About the Medicaid dental claims data
About the Medicaid dental claims data
Medicaid dental claims are submitted to the Minnesota Department of Human Services (DHS) by providers licensed with DHS to deliver dental services to individuals enrolled in a Minnesota Health Care Program (MHCP).
- The number and percentage of Minnesota Health Care Programs (MHCP) enrollees who had at least one dental service during the calendar year based on the claims submitted.
- Whether MCHP enrollees’ dental service use varies over time.
- If dental service use varies among certain MHCP programs, age groups, or counties.
MHCP enrollees represent low-income populations, including individuals with disabilities, older adults (65+ years), pregnant women, and children who may experience higher and more severe dental disease and oral conditions.
- Inform oral health, medical and public health professionals; educators, researchers, grant makers, policy makers, and the public.
- Focus resources and program activities towards specific MHCP enrollees, age groups, or counties with lower dental service use.
- State and local program planning, evaluation, and developing or modifying policies.
- Dental service use among Medicare (65+ years) patients (i.e., those not dual eligible for Medicare and Medicaid (i.e. Medical Assistance)).
- Dental service use among low-income individuals selecting not to enroll or not eligible to participate in a MHCP.
- Dental services provided to MHCP enrollees that were not submitted as a dental claim to the Department of Human Services for reimbursement.
- Specific types of dental or oral health service use (e.g., dental cleaning, root canal, etc.).
Dental service use: The number and percentage of all Minnesota Health Care Programs (MHCP) enrollees ages up to 100 years with at least one dental claim submitted during the calendar year (January 1 through December 31).
Dental service use:
The number of Minnesota Health Care Programs enrollees ages up to 100 years with at least one dental claim submitted during the calendar year for a dental service multiplied by 100 to get a percent.
The Minnesota Department of Human Services administers the Minnesota Health Care Programs for qualifying low income Minnesotans. The two major programs included in this data are:
- MHCP eligibility may change from month to month. Eligibility and the level of insurance coverage depend on income, household size, age, pregnancy or disability status, and the type of qualifying healthcare program.
- An individual is counted as a dental service recipient in each calendar year if at least one dental-related fee-for-service or managed care encounter claim was submitted with a service date during the calendar year (January 1 through December 31).
- Regardless of how many services (i.e. number of dental claims) were provided during the calendar year, MHCP enrollees served are counted once. However, if an individual is enrolled in more than one major program (i.e. Medical Assistance and MNCare) during a calendar year, they are included more than once in the total count of MHCP enrollees served.
- Data includes dental claims for both fee-for-service and managed care submitted by a licensed MHCP dental provider. Dental claims included in the 2012 through 2013 datasets were paid claims only. Dental claims included in datasets since 2014 include paid, unpaid, and denied claims.
- The county recorded in the dataset is the MHCP recipient’s county of residence. The county of residence is not necessarily the county where the recipient received a dental service. For each calendar year, the person is counted within the county of residence on record for the person’s last month of enrollment.
- MHCP recipient age is calculated as of the end of each calendar year. Enrollees without a recorded birthdate and enrollees who are more than 100 years of age are excluded.
- Medicare recipients are not included in the dataset unless they are dual-eligible (i.e., have Medicare and Medicaid (i.e. Medical Assistance)).
A dental service is any diagnostic, preventive or treatment service provided by or under the supervision of a dentist.
Medicaid recipients who are pregnant or under age 21 are required to have dental coverage under federal and state law (all medically necessary services as defined by the Department of Human Services).
Federal law does not require Medicaid to provide dental benefits to adults aged 21 years and older. However, the state of Minnesota provides limited coverage of dental care for adults including preventive services and one dental exam per calendar year.
To learn more about MHCP programs, including eligibility criteria and dental benefits visit: Minnesota Health Care Programs overview
Use caution when attempting to compare dental service use over time. Claim years 2012 through 2013 include paid dental claims only. Data collected since 2014 include paid, unpaid, and denied claims. Only years 2014 and onward can be compared.
Minnesota Department of Human Services. The Department of Human Services Data Warehouse stores information produced by the Medicaid Management Information System (MMIS) to track fee-for-service claims activity and encounter data from managed care health plans.
Minnesota Department of Human Services. Minnesota Health Care Programs Dental Services Recipients by County of Residence, Program Category and Age. Collected by the Minnesota Oral Health Program. St. Paul, Minnesota: Accessed from MN Public Health Data Access Portal. [Add URL] Retrieved month, year.
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