Dental Hygienists on their “own” in some states

Medicaid is regulated by state and federal laws and with that, there are up to this date 18 states that allow direct reimbursement to dental hygienists.  Those states are, AZ, CA, CO, CT, MA, ME, MI, MO, MT, NE, NM, NV, OR, RI, VT, WA WI currently. (Source 2019 Administrative with Confidence by Dr. Charles Blair)

Even with that, not all insurance companies recognize independent dental hygienists as providers when it comes to sending payment.   The majority of PPO plans limit recognition of providers like doctors and specialists.

The dental hygienist who is independent to be reimbursed needs to obtain a Type 2 NPI number and either submit the claims directly to the payer or bills the patient directly.

Dental hygienists working as independent providers will need to keep detailed notes as to the patient encounter.  This would be recommended to be in the SOAP note format for proper clinical notes. SOAP notes are defined as S=Subjective(What the patient reports as the issue or what is bringing them in for the appointment, O=Objective(What the hygienist observes of the patient needs and symptoms and clinical details reported. A=Assessment(What treatment is necessary and how it will be delivered); P=Plan What is the plan for this particular patient and what is the treatment sequence recommended.