The goals of the CADPP are to:
Practices that meet the eligibility criteria must submit a request for designation with all other required documentation.
All aspects of the CADPP are subject to change by the Minnesota Legislature.
Dentists and dental clinics must meet one of the following criteria (if criteria has multiple components, providers must meet all components under the given criteria and submit the documentation as verification with the request for designation):
Nonprofit community clinics, including those currently enrolled with MHCP, must complete the Community Clinic Applicant Assurance Statement (DHS-5732) (PDF) and any other required documentation before MHCP can consider the clinic for CADPP designation.
4. Dental clinic or dental group owned and operated by a nonprofit corporation that has:
MHCP will track provider performance per Provider Requirements to determine eligibility for continued participation.
To request CADPP designation, complete the appropriate MHCP designation request form:
If a practice has:
Note: Private practicing dentists must have a MHCP enrolled practice or clinic FEIN.
To complete the CADPP designation process:
You only need to complete this process once. MHCP will not require subsequent annual requests for designation. If MHCP designates you as a CADPP provider, you are responsible for informing MHCP if the status of the clinic changes or no longer meets the criteria for CADPP designation. DHS does require annual submission of critical access dental encounters from the previous year using the CADPP Encounter Data Request form (DHS-7602). Submit the CADPP encounter form annually on October 1. DHS will use the data to determine if your status as a CAD provider will continue.
Providers designated as CADPP receive add-on payments for services for Medical Assistance (MA) and MinnesotaCare recipients, including those enrolled in a managed care organization (MCO), as follows:
Fee-for-service (FFS) CADPP add-on payments are included in the reimbursement for each paid claim and appear on the provider’s remittance advice with a group code CO and adjustment reason 144.
Effective January 1, 2017, how CAD payments are calculated will change. The MCO CADPP will be included in the capitation payments paid to the MCOs. with an exception for Medica health plan providers. Each MCO will calculate and determine how the CAD payments are made to designated providers for MA and MinnesotaCare recipients. Contact the MCO with whom you have a provider agreement with any questions or concerns.
Follow these guidelines for billing:
Minnesota Statutes 256B.76, Subd. 4 (Physician and Dental Reimbursement - Critical access dental providers)
Minnesota Statutes 256L.11, Subd. 7 (Provider Payment - Critical access dental providers)
Minnesota Statutes 256B.76, Subd. 3c (b) (Dental subcommittee)
Minnesota Statutes 256B.0625, Subd. 30 (Covered Services, Other clinic services)