Emergency Dental Care Scheme Policy Manual

ORAL HEALTH SERVICES TASMANIA EMERGENCY DENTAL SCHEME POLICY MANUAL ISSUE DATE: 22/01/2009 DOCUMENT Nº: OHST-MAN-006

Emergency Dental Care Scheme Policy Manual

Oral Health Services Tasmania Version: 3.0

Department of Health and Human Services

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CONTENTS

1.0 Registration of Private Providers.................................................................................4

2.0 Client eligibility ..............................................................................................................4

3.0 Scheme process .............................................................................................................4

4.0 Schedule of treatments and fees..................................................................................4

5.0 Authorisation of treatment..........................................................................................4

6.0 Endodontic treatments .................................................................................................5

7.0 Claims for payment .......................................................................................................5

8.0 Additional services.........................................................................................................5

9.0 OHST contact details:...................................................................................................6

PRIVATE PROVIDER REGISTRATION FORM .................................................................7

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DOCUMENT MANAGEMENT

Purpose

The purpose of this document is to provide eligible Tasmanians with access to timely and effective emergency and urgent dental treatment through collaboration between private and public sector dental services.

Scope

This document applies to all clients offered treatment under the Scheme.

Related Documents:

OHST-FRM-030 – Private Provider Registration Form (included as part of this manual).

OHST-FRM-031 – Schedule of Emergency Treatment Fees and Authority & Treatment Claim Form.

OHST-FRM-032 – Schedule of Endodontic Treatment Fees and Authority & Endodontic Claim Form.

Definitions:

Emg – Emergency triage category

P1 – Urgent triage category

Emergency dental treatment – treatment for the client’s presenting condition only.

The Scheme – Emergency Dental Care Scheme

OHST – Oral Health Services Tasmania

PP – Private Provider registered on the Scheme.

Responsibilities:

Customer Service officers are responsible for administering the scheme.

Area Managers are responsible for ensuring the policy is followed, authorising registrations and approving some payments.

Policy Manual Approved by: Director, Oral Health Services Tasmania.

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1.0 Registration of Private Providers

1.1 Private Providers (PPs) can register to be involved in the scheme by completing the Private Provider Registration form.

1.2 Completed registration forms will be authorised by the relevant OHST Area Manager.

1.3 PPs can terminate their registration without showing cause at any time by written notice to OHST.

1.4 OHST may terminate the registration of a PP without showing cause by giving 5 Business Days’ written notice to the PP.

1.5 OHST may suspend a PP from the scheme if they do not comply with the Scheme policy. This would only occur following discussions between OHST and the PP to clarify the policy requirements.

1.6 PPs will inform the relevant OHST Area Manager if the conditions of their Dental Registration changes or place of work changes.

2.0 Client Eligibility

2.1 Clients will be eligible for treatment under the scheme if they;

hold a current Health Care Card or Pensioner Concession Card; and

have been triaged by Oral Health Services Tasmania (OHST) as requiring emergency/urgent treatment (Emg and P1 clients); and

are 18 years of age, or older.

2.2 OHST will ensure that the client is aware that only concession card holders are eligible for treatment.

2.3 The PP will verify eligibility by sighting the client’s concession card.

2.4 If the client cannot show a concession card they cannot be treated by the PP.

3.0 Scheme Process

3.1 OHST will provide eligible clients with the contact details of a PP to arrange an appointment.

3.2 OHST will select the PP based on proximity to the client’s residential address and the capacity of the PP to offer timely treatment.

3.3 A voucher will be issued from OHST to the PP to provide treatment.

3.4 A voucher will be valid for 10 days from the date of issue.

4.0 Schedule of Treatments and Fees

4.1 PPs can provide treatments listed on the Emergency Dental Care Scheme Schedule. The fees claimable are based on the Department of Veteran’s Affairs (DVA) fees.

4.2 OHST will update the fees once per year or on a needs basis.

5.0 Authorisation of Treatment

5.1 The voucher is the Authority and account details form. It authorises treatment and will be returned to OHST by the PP to claim payment.

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5.2 The PP will include all information requested on the form before submitting to OHST.

6.0 Endodontic Treatments

6.1 The PP must seek approval from OHST to undertake endodontic treatments other than for an emergency removal of dental pulp (Item 419).

6.2 If Item 419 is used, the tooth may be subsequently extracted if, following informed consent, a decision is made not to proceed with endodontics or if the tooth does not settle from the original pain episode. Treatment may be continued with full endodontic therapy following approval.

6.3 The OHST Senior Dental Officer or Clinical Director can approve treatments.

6.4 OHST will only give approval for endodontic treatments in exceptional circumstances.

6.5 If approval is given, the PP will use the Endodontic claim form and Endodontic fees schedule instead of the Authority and account details form.

7.0 Claims for Payment

7.1 Each voucher has a cap of $210.

7.2 The cap is based on the fees (rounded up to the nearest $10) for the common emergency and urgent treatment Items 013, 022 and either 311 or 314. The cap will be reviewed annually.

7.3 If the claim for payment is greater than the cap, the Senior Customer Service Officer will seek approval to proceed with the payment from the OHST Area Manager.

7.4 From the Emergency Dental Care Scheme Schedule, Items 311 (step down fee for second tooth), 322, 323 and 324 will be paid above the $210 cap.

7.5 If requested by OHST, the PP will send OHST pre-surgical radiological evidence for a client who has had a surgical removal of a tooth, extirpation of pulp or debridement of root canals. OHST will return radiographs.

7.6 OHST will provide payment to PPs for treatment where PPs have adhered to the Scheme policy.

8.0 Additional Services

8.1 If the client requires further dental treatment or treatment outside the schedules, the PP must refer the client back to OHST.

Note: Clients may have additional treatment completed by the PP at the client’s expense.

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9.0 OHST Contact Details:

Southern Dental Centre

Manager: Leanne Williams

Telephone: 6214 5433

Northern Dental Centre

Manager: Patsy Burgess


Burnie Dental Centre

Manager: Roseanne Robinson


Devonport Dental Centre

Manager: Roseanne Robinson


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Oral Health Services Tasmania

PRIVATE PROVIDER REGISTRATION FORM EMERGENCY DENTAL CARE SCHEME

Contact Details:

Name: .......................................................................................................................................................................................

Address of Principal Practice: .............................................................................................................................................

......................................................................................................................................................................................................

Telephone: ......................................................................... Fax: ...................................................................................

Email: .........................................................................................................................................................................................

Registration and Practice Details:

Dental Registration No.: .......................................................................

ABN: ..........................................................................................................

Practice 1: Address: .......................................................................................................................................................

Telephone: ................................................................... Fax: ............................................................

Practice 2: Address: .......................................................................................................................................................

(if applicable) Telephone: ................................................................... Fax: ............................................................

Bank Details:

Account Name: ......................................................................................................................................................................

BSB and Account No.: ..........................................................................................................................................................

Roles and Responsibilities Declaration: The roles and responsibilities for the provision of dental services through the Emergency Dental Care Scheme are set out under the Scheme’s policy (Version 3.0). By registering to participate in the Scheme the provider agrees to comply with the policy and accepts the fees listed in the schedules.

Office Use:

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Provider’s Signature: ............................................................... Authorised by: ...........................................................

Signature: ....................................................................

Date: ........................................................................................... Date: ............................................................................

Form No.: OHST-FRM-030 Issue Date: 06/08/07 Version: 1.0