DMO Credentialing Practices Continue to Burn Dental Providers

Back in early 2023, TDMR reported on the credentialing mess involving TMHP, UnitedHealthcare Dental, MCNA, and DentaQuest. We wrote the following articles, including filing a complaint with OIG on the continuing debacle.

• Credentialing Still a Disaster for Texas Medicaid Dentists
• Why Doesn’t Texas HHS Know Anything About Credentialing Dentists for Medicaid?
• D’oh! Another Approval Delaying TMHP DMO Credentialing Snafu!
• Complaint Filed by TDMR with the Office of the Inspector General on Dental Credentialing

We wrote an article earlier this year about DentaQuest denying substitute dentist requests.

• DentaQuest Denying Substitute Dentist Requests to Cover Vacations, Sick Days or Emergency Situations

Latest credentialing buffoonery

Screwing around providers on credentialing is apparently not a Medicaid bug. It is a DMO business practice and feature, more than likely to try to reduce their networks.

Witness the letter shown below, which was kindly provided to us by Austin administrative attorney Jason Ray earlier this week. Ray, a well-known and long-standing advocate for Medicaid dentists, details the current state of DMO chicanery in his letter sent to Dr. Ensy Atarod about the non-compliance with expedited credentialing requirements under the Texas Administrative Code – § 353.423.

“Delays in Confirming Application Completeness by DentaQuest”

Is it any surprise that foreign-owned DentaQuest would lead this hit parade?

“One of the most troubling patterns involves DentaQuest’s handling of credentialing applications for previously approved dentists who seek credentialing approval at new, affiliated practice locations. Under § 353.423(e), DMCOs are required to provisionally approve a provider’s application once the applicant has submitted “the information required by the MCO.” However, DentaQuest routinely delays confirming whether an application is complete—often waiting 30 days or longer before acknowledging receipt of all necessary documentation.

“This delay is inexcusable. In today’s digital environment, there is no legitimate reason why DentaQuest cannot confirm the completeness of an application within one to two business days. The prolonged silence appears to be a manufactured excuse to avoid triggering the provisional approval timeline mandated by the rule…This tactic not only violates the spirit of the rule but also deprives Medicaid patients of timely access to care from qualified providers.”

“Refusal to Retroactively Apply Effective Dates by MCNA and UnitedHealthcare”

“Separately, both MCNA Dental and UnitedHealthcare Dental are engaging in a practice that fully ignores the expedited credentialing process: they refuse to accept the original application date as the retroactive effective date of approval once final credentialing is completed…By denying retroactive effective dates, these DMCOs are essentially nullifying the provisional approval mechanism. Qualified dentists—who have already been vetted and approved at other locations— are prevented from immediately treating patients at new sites, even though they meet all criteria for provisional approval.”

Of course, these DMOs would do the same thing, as UnitedHealthcare owns MCNA.

Urges investigation by HHSC

Ray urges Dr. Atarod to have HHSC investigate these practices and “to issue clear guidance to all DMCOs requiring:

• Timely confirmation (within 48 hours) that an application is complete and ready for review,

• Immediate provisional approval upon receipt of all required documentation.

• Retroactive effective dates that reflect the original application submission date.”

DMOs may get their wish?

How long will providers continue to tolerate such dishonest business practices by state contractors and remain within the Texas Medicaid dental network?  Yes, networks may shrink.

And how many Texas children will suffer as a result?