01/04/2017
Molina Updates: Transportation, Dental, Behavioral Health, Appeals
2017 is ushering in a number of new changes for Molina’s MyCare Ohio and Medicaid providers, including changes to scheduling transportation services, changes to Medicaid’s dental benefit, a redesign of Medicaid’s behavioral health services and new requirements for an expedited appeals process. These are outlined below:
Transportation Updates Effective January 1, 2017
- All members must call 2 business days in advance to schedule transportation; 48-hour notice will no longer be accepted.
- Secure Transportation will transport ambulatory members to and from nursing facilities.
- Molina Healthcare is developing a comprehensive list of all contracted transportation providers. The list will be available on the Molina website in January and will include:
- Type of services offered
- Counties served
- Hours of operation
Dental Benefit Changes Effective January 1, 2017
The following changes will be implemented to the dental benefits and the provider manual, effective January 1, 2017.
Select codes will now require prior authorization. For adult Medicaid members, cleanings will increase to two per year. The complete list will be updated in the Dental Provider Manual benefits grid and posted to the website.
Some of these changes include, but are not limited to:
- D0120 - increased to one per six months per patient for all ages
- D1110 - increased to one per six months per patient for all ages
- D4341 & D4342 - decreased to one per 24 months per quadrant per patient all ages
- D0350, D0470, D7260, D7280, D8210, D8670 and D8680 will require PA
- D9610 will no longer require PA
There will be three new codes added:
- D1575 - Distal shoe space maintainer
- D7283 - Placement of device to facilitate eruption of an impacted tooth
- D7210 - Surgical extraction
ODM Behavioral Health Redesign
Effective July 1, 2017, as part of the Behavioral Health Redesign, the Ohio Department of Medicaid (ODM) will require rendering providers on claims for Medicaid community behavioral health services.
All provider organizations of this type must have all applicable rendering practitioners registered with Medicaid and linked to their organization through the Medicaid Information Technology System (MITS) portal before July 1. Visit the Ohio Department of Mental Health and Addiction Services website to view the MITS Claims Processing for updates.
Expedited Appeals Process Requirements
An expedited appeal is an oral or written request by a member, practitioner/provider or member's authorized representative received by Molina Healthcare for urgent review of an action.
The criteria for an expedited appeal are based on Ohio Administrative Code (OAC) 5160-26-08.4, which states that Molina Healthcare must grant an expedited appeal when "...taking the time for a standard resolution could seriously jeopardize the member's life or health or ability to attain, maintain, or regain maximum function."
If an appeal request does not meet these criteria, it is a standard appeal and will be resolved in no later than 15 calendar days. Questions may be directed to Provider Services at (855) 322-4079. (Molina)
