Statewide Prepaid Dental Health Plans (PDHPs)

Billing for Dental Services to Prepaid Dental Health Plan Enrollees

Due to a provision in Florida law, Medicaid recipients are no longer allowed to “opt out” of the Statewide Prepaid Dental Health Plan (PDHP) program and receive dental services through Medicaid Fee-for-Service (also called straight Medicaid).  Effective July 1, 2013, all Medicaid children eligible for the PDHP program were enrolled in one of the two PDHPs:  DentaQuest or MCNA Dental.

July Billing

Medicaid Fee-for-Service dental providers should not cancel appointments in July for recipients newly assigned to a PDHP.  Each PDHP is required to cover previously scheduled or ongoing treatments for a minimum of the first 30 days of a recipient’s enrollment.  Providers must check eligibility and bill the recipient’s PDHP for services rendered during the month of July 2013.  Providers who are not participating in one or both PDHP networks should contact the PDHP’s provider relations department(s) for information on how to submit claims. Fee-for-Service claims submitted for PDHP-enrolled recipients beginning with a July 1, 2013 date of service will automatically deny.

Active Orthodontia

For recipients in active orthodontia care prior authorized by Florida Medicaid, each PDHP is required to cover the completion of the treatment whether or not the orthodontist participates in the PDHP’s provider network.  Providers must check eligibility to determine the recipient’s enrollment and contact the PDHP’s provider relations department to obtain a continuity of care form.  A continuity of care form and Medicaid prior authorization approval must be submitted for each recipient in active orthodontic treatment.  Claims submitted to the PDHP without the continuity of care form and/or Medicaid prior authorization approval will automatically deny.

Continuity of care forms are available from the DentaQuest and MCNA Dental provider relations departments.  See below for contact information.

DentaQuest
FloridaProviders@DentaQuest.com
(877) 468-5581

MCNA Dental
PRdepartment@MCNA.net
(800) 494-6262, Option 6

Providers

Providers may become part of one or both of the Prepaid Dental Health Plan (PDHP) networks.

Recipients

The Statewide PDHP program is available in Medicaid Areas 1, 2, 3, 4, 5, 6, 7, 8, 9 and 11 (Monroe County only).

FAQs

The Agency has received lots of questions concerning the Statewide Prepaid Dental Health Plan program. 

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Upcoming Florida Dental Managed Care Steering Committee Meeting

MCNA and DentaQuest will host the Florida Dental Managed Care Steering Committee Meeting to discuss Statewide Prepaid Dental Health Plan (PDHP). 

The Florida Dental Managed Care Steering Committee Meeting will be
 Friday, November 8, 2013,
9:30 a.m. – 2:30 p.m. E.S.T.
at the DoubleTree by Hilton Orlando Downtown,
60 South Ivanhoe Boulevard, Orlando, FL 32804.

Please note that there will be no conference call capability for this meeting.  Your attendance is encouraged.  For additional information contact MCNA Provider Hotline at 1-855-698-6262, or DentaQuest Provider Relations Supervisor Carol Schoneke at 800-417-7140 ext. 82317.

UPDATE

Due to a provision in Florida law, Medicaid recipients will no longer be allowed to “opt out” of the Statewide Prepaid Dental Health Plan (PDHP) program and instead receive dental services through Medicaid Fee-for-Service (also called straight Medicaid).  Effective July 1, 2013, all Medicaid children eligible for the PDHP program will be enrolled in one of the two PDHPs:  DentaQuest or MCNA Dental.

Recipients who have opted out of the PDHP program up to this point will be notified of this change by mail and offered a choice between the two PDHPs.  Recipients who do not choose a PDHP will be assigned to one by the state effective July 1, but may change plans at any time thereafter.

For updates on the Statewide PDHP program as they become available, visit this website and watch for forthcoming Provider Alerts.  Please direct questions to the Statewide PDHP mailbox at statewide.PDHP@ahca.myflorida.com.

The Statewide Prepaid Dental Health Plan (PDHP) program is operational in the counties shown below on the color-coded map.

In the 2010 proviso language (Specific Appropriation 204 of HB 5001), the Agency was directed to implement a statewide Prepaid Dental Health Plan (PDHP).  As a result, Florida Medicaid has contracted with two PDHPs, DentaQuest and MCNA Dental Plans, to provide children’s dental services in all Florida counties except Miami-Dade and the Reform counties, which are Baker, Broward, Clay, Duval, and Nassau. 

Map of Counties and Rollout Schedule [112KB PDF]

View the Reference Information tab above to download a PDF version of this map or to contact an field office.

The PDHPs must cover all Medicaid State Plan dental services covered by Medicaid for children under 21 years of age.  Except for children enrolled in Medicaid managed care plans offering optional dental services, and a few special services excluded groups, most Medicaid children are required to enroll in one of the two PDHPs.  The amount, duration, and scope of covered dental services will remain the same. 

If you have any questions, please send an email to statewide.PDHP@ahca.myflorida.com.