Making members shine, one smile at a time™
Orientation Overview
For Participating Dentists and Staff
Nevada Medicaid Program
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Office # ___________________________ |
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DENTAL PLAN® |
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Making members shine, one smile at a time™
Orientation Overview
For Participating Dentists and Staff
Nevada Medicaid Program
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LIBERTY |
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Office # ___________________________ |
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Access Code: _____________________ |
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DENTAL PLAN® |
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welcome
LIBERTY Dental Plan of Nevada (LIBERTY) welcomes you as a network provider. We look forward to working together with you and your office staff in providing care to our members. This guide has been prepared to assist you and your staff in the administration of the Nevada Medicaid Program.
Member Eligibility
We recommend that your office staff verify eligibility for each member prior to their appointment. A LIBERTY ID card does not guarantee eligibility.
can be verified by visiting our website at www.libertydentalplan.com/NVMedicaid. Members will be assigned to a Dental Home. Select My Members on the web portal to
confirm that members are assigned to your office before providing treatment.
Medicaid Reimbursement
Contracted Medicaid network dentists are compensated on a
Electronic Funds Transfer
LIBERTY encourages network dentists to sign up for EFT (direct deposit) so that you receive your payments faster. The EFT form can be obtained online at: www. libertydentalplan.com/NVMedicaid.
Claims Submission
Network dentists are required to submit claims to LIBERTY in a timely manner. To avoid Sample of the Member ID card delay in payments, we recommend that you submit claims daily or weekly. Claims
may be submitted in one of the following ways:
•Through LIBERTY’s secure Provider Portal at: www.libertydentalplan.com/NVMedicaid
•Through your EDI clearinghouse - LIBERTY’s Payor ID is CX083
•LIBERTY accepts NEA FastAttach
If you are not able to submit claims electronically, you can send paper claims to:
LIBERTY Dental Plan of Nevada
Attn: Claims
PO Box 401086, Las Vegas, NV 89140
The state of Nevada requires offices to submit claims with
The average turnaround time for clean claims is 30 days. Timely filing is 180 days following the date of service for
Prior Authorization Submission
Prior authorization applies to primary dental providers and specialists for certain covered procedures. Please refer to the Nevada Medicaid benefit schedule for services that require prior authorization. Prior authorizations may be submitted in one of the following ways:
•Through LIBERTY’s secure Provider Portal at www.libertydentalplan.com/NVMedicaid
•Through your EDI clearinghouse - LIBERTY’s Payor ID is CX083
o LIBERTY accepts NEA FastAttach
If you are not able to submit claims electronically, you can send paper claims to: LIBERTY Dental Plan of Nevada, Attn: Claims, PO Box 401086, Las Vegas, NV 89140.
The average turnaround time for prior authorizations is 5 business days of receipt. Prior authorizations are valid for 180 days.
Specialty Care Referrals
Services beyond the scope of a General Dentist may require a referral to a contracted LIBERTY Specialist. A Specialty Care Referral can be submitted through LIBERTY’s secure Provider Portal at www. libertydentalplan.com/NVMedicaid. A Specialty Care Referral is not required for a Pediatric Dentist for
the Nevada Medicaid Program. In all areas of Nevada, orthodontic coverage is provided through the Fee for Service (FFS) benefit plan and requires a dentist’s referral. Prior authorization requests and claims for orthodontia must be submitted to Nevada Medicaid, not LIBERTY.
The turnaround time for Specialty Care Referrals is 5 calendar days / 24 hours for emergency care.
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Coordination of Benefits
Coordination of benefits (COB) applies when a member has more than one source of dental coverage. Medicaid is always the carrier of last resort. If additional information is identified by your office, please notate the information on the claim. LIBERTY provides a Third Party Liability (TPL) Questionnaire that can be downloaded from the website at www.libertydentalplan.com/NVMedicaid.
Patient Access Standards
LIBERTY appointment standards ensure patient access to dental services within
specified time frames.
