RULES OF THE GAME

TEAMS

• TEAMS WILL BE SELECTED DEPENDING ON

HOW MANY PEOPLE ARE IN THE ROOM

• YOUR TEAM WILL BE GIVEN QUESTIONS

AND YOU WILL COME UP WITH A TEAM

ANSWER

ANSWER QUESTIONS

• EACH TEAM WILL ROLL THE DICE AND

MOVE AROUND THE BORED TO ANSWER

QUESTIONS

• CATEGORIES ARE DETERMINED BY THE

COLOR YOUR PIECE LANDS ON

• QUESTIONS WILL BE IN ONE OF FOUR

CATEGORIES RELATED TO MEDICAID

FILL YOUR PIE

• FOR EACH QUESTION ANSWERED

CORRECTLY, EARN A PIE PIECE

• 4 PIECES ARE NEEDED TO WIN

• FIRST TEAM TO GET ALL 4 CATEGORY

PIECES WINS!!

CATEGORIES Web Portal Billing

Covered Services

Prior Authorizations

Program Integrity

Categories

WEB PORTAL BILLING

•HOW DO YOU CONFIRM YOUR CLAIM HAS BEEN SENT TO

WYOMING MEDICAID FOR PROCESSING?

WEB PORTAL BILLING

•TO HAVE YOUR CLAIM PROCESSED AND PAID THIS WEEK,

WHEN DOES IT HAVE TO BE SUBMITTED BY?

WEB PORTAL BILLING

•WHAT ARE THE 2 WAYS YOU CAN SUBMIT ATTACHEMENTS

TO YOUR CLAIMS?

WEB PORTAL BILLING

•WHAT IS THE BEST WAY TO SAVE THE OFFICE TIME AND

SAVE INFORMATION IN ADVANCE WHEN USING THE

WEBPORTAL?

PRIOR AUTHORIZATIONS

•HOW LONG AFTER A PROCEDURE IS COMPLETED DO YOU

HAVE TO OBTAIN A PRIOR AUTHORIZATION?

PRIOR AUTHORIZATIONS

•DO YOU NEED A PRIOR AUTHORIZATION TO COMPLETE A

3-UNIT BRIDGE ON AN 18 YEAR OLD?

PRIOR AUTHORIZATIONS

•WHERE DO YOU NEED TO REQUEST A PRIOR

AUTHORIZATION FROM?

PRIOR AUTHORIZATIONS

•PA ISSUED ON 3/17/17 WITH AN EFFECTIVE DATE OF 3/17/17-6/30/17

•OFFICE CALLS CLIENT ON 3/18/17 AND SCHEDULES CLIENT FOR

TREATMENT FOR 5/15/17

•CLIENT COMES IN FOR TREATMENT 5/15/17

IS THE PROVIDER GUARANTEED TO BE PAID FOR THIS DATE OF SERVICE

WITH THIS PA?

PRIOR AUTHORIZATIONS

•WHERE ARE THE PA REQUEST FORMS LOCATED?

COVERED SERVICES

•CLIENT, 42 YEARS OLD, PREGNANT, TREATMENT PLANNED

FOR MIFL ON # 8. IS THIS COVERED?

COVERED SERVICES

•CLIENT, 12 YEARS OLD, TREATMENT PLANNED FOR MOD

COMPOSITE ON # 18. IS THIS COVERED?

COVERED SERVICES

•CLIENT, 2 YEARS OLD. CAME IN FOR NEW PATIENT EXAM

AND CLEANING. UNCOOPERATIVE, NO TREATMENT

COMPLETED. CAN YOU BILL OUT D9920 BEHAVIOR

MANAGEMENT AND D1310 NUTRITIONAL COUNSELING?

COVERED SERVICES

•CLIENT, 73 YEARS OLD, ON NURSING HOME PLAN, HAS AN

UPPER DENTURE THAT WILL NOT STAY IN PLACE. IS A

RELINE COVERED?

COVERED SERVICES

•CLIENT, 26 YEARS OLD. COMES IN FOR NEW PATIENT

APPOINTMENT. DIAGNOSED WITH MODERATE PERIO

DISEASE AND TREATMENT PLANNED FOR 4 QUADS OF SRP.

CLIENT WANTS HER “FREE” CLEANING. CAN YOU

PERFORM SRP AND BILL MEDICAID FOR PROPHY?

PROGRAM INTEGRITY

•IF A PROVIDER RECEIVES A REQUEST FROM MEDICAID

FOR COPIES OF A CLIENT’S CLINICAL RECORDS, CAN THE

PROVIDER REFUSE FOR ANY REASON?

PROGRAM INTEGRITY

•WHEN MEDICAID REVIEWS RECORDS ON A CLIENT WHO

RECEIVED AN AMALGAM FILLING ON A TOOTH, WHAT 3

THINGS ARE THEY LOOKING FOR?

PROGRAM INTEGRITY

•WHAT ARE THE 3 WAYS A PROVIDER CAN REPORT

SUSPECTED FRAUD OR ABUSE BY ANOTHER PROVIDER OR

A CLIENT?

PROGRAM INTEGRITY

•ARE PROVIDERS REQUIRED TO PROVIDE TRANSLATION

SERVICES TO MEDICAID CLIENTS IN THEIR OFFICES?

PROGRAM INTEGRITY

•IF A GROUP PRACTICE HAS AT LEAST ONE ENROLLED

DENTIST, CAN ASSOCIATE DENTISTS TREAT MEDICAID

CLIENTS AND BILL UNDER THE GROUP PRACTICE USING

THE ENROLLED DENTIST’S NPI AS THE TREATING?