VOL 66 | AUG 2022 | QTR 3
TEXAS ROUNDUP
IN THIS ISSUE
Summer Oral Evaluations
Summer is a great time for children to receive their routine dental check-ups. Schedules are often more flexible, and kids don’t have to miss class during the school year to visit the dentist. In addition, summer is a convenient time for parents to schedule dental appointments before kids return to school.
Relaxed summer schedules can disrupt oral hygiene routines and lead to increased consumption of snacks and sugary treats. Remind parents that good oral hygiene practices, a healthy diet and twice-yearly dental exams play a big role in helping to keep their children healthy.
The sooner children begin getting dental checkups, the healthier their mouths will stay throughout their lives. Early checkups help prevent tooth decay, which can lead to pain and interfere with learning, speech and eating, leading to poor nutrition and problems in school.
Good oral health is an important part of a child’s overall well-being, and scheduling your pediatric patients for a summer oral evaluation will give them a head start on good oral health.
Main Dental Home Change Updates
As of May 1, 2022, DentaQuest no longer accepts Main Dentist change forms via fax. The fax line has been discontinued and all Main Dental Home provider changes must now be submitted by the Member's Head of Household using the online tool.
Texas Medicaid and Texas CHIP members can now change their Main Dental Home provider online at www.dentaquest.com/texas. With the online tool:
- Make changes faster than a call, 24/7
- No need to log in to the Member portal
- Use the same system our Member Services team uses
- Members show up on your patient roster within minutes — no reference number needed!
Member's Head of Household can use this QR code to change their main dentist now!
Texas Provider Marketing Guidelines
As part of its core mission, DentaQuest is deeply engaged in all of the Texas communities in which they serve, with a particular focus on the most underserved and neediest populations. As part of this community engagement, DentaQuest continually monitors developments that may impact the delivery of dental care to those who need it most.
As part of your agreement with DentaQuest to provide care for its members, you must comply with state and federal laws, rules and regulations governing marketing, as well as the Health and Human Services Commission’s (HHSC) marketing policies and procedures, including their Uniform Managed Care Manual. Included in these rules are restrictions prohibiting providers from offering cash, gifts or other items to Medicaid members to influence their health care decisions, either directly or through a third party. This includes hiring individuals and marketing firms to solicit Medicaid eligible children.
Any violations of this policy will result in termination from the DentaQuest network and may also result in Federal and state civil and criminal penalties. DentaQuest takes violations of its policies and procedures seriously, especially when children and other vulnerable individuals are impacted. DentaQuest investigates all reported allegations and takes appropriate action on all provider behavior that is inconsistent with policies and procedures regarding the solicitation of members.
For additional information, please refer to the Office of Inspector General (OIG) website.
Provider Network & Directory Audit
DentaQuest would like to remind all providers that provider directory information must be updated when a change in your office is made. This includes, but is not limited to the following information:
- Provider joins/leaves practice
- Telephone and/or fax number
- Office hours
- Ages treated
- Languages spoken
- Handicap accessible (yes/no)
- Plan participation
- Accepting new patients’ status
If you have any questions regarding directory updates, please call your regional Provider Partner.
Value-Based Care
DentaQuest is currently collaborating with network dentists to move dental care in a more sustainable, collaborative direction through Value-Based Care.
In a value-based system, quality and outcomes should improve while costs remain the same or decrease because the healthier a person is, the less they require expensive services. We know people are both in need of dental care and concerned about the cost of care. We process claims for services delivered in response to an already present dental disease. Fillings and extractions address the impact of disease but do not address or eliminate its cause. In other words, restorative care is more costly to the system and the person, while preventive care is more valuable for people and communities.
If you would like more information regarding DentaQuest’s Value-Based Care model, please contact your regional Provider Relations Contacts.
Behavior Management
DentaQuest must assure that all dental services are appropriately provided and billed according to the guidelines of the State Medicaid Program. In addition, we want to help network providers take the appropriate steps to assure that all treatment rendered is appropriate, medically necessary and has a positive long-term prognosis. DentaQuest routinely monitors dental service utilization and cost among providers.
The overall objective of the Behavior Management program is to build and strengthen our relationship with the provider community, with emphasis on gaining an understanding about the member base and approach to treatment. Based on a review of utilization and cost analysis, your regional Provider Partner will meet with office staff to discuss results of cost analysis and performance quality review, provide education on program policies and procedures, and implement a plan to address deficiencies and compliance concerns, if necessary. Please contact your regional Provider Partner if you have additional questions.
DentaQuest Holiday Closure
In observance of the Labor Day holiday, DentaQuest will be closed on Monday, September 5, 2022.
Provider Resources
The following documents are listed on the Provider Resources page:
Visit the Provider Relations Contacts page to locate your regional partner.
