Summary of Discussions
A team of WV dentists and your WVDA Executive Director met with WV Medicaid last month to discuss concerns and request strategic increases in select dental Medicaid fees. Following this meeting, the WVDA also sent a letter to the Governor making the same request. Please review the letter and the fee increase chart provided separately.
Additional Requests Submitted by WVDA
- Eliminate the 3-tooth extraction limit per appointment
- Remove pages 17 and 21 from MCO credentialing paperwork (duplicative information already required by WV Medicaid, not CAQH)
- Align traditional Medicaid pre-authorization requirements with MCO prior authorization requirements
- Establish MCO performance measures for broken (no show/failed) appointments or require submission of a code/claim for broken appointments at no cost to the dentist
- Approval for Oral Appliance Therapy Codes
Communication with MCOs
WV Medicaid asked the WVDA to address specific MCO complaints directly. A meeting with Liberty Dental was scheduled for late January but was cancelled by Liberty. WVDA sent a detailed email outlining concerns and will update members on any further developments.
Meeting Results to Date
- Due to changes in leadership — both at the WV Department of Human Services and the Governor’s Office — WV Medicaid must brief new leadership before any decisions are made. No decisions have been finalized yet.
- Periodontal Maintenance Code 4910 has been opened for coverage at a frequency of once per year. This change was made after WV received a poor national report score for lack of service provision. WVDA will continue to work with Dr. Jason Roush, WV State Dental Director, to increase this frequency in the future.
WVDA will keep all members updated as soon as there is new action or response regarding the submitted requests.
2025 Medicaid Fee Increase Ask to Governor 2025 Fee Increase request to Governor and Legislature
