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HORIZON
ORTHO
Instructions: Each row makes one card. Cut along the double lines and fold along the single lines. Then glue or tape the sides together.
| Is a referral required for managed care orthodontics? |
YES
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| Is a patient covered if they change in the middle of treatment from a traditional plan to a managed care plan? |
NO
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| If a member had previous treatment under a traditional plan and now has new treatment under a managed care plan are they covered? |
They are eligible for benefits under the managed care plan. Prior payments and maximum are not reduced from the managed care benefit.
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| Do appliance codes 8210/8220 require a treatment length? |
No, Appliance codes are paid in one payment.
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| Do we require the treatment length for groups that pay in 1 payment? |
NO- only groups that pay in 1 payment and ALSO have a yearly max require the treatment length
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| Does timely filing apply to orthodontics? |
YES
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| What do we do with claims that come in with the codes 8881, 8882, 8883 or 8892? |
We need to manually suspend S625 or the system will pay these codes
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