Texas Health Steps
Provider Training 2013
Welcome to DentaQuest!
We look forward to working with you
to make Texas smile.
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Agenda
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Texas Health Steps Overview
Benefits
Periodicity
Additional Benefit – Medical Transportation Program
(MTP)
 Questions and Answers
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What is Texas Health Steps?
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Texas Health Steps
Medicaid only
 Known nationally as Early and Periodic Screening,
Diagnosis, and Treatment (EPSDT)
 Federally mandated health care program focusing on
prevention, diagnosis and treatment
 Individuals birth through 20 years of age
Additional information can be located at:
http://www.dshs.state.tx.us/dental/thsteps_dental.shtm
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EPSDT Benefits
Screenings
Other
services to
correct or
improve
health
Dental
EPSDT
benefits
Hearing
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Vision
EPSDT Benefits
 Benefit consists of two mutually supportive, operational
components which states and the federal government are
responsible for ensuring:
 Availability and accessibility of medically necessary health
care
 Medicaid enrollees and their parents or guardians effectively
use the services
 CMS is committed to improving pediatric dental care in the
Medicaid program and ensuring the appropriate provision of
medically necessary dental services to children.
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First Dental Home…
Medicaid Members from six (6) through 35 months of age may be seen for
dental checkups by a certified First Dental Home Initiative provider as
frequently as every sixty one (61) days if Medically Necessary. The First
Dental Home visit (D0145) can be initiated as early as six (6) months of
age and must include, but is not limited to, the following:
 Comprehensive oral examination
 Oral hygiene instruction with primary caregiver
 Dental prophylaxis, if appropriate
 Topical fluoride varnish application when teeth are present
 Caries risk assessment
 Dental anticipatory guidance.
Providers must be certified to be a Texas Health Steps Dentist. To become a First Dental
Home Initiative Provider (Texas Health Steps), the dentist must complete either the online
module or in-person training and submit registration information. The Texas Health Steps
online First Dental Home Module can be accessed through www.txhealthsteps.com.
Dental Services
Preventive
 Dental examinations (initial, periodic or problemfocused)
 Cleaning (prophylaxis)
 Instruction in proper oral hygiene
 Application of topical fluoride
 Application of sealants to teeth at risk of dental decay
 Maintenance of space
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Dental Services
Treatment
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Restorations (fillings, crowns)
Endodontic treatment (pulp therapy, root canals)
Periodontic treatment (gum disease)
Prosthodontic (full or partial dentures)
Implants
Oral Surgery (extractions and other procedures)
Orthodontia (braces) if medically necessary (prior
authorization required)
 Maxillofacial prosthetics
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Dental Services
Emergency and Trauma Related
 Procedures necessary to control bleeding, relieve
pain, and eliminate acute infection
 Operative procedures required to prevent imminent
loss of teeth
 Treatment of injuries to the teeth or supporting
structures
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Dental Periodicity
 Texas Health Steps clients begin to receive periodic dental
checkups at 6 months of age and every 6 months thereafter
through age 20
 Payment is made for dental checkups that are exceptions to the
dental checkup periodicity for the following:
 Medically necessary based on risk factors and health needs
 Required to meet federal or state exam/checkup
requirements for Head Start, day care, foster care, or preadoption
 Children of Migrant Farm Workers
 Client changes their dental home provider
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Migrant Farm Workers Exceptions…
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Children of Migrant Farm workers due for a Texas Health Steps checkup
can receive their periodic checkup on an accelerated basis prior to leaving
the area. A checkup performed under this circumstance is considered an
exception to periodicity.
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When the need for an exception to periodicity is established, a narrative
explaining the reason for the exception to periodicity limitations must be
documented in the member’s file and on the claim submission. In order to
submit a claim with an exception, the claim must have the keyword
“EXCEPTION” in Block 35 of the ADA claim form or the optional comments
field if submitting via DentaQuest’s portal. If the keyword is missing, the
claim may deny for exceeding benefit limitations.
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Code D1110 or D1120 should be submitted based on the member’s age.
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Performing a make-up exam for a late Texas Health Steps checkup
previously missed under the periodicity schedule is not considered an
exception to periodicity nor an accelerated service. It is considered a late
checkup.
Additional Benefit – Medical
Transportation Program (MTP)
 Transportation to and from appointments is available
for Texas Health Steps clients who have no other
means of transportation
 Arranged by the Medical Transportation Program
(MTP)
 MTP arranges the most cost effective mode of
transportation to meet the client’s needs
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MTP Related Services
For certain Medicaid clients under 21 years of age,
MTP services may also include:
 Stays at lodging facilities
 Meal expenses for the client and one attendant
 Travel advances
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Requests For Service
Clients can call the Medical Transportation
Program at 1-877-633-8747 to schedule free
transportation.
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Texas Health Steps Outreach…
 DentaQuest’s Member Advocates will remind members of their
next appointment due date via outbound calls
 DentaQuest’s Member Advocates can assist with coordination
of care and non-capitated services upon request
 Outreach postcards will be sent as a reminder to make
appointment every six (6) months
 Outreach postcards will be sent to those who have not had a six
(6) month visit (non-compliant)
Questions and Answers
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