Chapter 7 – Member Care and Community Connections
CTDHP Member Care and Community Connection Overview
One of the components that make the Connecticut Dental Health Partnership (CTDHP) unique is its state-wide Member Care and Community Connections Team. HUSKY Health and Covered CT member care and community connections efforts focus on two distinct areas:
- Oral Health Navigation: Oral Health Navigators develop a collaborative process between the member and Dental Provider(s) to assess, plan, remove/reduce barriers and meaningfully link members to meet their acute oral healthcare needs and support the member in establishing routine and preventative oral health behaviors and services.
- Community Engagement: Community Engagement Specialists develop, design, implement, and monitor community-based communications and activities to increase awareness of the HUSKY Health dental plan benefits, promote contact information (phone and website), provide a broader understanding of the services provided by the CT Dental Health Partnership, and distribute oral health related information and education to members, community partners, provider populations and oral health advocates.
Oral Health Navigation
Oral Health Navigation (formerly referred to as Care Coordination) is a collaborative process between the member, Oral Health Navigator, and Dental Provider(s) to assess, plan, remove/reduce complex barriers to care and meaningfully link members to meet their acute oral healthcare needs and support members in establishing routine and preventative oral health behaviors and services.
Complex barriers to care are typically defined as members whose medical, behavioral, and/or social needs are impacting accessing and completing oral health treatment. Acute oral health needs are determined by both the member and the dental provider, evidenced by the member’s own experience, the dental treatment plan developed by the dental provider, and the HUSKY Dental Plan Benefit that determines payment for care.
Oral Health Navigation is longitudinal in nature and focused on marshalling the resources, education, and interventions to support members in meeting their oral health goals.
Oral Health Navigation Goals
- To ensure member’s acute oral health needs are met by dental providers.
- To assist in removing or reducing the member barriers to accessing oral health services and completing the dental treatment plan determined by the dental provider.
- To provide resources and education to empower members to achieve good oral health practices.
- To support the member in establishing routine preventative oral health services.
Philosophy of Person-Centered Care Coordination and Services
Oral Health Navigation is provided to members and is rooted in a philosophy of person-centered care. Adapted from the World Health Organization person centered care is: “[an] approach to care that consciously adopts the perspectives of individuals, families and communities, and sees them as participants as well as beneficiaries of trusted health systems that respond to their needs and preferences in humane and holistic ways. People-centered care requires that people have the education and support they need to make decisions and participate in their own care.”
In some cases you may receive assistance from our teams or Oral Health Navigators who can assist HUSKY Health and Covered CT members in coordinating their care. Referral is through the Member Services Call Center at 855-CT-DENTAL, through the Member Referral portal on ctdhp.org, or via the Unite Us referral tool. Oral Health Navigators assist Members who face significant barriers to accessing care. They will work with you, the Member and other providers to ensure that the Member gets the dental care that they need.
Community Engagement
Community Engagement Specialists (formerly known as Outreach – Dental Health Care Specialists) develop, design, implement, and monitor community-based communications and activities to increase awareness of the HUSKY Health dental plan benefits, promote contact information (phone and website), provide a broader understanding of the services provided by the CT Dental Health Partnership, and distribute oral health related information and education to members, community partners, provider populations and oral health advocates. Currently, CTDHP’s Community Engagement Specialists cover 4 regions in the state.
Enhanced CTDHP Website – CTDHP.COM is now CTDHP.ORG
The new CTDHP website offers a myriad of information for dental
professionals on a user-friendly, mobile-friendly platform.
Welcome
The Welcome Tab – gives you easy access to:
- Provider News and Updates;
- your Provider Login Page;
- the Dental Fee Schedule;
- the Dental Benefits Coverage List;
- the EPSDT Schedule;
- and the Gainwell phone number.
How to Enroll and Re-enroll
The How to Enroll and Re-enroll tab gives step by step instructions for enrolling in the HUSKY Health and Covered CT program as a participating provider.
Provider News and Updates
This tab provides yet another way of accessing Provider News and Updates that include Policy Updates and an Archive of all updates. The link also provides access to the most current and archive of Provider newsletters. It also offers a link to our Connecticut “Oral Health Heroes,” providers who have been noted for going above and beyond over the years. You can also access this information directly from the ctdhp.org home page, or welcome page.
Dental Coverage List
This tab provides access to the most up-to-date grid of dental benefits. This listing of dental limitations by program notes:
- Procedure Services
- Common ADA Codes
- And, any service information, source documents and limitations for HUSKY A HUSKY B (Eligible to age 19) HUSKY C & HUSKY D
HUSKY Dental Fee Schedule
This tab will lead you to the most up-to-date Dental Fee Schedule. This is a very colorful, printable document that includes: procedure codes and descriptions; fees for adults and children; copays, effective dates, end dates, PGM Limits and Specialist PA requirements.
Provider Manual
This section will be offered in a chapter by chapter and complete, printable document format and should be, for the most part, searchable using the website search tool.
Dental Provider Toolkit
This toolkit should contain all the tools you need for successful program implantation. It includes more easy links to:
- The Dental Coverage List
- For Adult Patients – the list of Medical Conditions that Qualify for Two Cleanings a Year
- The Dental Fee Schedule
It also provides access to three key sections:
- Forms and Compliance Documents
- Provider Reference Materials
- A link to Medical / Dental Integration and the ABC Program
1. Forms and Compliance
Included in this section:
- Treatment Plan Template – Example |
- Periodontal Treatment Pledge
and Action Plan (Also available in Spanish, French, and Portuguese). - Informed Consent for Payment – Sample Client Acknowledgment of the Receipt of Dentures
- Third Party Liability (TPL Information (How to Update)
- Annual Provider Survey
Secure Access to Dental Plan Related Patient Information
2. Provider Reference Materials
Included in this section are downloadable references in the following areas:
- Dentures
- Anesthesia
- Orthodontics
- Early Childhood and EPSDT
- Perinatal
- Periodonatal Services
- Oral Cancer and Tobacco Cessation
- Special Health Needs
- Abuse and Neglect
- CTDHP Logos
Member Rights, Privacy, and our Commitment to Health Equity
This tab links to the same information that is provided in the Member section of the website. It provides an outline of Member Rights and Responsibilities, Privacy Rights and important information to ensure oral health equity for HUSKY Health and Covered CT Members.
Provider Login
The last tab, is the one you may use the most. This is the access to our secure portal that still resides on the ctdhp.com platform. It has been kept their for extra security of HIPAA information and the information you will need for:
- Verifying Eligibility
- Uploading Prior Authorizations
- Verifying Prior Authorization Status
- Viewing Patient Treatment History
Making Referrals
Dental offices, other medical providers, community agencies and clients can call our toll-free client services line to make a referral for the above services:
Monday to Friday • 8:00 AM to 5:00 PM
Excluding major holidays • Answering service available off-hours
