Tools and Resources. The program offers free coverage to children and teens that fall within the Free CHIP Income Guidelines (PDF) . Find a Doctor. The list includes services most commonly provided to covered individuals, but other services may be covered for an individual member. To comply with Pennsylvania CHIP dental program guidelines, United Concordia recommends that orthodontists complete the If you indicate a “yes” response to one or more of questions 2–8, we ask that you submit the following to United Concordia for a final medical necessity determination:If one of the questions 2–8 on the ODC is not a “yes” response, most likely the orthodontic case will not meet medical necessity. The following is an abbreviated list of services and limits that are payable under the dental plan of the Pennsylvania Children’s Health Insurance Program (CHIP). To find out which insurance companies offer CHIP in your area, select your county from the map or drop down list below. CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid.

Completing the ODC will help to ensure unnecessary treatment is not performed before the final … This is great news for you because you can select the company that best meets your family's needs. Fluoride is allowed twice per calendar year, based on the American Dental Association’s Caries Risk Assessment tool or an approved Contractor tool.High risk patients are allowed three treatments per year and in some cases four.

If your children need health coverage, they may be eligible for the Children's Health Insurance Program (CHIP). To comply with Pennsylvania CHIP dental program guidelines, United Concordia recommends that orthodontists complete the Orthodontic Decision Checklist (ODC) to determine medical necessity for members enrolled in this program. Eligible children will receive comprehensive health and drug coverage, dental care and vision care.

As a reminder, all orthodontic services for CHIP members require prior approval. Applying for CHIP is easy.

The Children's Health Insurance Program (CHIP) is a state- and federally-funded health insurance program that provides health insurance coverage to all children who meet eligibility guidelines and are residents of Pennsylvania. CHIP dental coverage eliminates barriers to care. A full mouth X-ray or panoramic X-ray are allowed once every five years.Bitewing X-rays are allowed once a year, vertical bite wing series are allowed every three years.Intraoral periapical X-rays are only allowed in conjunction with full mouth series (210).Adult and child Prophys are allowed twice in a calendar year. In the service areas of Western, Northeastern, and Central Pennsylvania, uninsured children and teens under age 19 may qualify for coverage through Pennsylvania’s Children’s Health Insurance Program (PA CHIP) if they are not eligible for Medical Assistance (Medicaid)..

In some states, CHIP covers pregnant women. CHIP, brought to you by KidzPartners, is doing it right for children’s health. o While dental coverage for children is required to be offered in marketplaces, not all medical plans include dental insurance. High-risk patients signify pregnant individuals and those who are determined such by the American Dental Association’s Caries Risk Assessment tool or an approved Contractor tool.One, two, three and four surface amalgams for primary or permanent teeth are covered with no limitations.One, two, three and four surface resin-based composites are limited to permanent anterior teeth.One, two, three and four surface resin-based composites are limited to permanent teeth only where amalgams are not possible.Resin-based composite crown anterior teeth are not covered with the construction of a permanent crown for teeth 6-11 and 22-27.Limited to permanent teeth and primary teeth with no permanent successors.Some oral surgery procedures are covered under patient’s medical benefits.Surgical access of a ruptured tooth is covered if the member has been approved for a medical necessary orthodontics.Therapeutic pulpotomy is covered within 45 days of a root canal.Anterior bicuspid and molar root canals can be performed on permanent teeth only once per lifetime.Periodontal scaling is limited once per quadrant every 24 months and to no more than two quadrants done on the same date of service.Full mouth debridement is limited to one per lifetime after three years since a dental cleaning.Periodontal maintenance is limited twice a year to members that have health conditions which impact periodontal health.Lifetime maximum of $5,200 with prior approval using procedure code 8080 and 8090.Orthodontic benefits are rarely applied towards the individual yearly dental maximum of $1,500.Orthodontic treatment must be considered “medically necessary,” with pre-approval of orthodontic benefits authorized in one lump sum at the beginning of treatment.
Lacking coverage can pose a barrier to care.

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