For Primary Dental Providers:
•Urgent care/emergency appointments Within
•Routine or preventative dental services Within six (6) weeks
•Diagnostic care Within fourteen (14) days
•Referrals to specialty care Within thirty (30) days
•Lobby waiting time (for scheduled appointments) Not to exceed one (1) hour
For Specialists:
•Emergency appointments Within
•Urgent appointments Within three (3) calendar days of referral
•Routine appointments Within thirty (30) days of referral
Quality Assurance
LIBERTY is committed to ensuring and optimizing high standards of quality. Our Quality Assurance Management Program oversees the quality of care administered by network dentists.
Areas of plan oversight include:
•Complaint and grievance review
•Utilization Management
•Accessibility monitoring
•Periodic onsite assessments of dental facilities
•Satisfaction surveys
•Credentialing and
•Health promotion and preventive care
•Reporting results and implementing corrective actions
Quality of Dental Care
LIBERTY Dental Plan’s quality of care guidelines apply to all contracted network providers. Each contracted provider must have established protocols in place for the following:
•Patient confidentiality and protected health information (PHI) security to be maintained
•Documentation of medical and dental history
•Dental records
•Informed patient consent
•Personal protective equipment, face mask, gloves, barrier clothing
•Radiographs
•Continuity of care for maintaining good oral health
•Oral diagnosis and treatment planning procedures
Patient Treatment Plan
Members should receive a written treatment plan and estimate of costs based on the member’s explanation of benefits before treatment begins. A dentist may propose alternate treatment to a member including covered and
Treatment Plan Sequencing:
•Procedures for the relief of pain and discomfort, elimination of infection, irritations and trauma
•Treatment of active dental decay, necessary extractions, periodontal treatment, prophylaxis and oral hygiene instructions
•Final restorations and replacement of missing teeth
•Placement of an active recall system
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Second Opinions
Members may request a consultation with another network dentist for a second opinion to confirm the diagnosis and/or treatment plan. Dentists should refer these members to our Member Services Department at:
Appeals
Providers have the right to file an appeal regarding provider payment or contractual issues. Providers may act on behalf of the member with the member’s written consent. Providers have 90 calendar days from the original UM decision or claim denial to file a provider appeal.
Send appeals to:
LIBERTY Dental Plan of Nevada
Attn: Quality Management Department
PO Box 401086, Las Vegas, NV 89140
Language Assistance
As part of the Language Assistance Program, LIBERTY offers interpreter services to dentists and their staff. To obtain assistance, please contact LIBERTY’s Member Services Department at:
Online Services
LIBERTY offers 24/7
•Submit claims, prior authorization and referrals
•Verify Member eligibility and benefits
•View or print Member rosters
•View office and contact information
•Access benefit schedules and member history
For additional information on how to register or login, please refer to the LIBERTY Online Provider Portal User Guide or contact our online administrator at: support@libertydentalplan.com.
Changes to Office Profile
We encourage providers to communicate directly with their assigned Network Manager to assist with:
•Plan contracting
•Education on LIBERTY members and benefits
•Opening, changing, selling or closing a location
•Adding or terminating associates
•Change in name, ownership or tax payer identification number (TIN)
•Office updates
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Contact Us - Professional Relations Department |
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For Claims & Encounters: |
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For General Inquires: |
LIBERTY Dental Plan of Nevada |
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Phone: 800.888.700.0643 Hours: |
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Email Professional Relations: |
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Attn: Claims |
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PO Box 401086 |
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Las Vegas, NV 89140 |
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Website: www.libertydentalplan.com/NVMedicaid |
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Personalized Service |
Our Network Managers are available to provide exceptional service. Please contact your assigned network manager when you have questions. His or her contact information is below:
Name of Network Manager: ____________________________________________________________________________________________
Office Phone: 888.700.0643 Extension: ______________ Cell Phone #: ________________________________________________
Email: __________________________________________________________________________________________________________________
© 2018 LIBERTY Dental Plan |
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