Section He-W 566.10 - Payment for Services(a) Payment for dental services shall be made in accordance with rates established by the department in accordance with RSA 161:4, VI(a).(b) Dental providers shall submit claims for payment to the department's fiscal agent.(c) Pursuant to He-W 566.07(b)(2), for extractions that warrant immediate action, both the prior authorization request and the claim for payment shall be submitted to the address in He-W 566.07(b)(4).(d) Dental providers shall maintain supporting records, in accordance with He-W 520 and this part.(e) Payments for endodontic treatments, including root canal treatment, shall be made only when the provider submits a radiograph that demonstrates that the endodontic therapy was successful, effective, and complete when completely filled to the apex of the root(s) of the tooth.(f) Payment for palliative treatments shall be made only when the provider submits documentation by report that demonstrates that the treatment was completed and the services provided were consistent with palliative treatment as defined in He-W 566.01(n).(g) Payment for comprehensive orthodontic treatment shall be inclusive of, but not limited to: (1) All examinations associated with the orthodontic treatment including periodic and emergency examinations;(2) All periodic adjustments associated with the orthodontic treatment;(3) All radiographs, diagnostic models, images, and other records associated with the orthodontic treatment;(4) Space maintenance, when performed by the orthodontic provider within 2 years of the banding;(5) Appliances as applied;(6) Application and removal of appliances;(7) Replacement and repair of brackets, bands, and arch wires;(8) Retainers and follow-up examinations; (9) Treatment ancillary to the orthodontia, including, but not limited to, separators and radiographs;(10) Orthodontically related palliative treatment; and(h) Payment for interceptive orthodontic treatment shall be inclusive of, but not limited to: (1) All examinations associated with the orthodontic treatment including periodic and emergency examinations;(2) All periodic adjustments associated with the orthodontic treatment;(3) All radiographs, diagnostic models, images, and other records associated with the orthodontic treatment;(4) Space maintenance, if applicable;(5) Appliances as applied;(6) Application and removal of appliances;(7) Replacement and repair of brackets, bands, and arch wires;(8) Retainers and follow-up examinations, if applicable;(9) Treatment ancillary to the orthodontia, including but not limited to separators and radiographs;(10) Orthodontically related palliative treatment; and(i) Payments for comprehensive orthodontic treatment for services prior authorized shall be made to the provider in 3 equal installments upon the department's receipt of an orthodontic claim and as follows:(1) A payment shall be made following the application of appliances;(2) A payment shall be made following the completion of the 12th month of treatment and the submission of a progress report as described in He-W 566.05(l)(1); and(3) A payment shall be made following case completion and the submission of the final treatment report and photographs as described in He-W 566.05(l)(2).(j) In the event of termination, provider payment for comprehensive treatment shall be prorated as follows: (1) If the appliances have been applied and the recipient is terminated or transferred before completing 12 months of treatment, the provider shall receive payment in accordance with (i)(1) above plus a payment equal to the reimbursement rate for each periodic adjustment the recipient received; and(2) If the recipient has completed 12 months of treatment and is terminated prior to case completion, the provider shall receive payment in accordance with (i)(1)-(2) above plus a payment equal to the reimbursement rate for each periodic adjustment the recipient received following the 12th month of treatment, up to 10 adjustments.(k) If treatment of the recipient is transferred to another provider, the new provider shall:(1) Request prior authorization for treatment in accordance with He-W 566.07; and(2) Receive payment based on the terms of the treatment plan that has been approved through prior authorization by the department in accordance with He-W 566.07.(l) Prior to terminating orthodontic treatment of a recipient, the provider shall remove the appliances and provide retention.N.H. Admin. Code § He-W 566.10
#7012, eff 6-15-99; ss by #7912, eff 7-1-03; ss by #9902, eff 6-1-11
Amended by Volume XXXIX Number 24, Filed June 13, 2019, Proposed by #12782, Effective 5/21/2019, Expires 11/18/2019.Amended by Volume XL Number 2, Filed January 9, 2020, Proposed by #12937, Effective 12/7/2019, Expires 12/7/2029.