How Do I Verify My Patient's Eligibility for Dental Medicaid Services?

Jul 01, 2023

Understanding patient eligibility is an important part of growing profitability with dental Medicaid. Your patient’s eligibility and plan enrollment direct you on which plan to bill for the dental care provided.

To check eligibility, visit the eMOMed Portal. To use this system, the provider or their designated office personnel must register to gain credentials.

Once logged in, you’ll need one of the following data sets to check your patient's eligibility:

  • Participant DCN, Participant Last Name, First Name and Date of Birth
  • Participant Social Security Number and Date of Birth
  • Casehead DCN and Child's Date of Birth

A participant DCN is the same as their MO HealthNet ID number.  This number can be found on the participant's MO HealthNet or Managed Care ID card. 

Providers can also use a participant's Date of Birth and SSN to check eligibility if the participant does not have their current ID card.

To expedite your search, if any part of the participant’s last name has special characters (apostrophe, space, suffix, initials, hyphen, etc.) use their SSN and date of birth instead.

You should also note, the First Date of Service cannot be more than a year old, nor can it be more than 31 days in the future. Assign first and last dates accordingly.

Participant eligibility should always be verified on the date of service.

As you are checking eligibility, you will be looking to determine the plan in which the participant is enrolled. Eligibility can change, so verifying that the participant is active, and enrolled is key to having your claims paid.

If your patient falls in one of the following categories, they are most likely covered by Fee-For-Service Medicaid or “Traditional Medicaid”:

  • Adults
  • Adults with Disabilities (including visual impairment)
  • Seniors Over the Age of 65
  • Women with Breast or Cervical Cancer

The claims for Fee-For-Service patients are submitted to MO HealthNet for payment.

Providers must be enrolled with MO HealthNet to provide dental services through their Fee-For-Service Program.

Click here to begin or update your enrollment with MO HealthNet.

If your patient falls in one of these categories, they are most likely covered by a Managed Care Plan:

  • Children Including Foster Children
  • Pregnant Women
  • Newborns
  • Families

The claims for Managed Care Plan participants must be submitted to the care plan that was active on the date of service.

Providers must be enrolled with the Managed Care Plan in which their patient is participating to bill that plan for dental services provided. See the Managed Care Provider Toolkit for more details.

Enrollment with the individual Managed Care Plans can be initiated using these links:

Providers have the option, based on their practice and patient needs, to enroll exclusively with the Fee-For-Service program or a combination of the Managed Care Plans.

Regardless of the path you choose, the covered dental Medicaid services are the same.*

So, you won’t need to concern yourself with which plan covers more, but rather who you are more likely to be providing services for and the plans in which they participate.

For example, a pediatric-focused dental office may choose to exclusively enroll with one or all of the Managed Care Plans because they are the dental home for children and young families. Deciding which Managed Care Plan or plans in which to enroll is the decision of the provider.

Ready to Get Started?
Check out our Medicaid Mini - Credentialing 101 for relevant tips and tricks to assist with your credentialing application.

Need More? 
Your Medicaid Mentor – Jessica Emmerich, is here for you. Email, call or text her at 573-536-2474.

*One caveat for the Managed Care Plans is that providers do have the option to negotiate reimbursement rates with the carrier, just as they would with any insurance carrier.