2018/2019 Statewide Medicaid
Managed Care Program Prov ider Training
SPECIALTY CARE REFERRAL GUIDELINES FOR
THE SPECIALIST
The following guidelines outline the specialty care referral process. Failure to follow any of
these guidelines may result in financial penalties against your office.
•The specialty referral form can be found on www.LIBERTYdentalplan.com under “Provider Resources.”
•Referrals are subject to an enrollee’s plan-specific benefits, limitations and exclusions. Please refer to the Enrollees-specific Florida Medicaid Plan Benefit Schedule to determine plan-specific details regarding procedure codes and benefit coverage.
•Reimbursement of specialty services is contingent upon the enrollee’s eligibility at the time of service.
EXCEPTION: Enrollees with special health care needs do not require a Referral to a specialist. Either your office or the enrollee can contact LIBERTY’s Member Services
Department directly for assistance in locating a specialist that can treat the enrollee’s
dental needs, as well as any special health care needs.
Program Overview
Urgent Care Referrals
2018/2019 Statewide Medicaid
Managed Care Program Prov ider Training
The fastest method for Dentists to obtain a specialty care urgent referral is through our secure provider portal at www.libertydentalplan.com. Additionally, they can be requested:
Urgent Referrals and Hotline
(833)276- 0851 option 4
Fax: (888) 334-6033
Hours Monday-Friday
8 am EST- 8 pm EST
Urgent referrals are valid for seventy-two (72)hours (including weekends). A member or provider can request extensions.
Providers should not turn away members who are in pain. If a member presents to a Specialist’s office for urgent care without a referral, the provider should treat the condition and submit all appropriate documentation with the claim.
Providers should include a narrative to explain the urgent condition. All servicesprovided must meet benefit guidelines and will be subject to pre-payment review.
It is recommended that any additional, non-urgent treatment be preauthorized to ensure proper claim processing.
www.libertydentalplan.com |
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Making members shine, one smile at a time™ |
Program Overview
Specialty Care Referrals
Specialty Care Referrals requiring approval:
2018/2019 Statewide Medicaid
Managed Care Program Prov ider Training
Endodontist, Periodontist, Oral Surgeon, Orthodontist
Referrals require approval if a member is to be seen in the hospital.
The primary dental provider (general or pediatric dentists) must request the referral for the specialty care.
Enrollees with special health care needs do not require a Referral to a specialist.
Specialty Care Referral Guidelines are available in the LIBERTY Medicaid Provider Handbook Section 9.
Referrals are valid for 180 Days
Specialty Care Referral requests can be submitted through the secure provider web portal at www.libertydentalplan.com
www.libertydentalplan.com |
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Making members shine, one smile at a time™ |
Program Overview
Special Health Care Needs- Referrals Process
Special Health Care Needs
2018/2019 Statewide Medicaid
Managed Care Program Prov ider Training
— NO REFERRAL REQUIRED
Enrollees who face physical, behavioral, or environmental challenges daily that place at risk their health and ability to function fully in society
This includes individuals with intellectual and developmental disabilities or related conditions; individuals with serious chronic illnesses, such as human immunodeficiency virus (HIV), schizophrenia or degenerative neurological disorders; individuals with disabilities resulting from many years of chronic illness such as arthritis, emphysema or diabetes; and children/adolescents and adults with certain environmental risk factors such as homelessness or family problems that lead to the need for placement in foster care
Pre-Authorizations are Required
www.libertydentalplan.com |
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Making members shine, one smile at a time™ |
2018/2019 Statewide Medicaid
Managed Care Program Prov ider Training
FAQs
Q: Who generatesthe referral to the specialist?
A:The Primary Dental Provider submits the referral for specialty care to LIBERTY for review and approval.
Q: If I am a specialist how do I get a copy of the approved referral?
A:You can get a copy from the member or you can contact LIBERTY Dental Plan for a copy of the approved referral.
Q:If I have a member in my office with an emergency do I need to contact LIBERTYfor a referral.
A:The fastest method for Dentists to obtain a specialty care urgent referral is through our secure provider portal at www.libertydentalplan.com. Additionally, they can be requested at:
Urgent Referrals and Hotline
(833)276- 0851 option 4
Fax: (888) 334-6033
Hours Monday-Friday
8 am EST- 8 pm EST
Urgent referrals are valid for seventy-two (72)hours (including weekends). A member or provider can request extensions.
www.libertydentalplan.com |
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Making members shine, one smile at a time™ |
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Program Overview |
2018/2019 Statewide Medicaid |
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FAQ’s |
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Training |
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Managed Care Program Prov ider |
Q: Can I treat a member in pain as an emergency without a referral?
A:Providers should not turn away members who are in pain. If a member presentsto a Specialists office for urgent care without a referral, the provider should treat the conditionand submit all appropriate documentation with the claim.
www.libertydentalplan.com |
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Making members shine, one smile at a time™ |
