All dental providers practicing within the scope of practice for their licensure are eligible to provide services to PrimeWest Health members as long as they are willing to accept PrimeWest Health reimbursement as "payment in full" and agree not to balance bill our members.
Dental providers may also find the following resources helpful:
- The current PrimeWest Health Dental Covered Services chart explains what dental codes are covered for the following member groups:
- Children under age 21 and pregnant adults
- Non-pregnant adults age 21 and over
- This Dental Program Handout provides information on plan features, benefits, dental grants, and provider collaboration, as well as details on the dental care coordination and Service Authorization processes.
- The Quick Reference Guide for Dental Providers is a resource for dental billing, claims submission, Service Authorizations, covered services, and Provider Updates.
- Our Dental Services Handout offers more information on PrimeWest Health dental services
- Expand your practice with oral health services handout
- Our Early Dental Care booklet provides parents of young children with a dental activity book
- Recent information about Critical Access Dental Payment from the Minnesota Department of Human Services (DHS)
- Dental Services (Overview) from DHS
- Allied Oral Health Professional (Overview) from DHS
- Dental C&TC Standards from DHS
- PrimeWest Health-developed Dental Handouts with helpful dental information for members
PrimeWest Health Oral Surgery Service Authorization Criteria and Guideliness, Effective 11/20/14
Adult Prophylaxis D1110
Adult prophylaxis D1110 is now covered twice per calendar year for non-pregnant adults age 21 and over.
Claims for D1110 submitted and denied with a date of service January 1 – April 10, 2014 will be reprocessed and paid if the denial was due to the previous 365-day rolling year guideline that was in place effective July 1, 2013.
Adult prophylaxis D1110 authorization requirements for non-pregnant adults
Authorization is required for prophylaxis in addition to the two prophylaxes allowed and performed in accordance with an appropriate individualized treatment plan, up to a maximum of two additional prophylaxes within a calendar year. Service Authorization approval does not guarantee that two additional cleanings will be approved. There may be cases where only one additional cleaning is approved.
If you have additional questions, please review Chapter 19, Dental Services, of the Provider Manual or call the Provider Contact Center at 1-866-431-0802 (toll free).