Benefit Services of Hawaii. – sol(u)tions

HMSA PPP Individual Dental Plus Plan for 2012 (pdf)
Notice to Providers (pdf)

HMSA is pleased to share that providers can now add Fluoride Varnish (Code D1206) to their current list of preventive services. This change is effective as of April 11, 2011. HMSA's allowance for Fluoride Varnish is the same as the other topical fluoride application codes, and includes all L, V, C and D fully-insured and DHMO coverage codes as well as Federal Plan HMO 117. Federal PPO OOF is not included in this change as this plan does not cover fluoride treatments.

The new Fluoride Varnish code follows the current HMSA policy guidelines, allowances and age criteria for the topical application of fluoride (Codes D1203 and D1204). By adding this new code, eligible members can continue to receive up to two applications of fluoride in a plan year, now with a choice – a topical application, a varnish or a combination of one topical application and one varnish.

Fluoride Varnish offers a safe, easy, evidence-based treatment to help prevent dental caries. The coverage of this new code gives you a greater choice of fluoride applications to use on our eligible members and your patients.

Oral Health for Total Health Provider Brochure (pdf)

Beginning January 1, 2011, HMSA is recognizing three additional CDT codes as plan benefits. The three codes are new to the CDT code book and are found in the 2011 – 2012 edition of the American Dental Association dental code book. The newly recognized benefits and codes are:

D1352 – Preventive resin restoration in a moderate to high risk caries patient-permanent tooth.*

D3354 Puplal regeneration – (completion of regenerative treatment in an immature permanent tooth with a necrotic pulp); does not include final restoration.*

D7251 Coronectomy-intentional partial tooth removal.*

If your office has not yet purchased the 2011-2012 CDT code book, we encourage your office to do so. Please contact the American Dental Association to order one today.

*Please call our Dental Call Center at 948-6440 for the eligible fee specific for your dental practice.

To avoid delays due to submission errors on tax, we will process tax on paper and electronic claims for Federal Plan members only. If you elect to submit for this tax, please use the Z9020 tax code for all paper claims. Please remember to calculate the tax on your office charge and not your eligible charge. Enter this amount in box number 31 on the ADA 2006 claim form.

For all other non–federal plan HMSA dental members, you office will still be able to bill and collect the G.E.T. directly from your patient. When billing your patient for tax, the tax is based on the HMSA eligible and not your office charge. If your office submits for G.E.T. on a claim form, the patient's Explanation of Benefits will state that tax is not a benefit.

Benefit Services of Hawaii is now servicing HMSA Dental.

We encourage you to familiarize yourself with the Provider Resource Center's sections, particularly the following:

Provider E—Library –– presents the contents of HMSA's provider handbooks in an easy–to–use point–and–click format.

We appreciate your visiting our site and welcome your questions and comments about it.

Effective August 9, 2010, only x-rays that are marked "Return", will be sent back to provider. As a reminder, when x-rays are required, submit only duplicate or copies.