Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth MassHealth Dental Bulletin 42 May 2013 TO: Dental Providers Participating in MassHealth FROM: Julian J. Harris, M.D., Medicaid Director RE: New Claims Processing System and Web Portal Preparation for MassHealth Dental Providers Who Bill Current Dental Terminology (CDT) Service Codes - Corrected Background This bulletin describes the activities that will occur in June 2013, in preparation for the implementation of the new DentaQuest claims processing system and provider web portal (Windward) on June 27, 2013. These activities will affect all MassHealth dental providers who use CDT service codes and submit claims to DentaQuest, either electronically or have a waiver to submit claims on paper. The new system will provide new automated solutions that will impact the way you conduct business with MassHealth/DentaQuest. Examples of these changes include: * the ability to submit claims and pre-authorizations with attachments and X- rays on the DentaQuest web portal; * added security and flexibility to give staff different levels of access to information; * the ability to view the status of a claim much more quickly – usually within 24 hours; and * the ability to communicate with DentaQuest via secure messaging. Due to the significant amount of data to be migrated to the new and enhanced provider web portal, it will be necessary for DentaQuest to temporarily stop access to the current provider web portal, claims, and prior-authorization submission and payment cycles beginning June 15, 2013 through June 23, 2013. Providers are asked to plan accordingly for the upcoming implementation. It is important for providers to be prepared for the operational changes and transaction activities that the new claims processing system and provider web portal will bring, before implementation. This bulletin outlines the high-level details and transition activities that will take place for dental providers, the web portal, claims functions, prior-authorization submission, and payment cycles. All transition activities will be described in greater detail and with more specificity at upcoming training webinar sessions, and in remittance advice message text and letters. These communication methods will enable providers to know what they should do at any point during the transition to the new claims processing system and provider web portal. (continued on next page) Windward Implementation Timeline For the period between June 15, 2013 and June 23, 2013, the current claims processing system will be closed to claim submissions. Providers who have a waiver to submit claims on paper can and should submit claims, as they will be scanned during the downtime. These submissions will be entered into the system on June 24, 2013. All claims sent electronically via a clearing house/vendor will be held in a pending status during this time period. During this period, providers will not receive confirmation from their clearinghouse/vendor of acceptance of claims sent electronically. MassHealth strongly encourages all dental providers who use CDT service codes and submit claims to DentaQuest, whether electronically or on paper (provided that they have a waiver of the electronic claims submission requirement), to adjust their billing cycles to submit as many claims as possible before the period during which the DentaQuest claims processing system will be closed to submissions. Effective Dates Event June 17, 2013 The final payment run in the current DentaQuest claim payment system June 24, 2013 Claims will begin processing under the new system (Windward) and through the provider web portal. Please Note: MassHealth has up to 30 days from the date of receipt of the claim to release payment. Provider Web Portal Effective Dates Event June 26, 2013 The last day your login to the current web portal will be valid June 15, 2013 through June 26, 2013 The provider web portal will not be available for claims and prior- authorization submission. If you submit claims and prior authorizations via the provider web portal, you must hold all claims (including paper submissions) for this period. The provider web portal will continue to be available to view eligibility, remittance information, and the status of claims and prior authorizations. Membership will be loaded into the system to allow all “read only” information about current eligibility (updated nightly) to be viewed. Remittance viewing will be available with the most current remittance information through the June 17, 2013 adjudication. June 27, 2013 Provider claims and prior authorizations can be submitted via the new provider web portal. (continued on next page) Prior Authorization For the period between June 15, 2013 and June 26, 2013, all prior authorizations must be submitted via paper. Prior authorizations will continue to move through the appropriate process in utilization management. Communication to Providers Prior to Implementation Please look for specific provider communications via letter/fax from MassHealth/DentaQuest between May 1, 2013, and June 10, 2013. These communications will provide critical information about how the pre- implementation of the new claims-processing system and provider web portal may impact you and your business. Providers are urged to participate in one of the webinars hosted by DentaQuest on June 4, 5, 6, 12, and 13. The webinar presentation will include information about the claims-processing system hold on claims submission. The May 1, 2013 letter/fax from MassHealth/DentaQuest will provide additional information about the webinars. Questions If you have any questions about the information in this bulletin, please contact MassHealth Dental Customer Service at 1-800-207-5019, or e-mail your inquiry to inquiries@masshealth-dental.net