Welcome to the CivicSmiles by DeCare Dental site, created to provide you with
information about joining the network, submitting claims and contacting us. You
will also find frequently asked questions and relevant forms and literature.
ABOUT CIVIC SMILES BY DECARE DENTAL
CivicSmiles by DeCare Dental Q & A
Q. Who is CivicSmiles?
A. CivicSmiles by DeCare Dental is a new Medicaid network that will be administered through DeCare Dental and serve Medicaid members through our affiliated health plans or if we secure an independent contract with a state. We are currently in the process of building our network and would like you to consider becoming an in-network provider.
Q. Are you replacing our current Medicaid program?
A. We are not replacing any of the current Medicaid programs; however, CivicSmiles will be an additional option for Medicaid members.
Q. How are you different than our current Medicaid program?
A. CivicSmiles by DeCare Dental will be administered through DeCare Dental. DeCare Dental will have a Professional Services team responsible for handling claims, grievances, and any provider issues that may arise.
Q. What are the advantages of joining?
A. We believe we are experts in customer service and claims processing. Depending on the state or vendor, there is the possibility we will have Care Coordinators to help eligible members locate dental offices to best suit their needs, ensure they keep their appointment and follow-up with members. We have Network Representatives designated to work with CivicSmiles Participating Dentists, to make us easy to do business with.
Q. Do you have a website?
A. Yes, //www.decare.com/CivicSmiles.
Q. Is this a PPO?
A. Yes and No – Yes, from the perspective of a set fee schedule; no, from the perspective that all dentists are welcome and both fees and plan designs are governed by the State Medicaid Agency.
Q. Why did I only get 20 codes?
A. We are still in the development process of our full fee schedule. We have created a list of the most commonly submitted codes. The reimbursement examples you received are just that, examples. To our knowledge these are the reimbursement amounts currently used by your state’s Department of Human Services. It is our intention to at least match, if not exceed, the reimbursement you are currently receiving. In fact, if you have examples of reimbursement levels you are currently receiving from any carrier, we would appreciate it if you would share that information with us. It is our desire to at least meet, if not exceed, any reimbursement you are currently receiving.
Q. What will I be paid?
A. Reimbursement will be the lesser of the dentist’s submitted fees or the CivicSmiles fee table maximum as determined by DeCare Dental. A contracting dentist may not balance bill a member.
Q. Do you require pre-estimates/pre-authorization?
A. Depending on the state/vendor, certain procedures may require pre-estimates/pre-authorization. However, we encourage participating dentists to submit a pre-estimate for all major restorative, prosthetic, surgical, periodontal and orthodontic services prior to providing treatment, unless the time period between diagnosis and treatment precludes submission of a pre-estimate.
Q. Is there a yearly maximum of benefits?
A. This benefit will vary by state/vendor.
Q. What is DeCare Dentist's average claim turnaround time?
A. DeCare Dental will abide by each state’s Prompt Pay Laws, however, over 98% of the claims we Received are paid within 14 days, with most claims being processed in about (two) 2 business days.
Q. Is our office going to get audited every time we submit a claim?
A. No, not at all – DeCare Dental does have a process of post-payment review. Through this retroactive process, a very small number of dentists may be identified whose practice patterns may be extremely out of line compared to their peers. When DeCare Dental identifies this, they may conduct audits, required by state and federal law, as well as permitted by the participating dentist’s CivicSmiles contract.
Q. When will you be getting members?
A. We need to have in-network providers in states before we can get members. Once we have coverage in a state, we will be able to submit our bid to the state. Selected members will have the opportunity to select the CivicSmiles plan.
Q. Must patients pre-select a dentist?
A. No, members are free to go to the dentist of their choice. However it is important to understand in most states, benefits will only be paid to a dentist participating in the network.
Q. Is a referral required for specialty services?
A. No, a referral is not required for specialty services; however, to receive benefits, plan participants must see a specialist participating in the CivicSmiles Network. Our customer service team will be glad to assist you in identifying local participating specialists.
Q. Does each dentist in my office need to sign an agreement if he/she wants to contract with the network?
A. Yes, we contract each dentist individually. If you would like application materials sent to other dentists in your office, simply call us at 855-648-1404.
If you have additional questions please give us a call at 855-648-1404.
Professional Services Phone: 1-855-648-1404
Professional Services Fax: 1-855-311-1380
Professional Services Email: CVSM@decare.com
Mail Claims to:
CivicSmiles by DeCare
PO Box 1175
Minneapolis, MN 55440-1175
Contracting with CivicSmiles is easy. Complete the Contracting Dentist Agreement,
Facility Profile, W-9, and applicable Credentialing Application* for your state. We
have included a “Contracting and Credentialing Checklist” for your use to ensure we
receive all of the appropriate information. Dentists are not effective until the
credentialing process is complete.
Contact Professional Services at 1-855-648-1404 to request a fee exhibit for the
Top 20 Codes for your state.
Not ready to sign a contract? Click here to sign a Letter of Intent. A Letter of Intent states that you are interested in joining the network.
*Due to several states mandating a specific credentialing form, call us at 855-648-1404 and a representative will assist you regarding your state’s mandated application.
Forms and Literature
State Specific Credentialing Application
DeCare Dental manages more than 20 dental networks nationally.