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19.2.6 Medicaid Managed Care Enrollment
THSteps, ICF-MR, and emergency dental service providers do not need to enroll in Medicaid Managed Care.
All claims for services provided by a dentist for THSteps and ICF-MR clients are submitted to TMHP.
If the client is enrolled in Medicaid Managed Care, the dentist must request precertification or approval from the client's managed care organization (MCO) for anesthesia, facility use, and charges if the dental services are to be provided in an ambulatory surgical center (ASC)/HASC, or as an inpatient or outpatient at a hospital. The dentist must use the MCO's contracted facility and anesthesia provider. These services are included in the capitation rates paid to MCOs, and the facility/anesthesiologist risks nonpayment from the MCO without such prior approval. Coordination of all specialty care is the responsibility of the client's primary care provider. The primary care provider must be notified by the dentist and/or the MCO of the planned services.
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