儿童医疗补助牙科索赔与支付金额模式：对就诊机构和牙科服务提供者的分析
Patterns in Pediatric Medicaid Dental Claims and Payment Amounts: An Analysis of Settings and Dental Providers.
作者信息
Mommaerts Katherine, Roy Indrakshi, Bonah Cassandra, Reznicek Natalie, Muesch Helm Denise
机构信息
Dep. of Social Work, Northern Arizona University, 19 W. McConnell Drive, PO Box 15350, Flagstaff, AZ 86011, USA. Tel 928-523-2434.
出版信息
J Allied Health. 2025 Spring;54(1):e49-e55.
OBJECTIVE
To determine the trends in the settings and types of providers that provide oral health services to pediatric patients using Medicaid in Arizona.
METHODS
In a retrospective descriptive study, we examined the place of service and provider type of Medicaid-paid dental claims among pediatric patients from January 2016 to December 2019. We analyzed Medicaid reimbursed dental services using dental claims data.
RESULTS
More Arizona children aged birth to 21 were treated in health clinics than in private practice/dental support organization settings in 2019 than in 2016. Preventive and minor restorative dental claims were significantly higher in 2019 than in 2016 for pediatric patients in Arizona. Further, there was an increase in dental claims paid to non-dentists, such as dental hygienists and nurse practitioners, in 2019 compared to 2016.
CONCLUSIONS
The place of service and provider type are shifting among pediatric Medicaid patients in Arizona. Not only is there a shift from place of service, but preventive and minor restorative dental claims are being filed by more non-dental providers. This reveals the movement towards integrated oral health in primary care for pediatric Medicaid patients in Arizona.
目的
确定在亚利桑那州为使用医疗补助计划的儿科患者提供口腔健康服务的机构设置及提供者类型的趋势。
方法
在一项回顾性描述性研究中，我们调查了2016年1月至2019年12月期间儿科患者中医疗补助计划支付的牙科索赔的服务地点和提供者类型。我们使用牙科索赔数据分析了医疗补助计划报销的牙科服务。
结果
与2016年相比，2019年在健康诊所接受治疗的亚利桑那州出生至21岁的儿童比在私人诊所/牙科支持组织环境中的更多。2019年亚利桑那州儿科患者的预防性和小型修复性牙科索赔明显高于2016年。此外，与2016年相比，2019年支付给非牙医（如牙科保健员和执业护士）的牙科索赔有所增加。
结论
亚利桑那州儿科医疗补助患者的服务地点和提供者类型正在发生变化。不仅服务地点发生了转变，而且更多非牙科提供者提出了预防性和小型修复性牙科索赔。这揭示了亚利桑那州儿科医疗补助患者在初级保健中朝着综合口腔健康的发展趋势。
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