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|Is a referral required for managed care orthodontics?||
|Is a patient covered if they change in the middle of treatment from a traditional plan to a managed care plan?||
|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.
|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?||
|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