Provider Notice Issued 06/03/2019

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Date:   June 3, 2019

To:       Enrolled Dentists; Federally Qualified Health Centers; Local Health Departments; and Rural Health Clinics

Re:      Dental Member Eligibility Verification

This notice encourages providers to utilize the Department’s options to verify a participant’s eligibility prior to and on the specific date the provider is rendering a service.

Providers should always verify a member’s eligibility before providing services, both to determine eligibility for the current date and to discover any limitations to the member’s coverage. The Automated Voice Response System (AVRS), the Medical Electronic Data Interchange (MEDI) system, and the Recipient Eligibility Verification (REV) system are available.

Providers should not rely on DentaQuest’s web portal for eligibility. Any eligibility discrepancies that providers identify with the portal should be reported to a DentaQuest provider representative immediately.      

 Both the AVRS and the MEDI systems are available at no charge to verify member eligibility:

Automated Voice Response System (AVRS) — 800-842-1461

·        No charge to you or your authorized users to verify a participant’s eligibility.

·        A limit of six (6) participant eligibility inquiries per phone call.

·        Participant eligibility verification available seven days a week, 24-hours a day.

·        Participant eligibility inquiries can be made by using the RIN and the date of service.

The Medical Electronic Data Interchange (MEDI) website allows authorized users online access to Department information.

·        No charge to you or your authorized users to verify a participant’s eligibility.

·        No limit on the number of participant eligibility inquiries that can be made.

·        Participant eligibility verification available seven days a week 24-hours a day.

·        Participant eligibility inquiries can be made by using the:

·      Recipient Identification Number (RIN).

·        Participant’s first and last name (as it appears in the Department’s database) and date of birth.

·      Participant’s first and last name and Social Security Number.

·       Participant’s Social Security Number.

The REV system offers eligibility verification and other services at a charge to providers based on the scope of services needed. Please refer to the REV webpage.

Questions regarding this notice may be directed to your DentaQuest Provider Representative or the Bureau of Professional and Ancillary Services at 877-782-5565. 

Doug Elwell

Medicaid Director