Our Provider Network
A Network for TennCare Members
In 2013, TennCare selected DentaQuest as the new administrator of the TennCare dental program. We were selected based on the merits of our response to TennCare’s request for proposal (RFP) during a competitive procurement process.
In order to ensure that the approximately 750,000 children who are eligible for dental benefits have access to high-quality care, DentaQuest is now maintaining a statewide network of dentists. We are confident that the providers invited into the network will enable DentaQuest to provide the highest level of dental care to TennCare members.
Developing a High Value Network of Dentists
DentaQuest was charged by TennCare with establishing a completely new provider network, which was built from the ground up and developed to meet the state’s requirements for access, while also ensuring maximum quality and efficiency in how members receive, and providers deliver, dental care.
We invited providers into the new network who completed re-validation with TennCare, satisfied peer-reviewed criteria, including care quality and efficiency performance criteria, and met geographic access requirements to ensure care is provided close to home.
Included in our quality and efficiency measures are the Dental Quality Alliance (DQA) measures. The DQA was created by the American Dental Association at the request of the Centers for Medicare & Medicaid Services (CMS) to create quality and efficiency measures for dentistry. We use the exact specifications of those measures, which have been validated by the Institute for Child Health Policy at the College of Medicine at the University of Florida. Our evaluation criteria take the following into consideration:
Meeting patients’ needs consistently with best practices for preventive and acute dental care, with close attention to appropriate costs of care. For example, some of the quality measures include percent of patients ages 6-9 and 10-14 receiving sealants on permanent molars, percent of patients receiving fluoride and percent of patients receiving exams.
Coding and delivery of procedures typically provided to Medicaid populations. This information helps us to understand each provider’s approach to dental care.
Evaluating providers with higher-than-average claims denials and analyzing whether that’s an indicator of performing unnecessary procedures.
Review of claims data to analyze providers’ TennCare treatment and billing practices.
The benchmarks for all our quality and efficiency measures are calculated based on the performance of similar dentists in each geographic region to determine the “norm” for that region.
TennCare certified our network in December 2013 as exceeding every TennCare-established benchmark for network composition, access and geographic outreach. Our network of dentists currently has a 1:857 provider to patient access ratio, which also exceeds nationally recommended standards for provider to patient access ratios of 1:1,500.
We will continually evaluate the network and providers to ensure appropriate access and effectiveness.