MO HealthNet Provider 
Tip of the Week
Adult Dental – Physician Referral
November 16, 2009
Dental services for adults age 21 and over related to a medical condition will be covered when a written referral from the participant’s physician states the absence of dental treatment would adversely affect the stated pre-existing medical condition. This referral must be maintained in the participant’s record and made available to the MO HealthNet Division or its agent upon request. It is not necessary to attach a copy of the referral when submitting a paper claim form.
The referral by the participant’s physician must include the following:
- Referring physician's name
- Referring physician's NPI
- Type of dental services the participant needs
- The pre-existing medical condition that would be adversely affected without the dental care
For a list of covered procedure codes, providers can reference Section 19.1 of the dental provider manual.
2009 Archived Hot Tips
- Pre-Certification of Durable Medical Equipment
- Durable Medical Equipment Enrollment Guidelines
- End Stage Renal Disease
- Medicare Part C Using the Correct Claim Form
- Crossover Claims That Require Special Handling
- Ambulance Modifiers
- Suspended Claims
- Participant Inquiries
- After Hours and Holiday Physician Services
- Ambulatory Surgical Center Services
- Adult Preventive Medicine Codes
- Hospital Outpatient Laboratory Fees
- Wheelchair Option/Accessory Replacement and Repair
- HCY Screens and Immunizations
- CMS PERM Project
- Commercial Health Plans and Co-Pays
- Authorized Nurse Visits
- Dental Coverage for Vendor Facility Residents
- Participant Administrative Lock-In
- Claim Processing Schedule – FY 2010
- Provider Audio/Visual Presentations
- Releasing Billing or Medical Record Information
- Incarcerated Participants
- Claim Documentation
- Adjusting Claims Electronically
- Women's Health Coverage
- MO HealthNet E-mail News
- Medicare Part C Non-QMB Claims
- NEMT – Where's My Ride?
- Using Locum Tenens
- IM-62 Form
- Emergency Ambulance vs. NEMT Transports
- Registering for On-line Training Sessions
- "21" Modifier No Longer Used
- Participant Liability Services at the Hospital
- Pre-Certification for Specific Codes
- Billing Anesthesia Services
- Denture Coverage
- Hospice Election & Revocation
- Provider Initiated Self Disclosures
- MO HealthNet Provider Fee Schedule
- Paper Medicare/Medicaid Crossover Claims
- Inpatient Hospital Claim Value Codes and Amounts
- ICD-9 Diagnosis Code V708 Usage
- Give Us Your Suggestions!
The MO HealthNet Division provides weekly tips to providers to assist them in receiving timely reimbursement for services provided. As each new tip is posted, existing ones are archived on the same site for easy reference. Please share these weekly tips with your billing staff.
