Dental Practitioners

General dentists, allied oral health professionals (including collaborative practice dental hygienists, dental therapists [DTs], and advanced dental therapists [ADTs]), endodontists, oral and maxillofacial surgeons, orthodontists, pedodontists, periodontists, and prosthodontists are considered eligible providers.

Locum Tenens Dentist

PrimeWest Health recognizes that some dentists retain a substitute dentist to take over their professional practices while they are absent for reasons such as illness, vacations, continuing medical education, and pregnancy.

PrimeWest Health further recognizes locum tenens arrangements and pays the regular fee-for-service (FFS) for the services provided by the substitute dentist if the following are established:

  1. The regular dentist is unavailable to provide services
  2. The member has arranged or seeks to receive the services from the regular dentist
  3. The regular dentist pays the locum tenens dentist on a per diem or a fee-for-service basis
  4. The locum tenens dentist does not provide services over a continuous period of longer than 60 day

PrimeWest Health covers locum tenens dentist services using PrimeWest Health covered dental services guidelines. Current licensure is required.

Documentation

The regular dentist must keep a record of each service provided by the locum tenens dentist along with the substitute dentist’s National Provider Identifier (NPI).

Refer to the following billing guidelines for locum tenens dentists:

  1. The member’s regular dentist bills and receives payment for locum tenens dentist covered services
  2. The locum tenens dentist does not have to be identified on the claim or need to enroll with PrimeWest Health
  3. Enter “locum tenens” in the text field

Dental Therapists (DTs) and Advanced Dental Therapists (ADTs)

DT and ADT enrollment requirements

  • DTs and ADTs providing services for PrimeWest Health members must be enrolled with PrimeWest Health and be identified as the treating provider on claims
    • PrimeWest Health requires a Minnesota Uniform Credentialing (MUC) application to be completed and a copy of the collaborative agreement attached. PrimeWest Health verifies the supervising dentist’s license before enrolling a DT or ADT.
  • Licensed DTs and ADTs must retain a Minnesota Board of Dentistry-approved Collaborative Management Agreement (CMA) with a PrimeWest Health-enrolled Minnesota licensed dentist
  • The collaborating dentist must accept responsibility for all services authorized and performed by the DT and ADT authorized in the CMA
  • DTs who become certified as ADTs must provide PrimeWest Health with an updated CMA and a copy of their certification
  • Dental services performed by DTs and ADTs must be billed within their scope of practice as authorized in their CMA. The DT and ADT must be identified as the treating provider on claims. Permitting a DT or ADT to perform a dental service other than those authorized violates MN Stat. secs. 150A.01 – 150A.12.

Collaborative Practice Dental Hygienist

Collaborative practice dental hygienists must be licensed by the Minnesota Board of Dentistry and have a collaborative agreement registered with the Board of Dentistry.

PrimeWest Health requires a MUC application to be completed and a copy of the collaborative agreement attached. PrimeWest Health verifies the supervising dentist’s license before enrolling a collaborative practice dental hygienist.

Collaborative practice dental hygienists must retain a Minnesota Board of Dentistry-approved CMA with a PrimeWest Health-enrolled Minnesota licensed dentist

Bill all services completed in a collaborative practice dental hygienist capacity using the following:

  • 837D format
  • Individual collaborative practice dental hygienist NPI as the rendering provider
  • Appropriate health care facility, program (such as Head Start), or non-profit NPI as the pay-to-provider

Eligible Limited Service Providers

  • Community health workers (CHWs)
  • Head Start agencies
  • Nurse practitioners (NPs)
  • Physicians
  • Physician assistants (PAs)
  • Public Health nurses
  • Women, Infants, and Children (WIC) programs

Updated_9/17/2019