Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111

MassHealth
Dental Bulletin 23
June 1999

TO:      Dental Providers Participating in MassHealth

FROM:      Bruce M. Bullen, Commissioner

RE:      Oral Surgery and MassHealth-Contracted Managed Care Organizations, including
MassHealth-Contracted Health Maintenance Organizations (HMOs)

Background                       To direct providers to the appropriate source of reimbursement, this bulletin describes when emergency dental care and oral surgery are covered by MassHealth-contracted managed care organizations (MCOs), including any MassHealth-contracted health maintenance organization
(HMO), and when those services are covered by MassHealth.  This bulletin also describes the procedure for oral surgeons and dentists to rebill the Division for claims for services provided to MCO-enrolled MassHealth members where the Division erroneously denied those claims.

MCO                                 MassHealth-contracted MCOs cover emergency dental care and
Coverage                          emergency oral surgery when provided by a physician (an M.D.). Specifically, to be covered by the MCO, the care must:
(1) be associated with a medical emergency, such as trauma or accident,
(2) be provided by a physician, and
(3) include hospital emergency room or operating room services.

MassHealth                       Oral surgery and dental benefits not covered by an MCO are covered by
Coverage                          the MassHealth dental program if the services were performed by a MassHealth dental provider in accordance with all MassHealth regulations, including those at 130 CMR 420.000.  This includes dental emergency procedures performed in office, clinic, and dental school settings as well as oral surgery provided in a hospital or non-hospital setting by dentists or oral surgeons who are not physicians.

MassHealth
Dental Bulletin 23
June 1999
Page 2

Rebilling Erroneous           The Division will accept resubmittals of certain denied oral surgery claims
Denials                              for MassHealth members enrolled in a MassHealth-contracted MCO on the date of service, when services were delivered as described in the
“MassHealth Coverage” section of this bulletin.  Claims that may be resubmitted include only dental and oral surgery claims with dates of service between July 1, 1998, and April 30, 1999, that denied for error code 983 (service covered by MCO).  Those claims may be resubmitted to the following address:

Unisys
Attention:  Resubmittals
P.O. Box 9105
Somerville, MA  02145

Questions                         If you have any questions about the information in this bulletin, please contact the Unisys Provider Services Department at 1-800-325-5231 or
(617) 628-4141.