NY Manual
SHP Manual

New York Provider Manual
10.5 Home Healthcare | 10.7 Routine Vision

10.6 Dental

Dental services for Healthfirst members are provided and managed by DentaQuest, a delegated vendor that maintains a comprehensive network of dental providers.  Healthfirst Medicare members should refer to their Evidence of Coverage (EOC) to determine the extent of their dental benefit. Members may access any network dental provider without a referral. To assist a member in obtaining dental services, please contact Healthfirst Member Services at 1-866-463-6743. Members may contact Healthfirst Member Services or DentaQuest Member Services at 1-800-508-2047 if they have questions regarding dental benefits.

In addition to providing primary care dental services, the network includes specialty care dental providers such as orthodontists, endodontists, and oral surgeons. These providers see Healthfirst members without a referral but with approvals obtained from the delegated vendor. In general, the oral surgery performed by these providers is done in the provider’s office and involves procedures such as the extraction of impacted wisdom teeth; however, there may be oral surgery cases involving small children that must be performed under general anesthesia in a hospital setting. In these situations, the delegated vendor authorizes the oral surgery and reimburses the surgeon, but the hospital and anesthesia service component of the treatment must be pre-authorized by Healthfirst. This may be handled through communication initiated by either the hospital or the member’s PCP.

In situations when oral surgery is required to treat medical problems such as head and neck cancers, a referral from the member’s PCP to the oral surgeon is required, and all required prior authorization must be obtained from the Healthfirst Medical Management department. In these cases, all services are authorized and reimbursed by Healthfirst.

HIV-positive members may select an HIV specialist dentist by contacting the DentaQuest Dental Member Service Department at 1-800-508-2047.

Members may call Healthfirst Member Services with any questions at 1-866-463-6743.