Understanding Billing and Benefits for Medallion and CCC+

This fall is an exciting time in Virginia as hundreds of thousands of new Virginians enroll in Medicaid health plans. As you know, nearly 400,000 Virginia adults now have access to medical coverage, thanks to Medicaid expansion. What you may not know, however, is that several Medicaid health plans (known as managed care organizations or “MCOs”) are also offering enhanced dental benefits to members. While this is good news for Virginians, providers and patients have many questions about the different insurance options, what is covered, and how to bill services.

To help providers and patients navigate coverage and billing for enhanced dental benefits, we developed the following handouts about enhanced dental benefits in Medicaid managed care programs, Medallion 4.0 and Commonwealth Coordinated Care Plus (CCC+):

• Provider FAQ: Medicaid Adult Dental Coverage in Medallion 4.0
• Provider FAQ: Medicaid Adult Dental Coverage in CCC+

Medallion covers most adults, children, and pregnant women enrolled in Virginia Medicaid. Four of the six health plans (MCOs) in Medallion are providing enhanced dental services to members; United Healthcare and Anthem do not offer enhanced dental benefits at this time. These benefits vary greatly by MCO, so be sure to view the chart on the last page of our FAQ to better understand what is covered in a specific plan.

CCC+ covers several Medicaid waiver populations and virtually all Medicaid-enrolled individuals who are aged (over 65), blind, or disabled. Some MCOs that participate in CCC+ are offering additional, enhanced dental benefits. Review specifics for each plan, including billing instructions and the services covered by each, in our CCC+ FAQ.

To learn more about eligibility and enrollment, visit CoverVA.org. For additional questions about enhanced dental benefits in MCOs, don’t hesitate to contact us!