Dental services include comprehensive dental care through primary prevention, early intervention, diagnosis, medically necessary treatment and follow-up care.
Mercy Care DCS CHP pays for routine dental services without Prior Authorization (PA) or predetermination. Routine dental services include:
- Dental exams and X-rays
- Treatment for pain, infection, swelling and dental injuries
- Cleanings and fluoride treatments
- Dental sealants
- Medically-necessary stainless steel, resin or composite crowns
- Pulp therapy and root canals
- Fluoride varnish applied by a PCP or PDP
- Dental education
A dentist needs a PA for major dental services, including general anesthesia and braces.
All Mercy Care DCS CHP members must have a full well visit and a dental visit within the first 30 days of removal and placement in out-of-home care.
Mercy Care DCS CHP members can choose a Primary Dental Provider (PDP) and Dental Home upon enrollment in Mercy Care DCS CHP. You can change the member’s PDP/Dental Home at any time, for any reason. Some reasons to change a PCP and PDP are:
- If the member moves
- If you or the member do not feel comfortable
- If the office is far from you and the member
- If you or the member don’t understand what the PCP/PDP says
If you change the member’s PDP, ask the current providers to transfer the member’s medical records to the new PDP.
To request a change or to notify Mercy Care DCS CHP of a change, you can call Member Services at 602-212-4983 or 1-833-711-0776 (TTY/TDD 711)
Tooth decay can occur at any age including in the baby teeth, so it is important to start dental care at an early age and continue regularly. Mercy Care DCS CHP members should start dental services by 1 year of age or with the eruption of the first tooth. This early visit is known as a well-baby checkup and establishes a Dental Home for future care. Regular dental checkups should occur every 6 months following the first visit. Dental checkups include dental cleaning and fluoride treatment to help ensure the long-term health of the child’s teeth and gums. Consider scheduling the next dental checkup before leaving the PDP’s office. An oral health screening is part of an EPSDT screening done by a PCP.
Providers can apply fluoride varnish to members who are at least 6 months of age, with at least one tooth eruption. The oral health screening at the EPSDT visit does NOT take the place of an exam by a dentist. The baby should still be seen by the dentist by 1 year of age.
Members do not need a referral for dental care and can see any dentist listed in the Provider Directory. To make, change or cancel a dental appointment, call the provider at least one day before the appointment. Some providers may attempt to charge a fee for a missed appointment. Arizona law states Mercy Care DCS CHP cannot pay for missed or no-show appointments.