Texas Dentists for Medicaid Reform

Controversy over DMO Not Paying for Work on Same Tooth

July 12, 2019

Back in February, MCNA issued a Provider Bulletin that effective March 15 it would start reviewing restorations being redone within 36 months. The company would also start requiring prior authorizations for identical restorations and similar restorations on the same tooth. Prior authorizations needed with evidence for work on same tooth According to the bulletin (available below), for similar restorations on the same tooth, the prior authorization requests must include "a narrative explaining the rationale for the rework and supporting radiographs and/or photographs." Report of prior … [Read More...]

TDMR Launches Medicaid Provider Survey 2019

July 5, 2019

It has been a few years since we polled all categories of Medicaid providers about their experience in Texas Medicaid. Previous survey results Back in 2016, the last time we published results, there was a significant difference in the answers of dentists and other health care providers regarding the biggest challenge in Medicaid at the … [Read More...]

Dentist Quits Texas Medicaid in Disgust Over MCNA and DentaQuest

June 14, 2019

DentaQuest headquarters in Boston, MA UPDATE: We published this story back on September 12 last year about a provider quitting MCNA in disgust over a $33,000 recoupment demand. This provider added a comment on this story last week which we want to highlight as he has now quit DentaQuest for similar reasons and dropped out of Texas Medicaid. It is a … [Read More...]

TDMR Founder Inducted into “Walk of Fame”

June 6, 2019

Dr. Juan D. Villarreal, founder of Texas Dentists for Medicaid Reform and CEO & founder of Harlingen Family Dentistry and six satellite offices, was inducted into the Rotary Club of Harlingen's Walk of Fame this past Friday, May 31. Walk of Fame honors civic contributions and life achievements The Walk of Fame is a celebration of the citizens … [Read More...]

Members Sought for the State Medicaid Managed Care Advisory Committee

June 4, 2019

Angry about Medicaid Managed Care? Here's your chance to make a difference. Texas HHS sent out an announcement this morning that it is again seeking members for their State Medicaid Managed Care Advisory Committee. Here is the full notice: Members Sought for the State Medicaid Managed Care … [Read More...]

2019 Survey Results: Medicaid Dentists “on the Verge of Quitting” Doubled Over Last Year

May 31, 2019

A day ago we closed off our Texas Medicaid Dental Maintenance Organization Annual Survey 2019 and have tallied the results to share. We are pleased that we were able to attract 101 individuals to take the survey which is more than double over last year. Again, we must repeat a warning that this survey is anonymous and informal. The … [Read More...]

Texas HHS-OIG Issues Fraud and Abuse Prevention Advisory about Dental Marketing

May 15, 2019

Yesterday, HHS-OIG issued an update on its activities. Among other things, it had a link to a fraud and abuse prevention advisory about dental marketing schemes in which hired marketers find and steer Medicaid eligible children into treatment via their parents by offering cash or gift cards. It is a sad thing that some dental practices cannot … [Read More...]

Texas HHS: No DMOs Chosen Yet for New Medicaid Contract

May 13, 2019

The RFP for Texas Medicaid dental services went out October 1, 2018, with the deadline for submissions November 30. More than five months have gone by and there is an anticipated contract start date of September 2. There has been no news about the contract or possible awardees. So TDMR contacted Texas HHS about 10 days ago to see if anything was … [Read More...]