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
Is a patient covered if they change in the middle of treatment from a traditional plan to a managed care plan?
NO
If a member had previous treatment under a traditional plan and now has new treatment under a managed care plan are they covered?
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They are eligible for benefits under the managed care plan. Prior payments and maximum are not reduced from the managed care benefit.
Do appliance codes 8210/8220 require a treatment length?
No, Appliance codes are paid in one payment.
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
Does timely filing apply to orthodontics?
YES
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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