remind them that services are still reimbursed through the fee for service system. All Medicaid dental providers have access to the Dental Office Reference Manual (pdf), which contains instructions for verifying client eligibility, requesting prior authorization through DentaQuest, and submitting claims to DentaQuest. The manual also contains contact information for various issues that require additional support, most of which are handled by DentaQuest on behalf of the Department.

Issued by the Illinois Department of Healthcare and Family Services
December 2014