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IOWA Medicaid

IOWA Medicaid Teams Up with Orthodontic Experts

Your Medicaid Benefits, Our Expertise: Together, We Create Radiant Smiles.

Orthodontic Experts is thrilled to announce that we have been credentialed with Iowa Medicaid. This means that individuals with Medicaid coverage can now receive top-quality orthodontic treatment from our expert team of orthodontists. With our Dekalb clinic becoming credentialed with Iowa Medicaid, we can now offer our treatments to more patients than ever before. We understand the importance of navigating the Medicaid system, so we have streamlined the submission process to make it easy for our orthodontic professionals and patients.

Submitting a Pre-authorization Form

Submitting a pre-authorization form is a crucial step for Iowa Medicaid patients who wish to undergo orthodontic treatment with Orthodontic Experts. This process ensures that all necessary approvals and authorizations are obtained before the treatment begins. When submitting a pre-authorization form, it is important to provide accurate and complete information, including relevant documentation and treatment details, you can help expedite the approval process.

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Pre-authorization Submission Requirements

If you are an Iowa Medicaid patient, you may be wondering what pre-authorization submission requirements are necessary for treatment with Orthodontic Experts. Here’s a breakdown of the necessary steps:

  • ADA Claim form 2012+​
  • Cephalometric x-ray​
  • Panoramic x-ray​​
  • Diagnostic photos (Layout)​​​
  • Narrative (including treatment length)​​​
  • Salzmann index form (suggested for D8080)​​​
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Eligibility Criteria

To qualify for orthodontic treatment coverage under Iowa Medicaid, members must meet specific eligibility criteria. Firstly, they must be under 21 years of age, as orthodontic interventions are most effective during the developmental stages of the jaw and teeth. Secondly, they must have a diagnosed severe handicapping malocclusion. This indicates a significant level of misalignment or improper jaw positioning that may cause functional or aesthetic impairments. The severity of malocclusion is assessed using a scoring system, with a threshold of 26 or above set for approval.

Billing for orthodontic treatment under Iowa Medicaid, in collaboration with Orthodontic Experts, follows specific guidelines and requirements.

  • Approval for orthodontic treatment is limited to members under 21 years of age who have been diagnosed with severe handicapping malocclusion scored at 26 or above.​​​
  • Before proceeding with treatment, pre-authorization is required, which involves submitting the necessary documentation for review and approval.
  • Once pre-authorization is granted, it remains valid for a period of one year.
  • In case of approval, MCNA will authorize a one-time lump sum payment of the appropriate comprehensive orthodontic procedure code.
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Billing Fee Schedule

Understanding the billing fee schedule is important for Iowa Medicaid patients receiving orthodontic treatment with Orthodontic Experts. The billing fee schedule outlines the charges associated with various procedures and services.

  • D8080 – Billed after pre-authorization approval and bonding procedure have been performed​.
  • D8670 – Included in D8080​
  • D8680 – Included in D8080
  • Additional appliances – Included in D8080​​​
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How to Bill a Claim​?

Billing a claim for Iowa Medicaid patients has never been easier, thanks to the user-friendly software of MCNA’s online Provider Portal for electronic claims submission. The best part? It’s completely free of charge! Fill out the claim form accurately, providing all the required information. Double-check for any errors or omissions to avoid delays in processing. Make a note of the submission date and any confirmation numbers or receipts provided by the billing system. This helps in tracking the progress of the claim. Take advantage of this convenient option to simplify your billing process and ensure efficient claim submission.
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Claim Denied? Embrace the Power of Appeals!

If a claim is denied or there is a disagreement regarding a determination related to medical necessity or benefit coverage, the process of appeals provides an avenue for resolution.

  • Iowa Medicaid patients and providers have the option to file an appeal within 60 calendar days of the initial claim determination.​​​
  • Appeals can be filed when there are concerns regarding the medical necessity of a treatment or if there is a dispute regarding the coverage of benefits.
  • When submitting an appeal, it is crucial to include any requested or supporting information, such as x-rays or a detailed rationale that supports the case.
  • Providers may submit an appeal online through MCNA’s Provider Portal.
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Verify Eligibility for IOWA Medicaid Patients with Ease

Member eligibility is a dynamic factor that changes month by month. As dedicated providers, it is our responsibility to verify member eligibility with MCNA before delivering exceptional services. We’ve got you covered with 24/7 eligibility verification options that fit your busy schedule. Harness the convenience of electronic verification through MCNA’s online Provider Portal or simply dial the MCNA Provider Hotline. MCNA strongly recommends utilizing the Provider Portal or the Medicaid Eligibility Systems, empowering you to effortlessly and swiftly verify the eligibility of every member.

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Appointment Expectations

Once your application has been approved, you will be scheduled for an orthodontic appointment. This initial appointment serves as an assessment to determine the specific orthodontic needs and treatment plan.
Our orthodontists will conduct a thorough examination, including a review of your dental and medical history, x-rays, and impressions of your teeth. This evaluation helps the orthodontist assess the severity of your malocclusion and develop an appropriate treatment plan.
This appointment provides an opportunity for you to ask any questions or express concerns related to the proposed treatment. The orthodontist will address these inquiries, ensuring that you have a clear understanding of the process.
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Experience Affordable Orthodontic Excellence

Schedule Your Appointment Today!

At Orthodontic Experts, we go above and beyond to ensure our patients receive the best possible care. We offer a comprehensive range of braces and other orthodontic treatments to correct misalignments, gaps, and other dental issues. With our new credentialing, we can now provide even more affordable and accessible orthodontic services to our Iowa Medicaid patients. If you or your loved ones are interested in our cost-effective orthodontic treatments, we invite you to visit any of our clinics or reach out to us directly to book your no-cost initial appointment.
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frequently asked questions

Will Iowa Medicaid cover the cost of Clear Aligners?

Unfortunately, Iowa Medicaid does not cover the cost of Clear Aligners. The coverage for orthodontic treatment under Iowa Medicaid is typically limited to necessary orthodontic treatments like Traditional Metal Braces.

Are there any specific eligibility criteria or requirements to access orthodontic treatment through Iowa Medicaid?

Yes, eligibility for orthodontic treatment through Iowa Medicaid is limited to members under 21 years of age who have been diagnosed with severe handicapping malocclusion scored at 26 or above.

How long does it take to get approved for Iowa Medicaid?

If your orthodontic provider has supplied all the required information, the approval process for Iowa Medicaid coverage is usually finalized within 10 to 15 business days.

Is Orthodontic Experts accepting Iowa Medicaid at all of their clinics?

No, Orthodontic Experts is only accepting Iowa Medicaid at their Dekalb clinic. If you live in the Dekalb area and are eligible for Iowa Medicaid, you can access affordable orthodontic treatment with Orthodontic Experts.

What are the steps to access orthodontic services through Iowa Medicaid's partnership with Orthodontic Experts?

To access orthodontic services through Iowa Medicaid’s partnership with Orthodontic Experts, you need to follow a few simple steps. First, confirm your eligibility for Iowa Medicaid and ensure you meet the necessary criteria for orthodontic coverage. Next, find a participating clinic and schedule an appointment for an initial consultation where our orthodontists will evaluate your needs and create a treatment plan. Depending on the treatment, you may need prior authorization from Iowa Medicaid. Submit the required documentation, such as proof of Iowa Medicaid coverage, to the clinic and Iowa Medicaid. Once all approvals are in place, you can begin your orthodontic treatment with Orthodontic Experts.

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