All Gainwell Provider Updates here.  The most recent update was issued on 2/29/24.

Emergency Prior Authorizations may be called into the Provider Services Prior Authorization line at 888-445-6665.

For claims payment related issues, please call the Gainwell Helpline at 800-842-8440.

New! Temporary Process to Receive Client Eligibility Status, Claims History and Adult Benefit Maximum Data from CTDHP: Providers can contact the Member Service Center to receive Patient information on 5 or fewer patients per call. Please call 855-283-3682. And, have the following information ready for CTDHP: Client Name, Medicaid ID, Date of Birth, Provider NPI.

Providers can also complete this form and fax to CTDHP at 860-674-8174 to receive information for 6 or more patients. You can provide multiple copies of the form.

CTDHP will return via fax the completed information. Faxes will be processed in the order received and completed within 4 hours of when the fax was received. Any faxes sent to CTDHP after 4pm will be processed and sent the next business day.

Prior Authorization and Post Procedure review can be submitted via standard mail. The J434 Standard ADA Claim Form and all required supporting documentation may be sent to CTDHP/BeneCare at:

CT Medicaid Prior Authorization

C/O Dental Benefit Management/BeneCare
555 City Ave East Suite 600
Bala Cynwyd, PA 19004
Orthodontic Prior Authorization requests can be sent to:

Orthodontic Case Review
C/O BeneCare Dental Plan
195 Scott Swamp Road, Suite 101
Farmington, CT 06032

Please note, decisions regarding the Prior Authorization requests are provided within fifteen business days of receipt.

interChange Provider Important Message

Attention Dental Providers:
UPDATED Service Interruption BeneCare is currently experiencing a systems outage. The Benecare/CT Dental Health Partnership call center can receive calls but are currently unable to provide information in relation to claims, prior authorizations (PA) status, or if the client has reached the Adult Benefit Maximum (ABM). They can verify Medicaid client eligibility status. Client services such as locating a dentist, assistance with transportation and appointment scheduling and care coordination services are fully operational within the call center.

Please use the ctdhp.org website as BeneCare is posting daily updates to keep you informed about their operational status. Do not use the ctdhp.com website.

Eligibility verification and PA status can be confirmed by the provider signing into their secure web portal at www.ctdssmap.com and selecting either “Eligibility” or “Prior Authorization” on the menu bar or selecting “Client Eligibility Verification” or “Prior Authorization Inquiry” under quick link on the right-hand side.

For claim history, providers should utilize the Web self-service functionality to verify denture history, dental restoration, and dental benefit limits. To access “Claim History for Specific Services”: Provider must sign into their secure web portal at www.ctdssmap.com select “Claims”, and then select “Claim History for Specific Services” menu option.

Information is accessed by entering the client ID, inquiry type and date of service (use a date in the past to obtain history). Inquiry type must either be “Denture Services”, “Dental Restoration”, or “Dental Benefit Limit”.

For difficulty logging into the secure Web portal, refer to the step-by-step instructions on accessing the secure web portal found on www.ctdssmap.com, go to “Information” on the menu bar, then select “publications”. Scroll down to the Provider Manual panel and click on the link under Chapter 10. Detailed interChange Provider Important Message instructions can be found on page 32 to 34. Or use the following link: Chapter 10 Web Portal /AVRS see page 32. For further assistance please contact the Provider Assistance Center at 1-800-842-8440.

We apologize for the inconvenience. Please check ctdhp.org often for updated information. We apologize for the inconvenience and BeneCare is working diligently to resolve this issue.

You can download the notice here:

Provider Public and Secure Web Portals (ctdssmap.com)

Attention Dental Providers: Service Interruption

BeneCare is currently experiencing an outage with their internet and phone systems. There are a limited number of call center representatives who can take calls but are unable to provide information in relation to claims, prior authorizations (PA) and client eligibility status. Some of the calls are being diverted to another call center, however, they are also unable to provide client eligibility information, PA status or if a client has reached the adult benefit maximum.

BeneCare will provide updates to their operational status on their website at https://ctdhp.org. Eligibility verification, Dental Annual Benefit Maximum limit and PA status can be confirmed by the provider signing into their secure web portal at www.ctdssmap.com and selecting either “Eligibility” or “Prior Authorization” on the menu bar or selecting “Client Eligibility Verification” or “Prior Authorization Inquiry” under quick link on the right-hand side.

We apologize for the inconvenience and ask that you try your call again, at a later time, if possible. Please check this Web site often for updated information on when this issue is expected to be resolved. We apologize for the inconvenience and BeneCare is working diligently to resolve this issue.

For HUSKY Dental Providers:

For Claims Payment related issues, please call the Gainwell Helpline at 1-800-842-8440

Emergency Prior Authorizations may be called into the Provider Services Prior Authorization line at 888-445-6665.

Prior Authorization and Post Procedure Review can be submitted via standard mail. The standard ADA Claims Form and all required supporting documentation may be sent to CTDHP / BeneCare at:

CT Medicaid Prior Authorizations
c/o Dental Benefit Management/BeneCare
555 City Ave East, Suite 600
Bala Cynwyd, PA 19004

Orthodontic Prior Authorization requests can be sent to:

Orthodontic Case Review
c/o BeneCare Dental Plan
195 Scott Swamp Road Suite 101
Farmington, CT 06032

Please note, decisions regarding the prior authorization request are provided and posted within fifteen business days of receipt.   Allow for delays with the U.S. Postal Mail Service.

A new workshop has been scheduled for new providers. Learn more here.

This provider bulletin (PB) will supplement guidance found in PB 2023-69 “UPDATED: Addition of Periodontal Benefits and clarify the dental examination parameters and requirements for the submission of prior authorization requests for Periodontal Services. According to the 2024 Current Dental Terminology (CDT) coding, the following codes should be used under different circumstances.

Read the Policy Bulletin Here

The Policy Bulletin

The Periodontal Treatment and Action Plan

Commonly Asked Questions

PA Upload Instructions

The Fee Schedule (all services)

The Dental Coverage List (all services)

An Informational Article on Periodontal Disease

Effective for dates of service January 1, 2024, and forward, the Department of Social Services (DSS) will pay for select Periodontal Procedure Codes for the evaluation and non-surgical treatment and non-surgical management of Periodontal Disease, regardless of whether surgical intervention may be recommended or required in the future. The select Healthcare Common Procedure Coding System (HCPCS) for the current Dental Terminology (CDT) periodontal procedure codes have been added to the Dental Adult and Dental Pediatric fee schedules.

The changes apply to services reimbursed under the HUSKY A, B, C, D and Covered CT programs.

Policy Bulletin

Provider Frequently Asked Questions

The CDT codes D7284 and D2991 have been added to the dental fee schedules for adults and children. These CDT codes are now more specific in describing the types of dental services that will be rendered.

Read the Policy Bulletin Here

Are you, or your staff, in need of a refresher in current Connecticut Medical Assistance Program
dental policies and claims procedures? This workshop will provide you and your staff with an
understanding of recent changes to Dental billing and how claims are processed today. We
encourage you and your staff to attend.

Virtual training dates:  December 14th and December 18th

Read more and Register Here.