Assessment of HLDI Scoring Methods and Their Effect on Orthodontic Medicaid Approval/Denial Rates.

In 2017, the state of Illinois implements Handicapping Labio-Lingual Deviation Index (HLD) as a system to determine severe malocclusion of children they will cover for orthodontic treatment. This index evaluates 13 factors and occlusal traits, such as overjet, overbite. These factors are weighted to provide a final score that is used to determine access to care and insurance coverage. Insurance claim submission process for DentaQuest insurance company required patient digital records and scored HLDI sheet by orthodontist. A board of case assessors at DentaQuest Medicaid insurance company will assess the cases provide the result. Objective: The aims of this study are to assess the reliability of two different scoring methods of HLDI visual Inspection (VI) and 3D Digital measurements (CAD). Determine the association between VI and MCO-DQ HLDI assessment and the association between the CAD and MCQ-DQ HLDI assessment. Hypothesis: There is no association between approval/denial determination via VI and digital casts CAD HLDI assessment. There is no association between approval/denial determination via VI and Medicaid MCO-DQ HLDI assessment. There is no association between approval/denial determination via CAD and Medicaid HLDI MCO-DQ assessment. Methods: Digital records were obtained from 401 insurance submitted patients by UIC Orthodontics clinic, HLDI measurements were completed via visual inspection of the intra oral photos. The same 401 subjects measured again by digital dental cast via OrthoCad software. Final score results were compared to each other and compared to DentaQuest result. The non-parametric statistical analysis was performed at p=0.05. Results: VI and CAD, Cramer’s V test was (0.845) and Kappa test was (0.803), indicating strong association and agreement. MCO-DQ and CAD, Cramer’s V test was (0.318) and Kappa test was (0.312), indicating low association and agreement. Conclusions: There is substantial association between approval/denial determination via VI and digital casts CAD HLDI assessment. There is a low level of association between approval/denial determination via VI and Medicaid MCO-DQ HLDI assessment. There is a low level of association between approval/denial determination via CAD and Medicaid HLDI MCO-DQ assessment.