Provider Frequently Asked Questions

What is Healthy Michigan Dental?

Healthy Michigan Dental is a licensed dental insurance company providing dental services for Healthy Michigan Plan beneficiaries enrolled through a qualified health plan.

What is the Healthy Michigan Plan?

The Healthy Michigan Plan is a Michigan Medicaid Expansion program that provides health care coverage for adults ages 19-64 who earn between 100-133% of poverty level.  For more information about the Healthy Michigan Plan, please visit the State of Michigan website at: http://www.michigan.gov/healthymiplan.

Where can I find More information about the Healthy Michigan plan?

Additional information about the Healthy Michigan Plan may be found by visiting the State of Michigan website at:  http://michigan.gov/healthymiplan.

What fee schedule should I use for Healthy Michigan Plan patients?

Each patient may have a unique fee schedule with different plan benefits, exclusions, and limitations. In order to ensure that you are utilizing the appropriate fee schedule, it is important to verify health plan enrollment with each patient.

If you need a copy of our Covered Services and Reimbursement Schedules, you may email our Provider Relations department at: providerrelations@hmidental.com.

How are providers paid for services?

Claim payments to providers for services rendered are sent via postal mail by check. Future system enhancements will allow for the capability of electronic payments and paperless explanation of benefits; to be announced Spring/Summer 2017.

How do I confirm if a patient is eligible to be serviced?

Providers are required to confirm benefit eligibility for each patient prior to rendering services; patient eligibility can change at any time during the month. Please contact Healthy Michigan Dental at (800) 875-2400 or visit the provider web portal.

Can Providers charge patients a Co-Pay?

Patients enrolled in the Healthy Michigan Plan do not have a co-pay for services listed on the “Covered Services and Reimbursement” schedule. To obtain a copy of the covered services, please visit our provider web portal.

Can the office fax radiographs?

If your office is submitting radiographs to facilitate the processing of a prior authorization request you have the ability to submit via e-mail to pa@hmidental.com, postal mail to the address listed below, or through NEA attachment services. For more information about NEA, please contact us at (800) 875-2400.

US Postal Mail      
c/o Carriers TPA, LLC
P.O. Box 2819
Detroit MI, 48202

What types of procedures are considered an emergency?

If you have an emergency prior authorization request, our office will expedite your request and process within 3 business days. Emergencies are defined as any treatment necessary to alleviate the member from pain. If you have a patient that requires an emergency prior authorization, please contact our office at (800) 875-2400

How does an in network provider submit claims to Healthy Michigan Dental?

In Network providers can submit claims for payment to Healthy Michigan Dental in the following ways:

US Postal Mail      
c/o Carriers TPA, LLC
P.O. Box 2819
Detroit MI, 48202

Fax (313) 875-2401

Electronically via Claims Clearinghouse [EDI]
Payer ID: CARRS

When submitting claims which form should be used?

When submitting claims, Healthy Michigan Dental recommends using the most recent ADA claim form, filled out completely, according to the CDT manual’s instructions.

How long after submitting a claim will payment be issued?

Payment will be issued within 30 days of the date received.

How can an in network provider check the status of a received claim?

In order to check the status of a claim that has been received, Providers can call our dental customer service line at (800) 875-2400 and status a claim over the phone or online using the Healthy Michigan Dental web portal.

How can an in network provider correct a previously submitted claim?

In the event that a claim is submitted in error, or needs a correction to a previously processed claim, please call our dental customer service line (800) 875-2400 and one of our agents can further assist you.

Can an in network provider appeal a claims decision?

To appeal a claims decision, please call our dental customer service line (800) 875-2400 for details concerning the appeals process.