Providers

Dental


Through DentaQuest®, Healthy Connections covers most routine dental care for members under age 21, as well as preventive dental benefits for members 21 and older. In fact, eligible Medicaid beneficiaries age 21 and older may receive a maximum $750 annual benefit in covered dental services.

DentaQuest is an independent company that provides dental services on behalf of BlueChoice HealthPlan.

Healthy Connections dental benefits for members through DentaQuest

For members under age 21:

  • Routine dental care
  • Oral exams
  • Cleanings
  • X-rays
  • Fluoride treatments

For members age 21 and older:

  • Up to $750 per year that can be used for covered dental services:
    • Oral exams
    • Annual cleanings
    • X-rays
    • Extractions
    • Fillings
    • Emergency medical procedures performed by an oral surgeon, as necessary

A $3.40 copay is required toward the cost of a member’s care per date of service. Copays are not required for emergency services.

DentaQuest claims submission

DentaQuest processes most dental claims based on the Healthy Connections dental benefit, fee schedule and coverage policies. Providers should submit claims to DentaQuest for routine dental services for members under age 21 and preventive dental benefits for members 21 and older.

Providers can submit dental claims using any one of the following four options:

  1. Electronic claims via DentaQuest
  2. Electronic submission through a clearinghouse
  3. HIPAA-compliant 837D or 837P file
  4. Paper claims mailed to the following address:
    DentaQuest, LLC — Claims
    P.O. Box 2136
    Columbia, SC 29202-2136

DentaQuest prior authorization submissions

Dental prior authorization requests should be submitted to DentaQuest using any one of the following five options:

  1. Electronic prior authorizations via DentaQuest
  2. Electronic prior authorizations via Fast Attach or call the National Education Association at 800-782-5150 (Fast AttachTM is an independent company that provides prior authorization services on behalf of BlueChoice HealthPlan.)
  3. Email emergency prior authorizations to DQSCEmergency@DentaQuest.com
  4. Fax emergency prior authorizations to 800-521-1735
  5. Prior authorizations for hospital operating room cases should be mailed to:
    DentaQuest, LLC — Authorizations
    P.O. Box 2136
    Columbia, SC 29202-2136

More information about the Healthy Connections dental benefits, fee schedule, coverage policies and claims submission

  • Call DentaQuest at 888-307-6553 Monday–Friday, 8 a.m.–6 p.m. ET.
  • View the DentaQuest and Healthy Connections Dental Office Reference Manual
  • Log in to the DentaQuest Provider Web Portal to view the adult preventive dental benefit (the unused annual maximum benefit amount):
    • Beneficiary eligibility verification
    • Claims submission
    • Authorization submission
    • View claim status
    • Create claim tracking reports
    • Beneficiary treatment history
    • Annual maximum accumulator for adult beneficiaries
    • Remittance advice
    • Event and training calendar
    • Links to resources such as the South Carolina Department of Health and Human Services fee schedule, provider bulletins and general oral health resources

Healthy Blue dental benefits include:

  • Children’s preventive dental assessment through the month of the member’s 21st birthday:
    • Dental assessments include relief of pain and infection, restoration of teeth and dental health maintenance.
  • Child and adult anesthesia for emergency dental procedures while in the hospital.
  • Child and adult emergency outpatient dental services.
  • No required copay for emergency care in a doctor’s office or hospital.
  • Ambulatory surgical center outpatient emergency dental services with prior authorization.

Healthy Blue claims submissions:

Providers can submit anesthesia claims for emergency dental procedures to Healthy Blue, as well as inpatient dental facility charges, outpatient dental facility charges and ambulatory surgical center charges for dental services, as part of the Healthy Blue coverage.

For more information about Healthy Blue coverage policies, the Healthy Connections fee schedule and claims submission, call the Healthy Blue provider Customer Care Center at 866-757-8286, Monday–Friday from 8 a.m.–6 p.m. ET.

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