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Based on a memo received from AHCCCS on February 27, 2023, the following dental coverage changes will apply. Mercy Care, in accordance with AHCCCS will be following this direction. We wanted to share this important information with our provider network. Please be advised that our Provider Manual is in the process of being updated as well. The change is as follows:
As per Arizona Medicaid Section 1115 Demonstration Waiver extension, effective 10/14/2022, the $1,000 dental services limits for American Indian and Alaskan Native (AI/AN) members 21 years of age and older receiving services for medically necessary diagnostic, therapeutic, and preventative dental services at IHS and 638 Tribal facilities are eliminated.
Services performed outside of the IHS/638 Tribal facilities remain limited to the $1000 Emergency Dental Benefit for members 21 years of age and over, and the additional $1000 for dental services for members on ALTCS.
AHCCCS Division of Fee-for-Service Management (DFSM) will continue to reimburse for medically necessary services that are eligible for 100 percent Federal reimbursement and that are provided by an IHS or 638 tribal facility to Title XIX members enrolled with Mercy Care.
AHCCCS Medical Policy Manual, Policies 310-D1, Dental Services for Members 21 Years of Age and Older and 310-D2, Arizona Long Term Care System Adult Dental Services have been revised to reflect this benefit change. These policies are open for public comment through March 31, 2023.
As always, don't hesitate to contact your Mercy Care Network Management Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care website.
Thanks for all you do!
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