As dental coverage is included as part of our CHIP product, it’s important that our providers monitor this population for dental health.
One of the measures that we track related to this is the HEDIS measure Annual Dental Visit (ADV), which ensures CHIP members ages 2-20 have at least one dental visit during the measurement year. This measure is available for viewing through our Theon® Care Optimizer® platform tool.
The second measure is a PA-specific administrative measure, dental sealants for 6-9 year old children at elevated caries risk (SEAL-CH). This measure evaluates the percentage of enrolled children ages 6-9 years at elevated risk of dental caries who received a sealant on a permanent first molar tooth within the measurement year.
The Bright Futures periodicity schedule advises the assessment of a dental home for children starting at six months1. To assist with this, we’ve provided the American Dental Association’s Caries Risk Assessment Form that can be implemented into standard practice for your pediatric patients. If you need assistance integrating oral health into your practice, the US Department of Health & Human Services has an excellent toolkit for this, "Considerations for oral health integration in primary care practice for children".
Coverage and reimbursement for fluoride varnish
We also provide coverage and reimbursement for the application of a fluoride varnish to primary teeth starting at the age of primary tooth eruption by the primary care clinician with proper coding and/or certification. This is a preventive benefit for the member and follows the recommendations of the United States Preventive Services Task Force. Our preventive services health coverage guidelines found in the provider library will assist you in proper coverage for this service.