Nevada Office of HIV Ryan White Part A Ryan White Dental

Nevada Office of HIV

Ryan White Part A

Ryan White Dental Insurance Referral Procedure

21-01: Ryan White Dental Referral Procedure: 7,16,2020, 2/10/2021

Purpose

This document will provide Liberty Dental Portal users on guidance to assist clients with

enrolling in the Ryan White Dental Insurance Program.

Process

Step 1. Eligibility Specialists will fill out the Dental Insurance Enrollment Form as part of the Universal

Eligibility packet for those clients enrolling in dental coverage. Please view the Sample Demographics Field

below, then view the Form Requirements in order to correctly complete step 1 of the Dental Form.

• The Dental Insurance Form (19-08) must be completed at every Re-Certification and Annual

appointment if the client would like to maintain active dental coverage. The Dental Insurance Form is

part of the Universal Eligibility Application; therefore, it is the responsibility of the agency completing

the Universal Eligibility Application to confirm Payer of Last Resort. As Nevada Medicaid does not

provide comprehensive dental coverage, Ryan White Part B has determined that Medicaid eligible clients are

under-insured for dental coverage. As such, Ryan White-Medicaid eligible clients may elect to enroll in the Ryan

White Dental Insurance Group (Liberty Dental).

Step 2. In order to complete step 2 of the Dental Form, the client must read the form, check the

boxes, and sign the form.

Once completed, the Dental Insurance Form must be uploaded to Part A/B CAREWare(s) as an attachment with the

Universal Application.

Each category must be filled in

except, when applicable, the

Emergency Dental Request.

Please fill this category in only if

it is an emergency request.

The SSN or TIN category will be

used for verification of other

health benefits. This category

may be left open if the client

does not have an SSN or TIN.

Nevada Office of HIV

Ryan White Part A

Ryan White Dental Insurance Referral Procedure

21-01: Ryan White Dental Referral Procedure: 7,16,2020, 2/10/2021

Step 3: Now that you have completed the Dental Insurance Enrollment Form you are now ready to enter the client into

the Liberty Dental portal. You will need to follow the instruction below to enter clients into the liberty’s portal. Please

see the Liberty Dental Tutorial starting on page 3.

Step 4. For Ryan White Part A clients wishing to enroll into Liberty Dental, the client will need to be referred

for Part B mirroring to ensure the client’s latest eligibility information is in the Part B CAREWare for reporting

purposes. In order to streamline mirroring referrals, the below assignments have been established. The

assigned Part A sub-recipients may only send mirroring referrals to the corresponding Part B NMCM sub-

recipient for submission. Part B NMCM sub-recipients are only responsible for mirroring Ryan White Part A’s

CAREWare information into Ryan White Part B’s CAREWare.

Mirroring Assignments

Part A Agencies

Part B NMCM Agencies

• Aids Healthcare Foundation

• University Medical Center Wellness

Clinic

• Track B/Nevada Aids Research and

Education Society

• Community Counseling Center

• Access to Healthcare Network

• North County Healthcare

• Nye County Health and Human

Services

• Community Outreach Medical Center

• Horizon Ridge Clinic

• Aids for Aids Nevada

• Golden Rainbow

• Help of Southern Nevada

• UNLV School of Dental Medicine

• Dignity Health St. Rose Dominican

• Huntridge Family Clinic

• Southern Nevada Health District

Nevada Office of HIV

Ryan White Part A

Ryan White Dental Insurance Referral Procedure

21-01: Ryan White Dental Referral Procedure: 7,16,2020, 2/10/2021

Nevada Office of HIV

Ryan White Part A

Ryan White Dental Insurance Referral Procedure

21-01: Ryan White Dental Referral Procedure: 7,16,2020, 2/10/2021

Nevada Office of HIV

Ryan White Part A

Ryan White Dental Insurance Referral Procedure

21-01: Ryan White Dental Referral Procedure: 7,16,2020, 2/10/2021

Nevada Office of HIV

Ryan White Part A

Ryan White Dental Insurance Referral Procedure

21-01: Ryan White Dental Referral Procedure: 7,16,2020, 2/10/2021

Nevada Office of HIV

Ryan White Part A

Ryan White Dental Insurance Referral Procedure

21-01: Ryan White Dental Referral Procedure: 7,16,2020, 2/10/2021

Nevada Office of HIV

Ryan White Part A

Ryan White Dental Insurance Referral Procedure

21-01: Ryan White Dental Referral Procedure: 7,16,2020, 2/10/2021

Nevada Office of HIV

Ryan White Part A

Ryan White Dental Insurance Referral Procedure

21-01: Ryan White Dental Referral Procedure: 7,16,2020, 2/10/2021

Nevada Office of HIV

Ryan White Part A

Ryan White Dental Insurance Referral Procedure

21-01: Ryan White Dental Referral Procedure: 7,16,2020, 2/10/2021

Nevada Office of HIV

Ryan White Part A

Ryan White Dental Insurance Referral Procedure

21-01: Ryan White Dental Referral Procedure: 7,16,2020, 2/10/2021

Nevada Office of HIV

Ryan White Part A

Ryan White Dental Insurance Referral Procedure

21-01: Ryan White Dental Referral Procedure: 7,16,2020, 2/10/2021

Nevada Office of HIV

Ryan White Part A

Ryan White Dental Insurance Referral Procedure

21-01: Ryan White Dental Referral Procedure: 7,16,2020, 2/10/2021

Nevada Office of HIV

Ryan White Part A

Ryan White Dental Insurance Referral Procedure

21-01: Ryan White Dental Referral Procedure: 7,16,2020, 2/10/2021