Happy New Year! Important information at a glance

COVID-19 CDT Codes The American Dental Association (ADA) has developed seven COVID-19 vaccine administration codes dental offices can use for reimbursement. Humana does not cover any of them under its dental plans. However, you do have an option to bill a member's medical plan.

According to Centers for Medicare & Medicaid Services (CMS) guidelines, patients who were enrolled in Medicare Advantage (MA) plans in 2020 and 2021 should submit COVID-19 vaccine administration claims to Original Medicare through their Medicare Administrative Contractor (MAC). Use your patients’ Medicare Beneficiary Identifiers (MBIs) – not their MA Plan Member IDs – to bill Original Medicare. Ask your MA patients for their Original Medicare card. All Medicare patients, including those enrolled in an MA plan, have a red, white and blue Medicare card with an MBI. If your patients do not have their Original Medicare card or do not know their MBI, use the MBI look-up tool in your MAC’s secure portal). You will need your patients’ first names, last names, dates of birth and Social Security numbers. You can look up the MBI for any Medicare patients, including those enrolled in a Medicare Advantage plan.

To learn more, visit Medicare Billing for COVID-19 Vaccine Shot Administration | CMS

Medical billing for COVID-19 vaccination

The American Medical Association (AMA) has created the codes listed in the chart below for reporting the COVID-19 vaccine. See the AMA’s website for more information on COVID-19 vaccine coding. If the AMA creates more CPT codes for additional COVID-19 vaccines, we will update this FAQ.

When billing to medical, be sure to include a diagnosis code as well, to ensure faster adjudication.

HumanaDental® Highlights A publication of Humana Dental

Quarter 1- 2022

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2022 CDT Code Changes

Annually, the ADA updates and adds new CDT codes. Follow this link to view the list of new, deleted and updated codes for 2022.

Note: The new ADA CDT codes may or may not be covered, as plan coverage varies by product or group benefits. To determine benefit coverage, request preauthorization or call Humana at the number on the back of the patient’s Humana ID card.

Important Information about Humana 2022 MA Supplemental Dental Benefits The Humana 2022 Medicare Advantage (MA) Dental Office Handbook is now available on Humana.com/sb. We also have a brief informative video about Humana MA benefits.

The Dental Office Handbook contains important information about your patients’ Humana MA supplemental dental benefits.

Key features of the handbook Page 3: Humana MA supplemental dental benefits are provided through the HumanaDental® Medicare Network, a preferred provider organization (PPO) network, for patients who purchase their plans in all states, except Florida. MA members who purchase their plan in Florida use the Careington Medicare Network.

A sample Humana Medicare Advantage ID card is shown below. Patients will not have a separate dental ID card. Some ID cards have “HMO” printed on the front of the card, but that refers to the medical network ONLY. The dental plan name for Humana MA supplemental dental benefits appears on the back of the ID card, using the letters DEN plus a

Numbers to know

Humana’s automated customer service lines provide claims and patient information. When calling, please have the following information handy:

• Dentist Tax Identification Number (TIN)• Patient’s name, date of birth, Humana ID• Date(s) of service

Humana Dental/Medicare dental 800-833-2223 Monday – Friday, 8 a.m. – 8 p.m., Eastern time

Federal Advantage Plan: 877-692-2468Monday-Friday, 8 a.m. – 7 p.m., Eastern time

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three-digit number (e.g., DEN016). The web address for the Dental Office Handbook is printed on the back of every Medicare Advantage ID card – Humana.com/sb.

Page 4: Links to benefit documents are available in the handbook for each dental plan. The benefit documents, listed in numerical order, provide the covered ADA codes and benefit frequencies. MA plans have unique dental benefit plan designs. Most plans have a coinsurance plan design; however, there are some plans in 2022 that include a member copay for covered basic services. The fillings benefit in DEN206 is one example. If a code is not listed in the DENxxx benefit document, that service is not covered by the MA dental benefit. Please let your Medicare Advantage patient know, in advance of doing a procedure, if that procedure is covered by their dental plan and if the dentist performing the procedure is in-network for the plan. If a patient has questions or needs more information, direct him or her to call Humana at the telephone number on the back of the patient’s ID card.

Page 8: This page includes Humana contact information for dental provider customer service and a link to a welcome guide with information regarding claim submissions.

Please share this information with your office staff.

Thank you for the support you provide so more individuals can maintain a healthy smile.

Sincerely,

Humana Specialty Product

Predeterminations Spotlight!

o Predeterminations are not required but rather recommended by Humana. They can help members determine theirout-of-pocket expense when a service is going to cost more than $300. Predeterminations also helps membersdetermine if a service is covered.

o Dentists submitting predeterminations should refer to the Claim Documentation guideline to determine if thespecified service are diagnostics that are required for a specified service requires diagnostics. Submitting therequired diagnostics with the predetermination can help to facilitate timely processing.

Helpful links to make your life easier

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o Medicare Handbook: https://www.Humana.com/provider/dentist-resources/medicare-advantage-supplemental-dental-handbook

o Provider Manual: https://www.Humana.com/provider/dentist-resources/tools-resources

o Resources for you: https://www.Humana.com/provider/dentist-resources

Humana now offers preferred provider organization (PPO) benefits to federal employees and TRICAREretirees, effective Jan. 1, 2021. The granted states, along with the District of Columbia, are Alabama, Arizona, Arkansas, California, Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maryland, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, Texas, Utah, Virginia and West Virginia.

HumanaDental Highlights is a quarterly publication for dental providers throughout the Humana network.

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