GOOD NEWS! Texas HHS Acts on Complaints & Pressures DentaQuest to Relent on Two Surface Filling Payments

TDMR is pleased to announce that we received confirmation today from Texas Health and Human Services that, as of yesterday, DentaQuest is no longer paying a one-surface fee for non-interproximal two-surface fillings and will be reprocessing previously denied claims.

Win for Medicaid dentists

Tiffany Young, the agency’s deputy chief public relations officer, sent the following.

“HHSC has been in discussions with DentaQuest. As of Sept. 23, 2024, DentaQuest has changed its system to reflect that two surface restorations not involving an interproximal surface downcoding policy has been discontinued. DentaQuest is in the process of identifying claims for reprocessing.”

Must be vocal to get change

Complaints by dentists to the agency have been successful in getting this harmful payment policy of DentaQuest discontinued and getting the company to pay providers back for previously disapproved two surface claims.

This proves the necessity for Medicaid providers in general, not just dentists, to be vocal about needed changes in the system and not just sit back and let the system roll over them.  It is your system, too.

Congratulations on being heard!

 

5 Responses

  • As of yesterday (10/3/2024) when we called about a 2 surface filling payment we were told to send in the x-rays and they would reconsider payment. Nothing has changed. Filling was an OB on tooth #30.

    • I’m not holding my breath either: I’m sure the logistics will make it almost impossible for anyone to recoup anything:
      1.”we need an x-ray”
      (6 months, 3 phone calls later…
      2.”we never received the x-ray, send it again” (X3)
      (6 months later…)
      3.”x-ray doesn’t show anything-denied. You can re-appeal”
      REPEAT 1-3
      4. “send an intra-oral picture”
      (meanwhile, Pt. has moved/cannot be contacted/no longer has the tooth/has been further restored)

  • aaaandd…DENTAQUEST FIRES BACK WITH A RESPONSE

    Dentaquest
    October 10, 2024
    Re: DentaQuest Texas Medicaid Network
    Dear Provider(s),
    Please be advised that effective on October 15, 2024, DentaQuest USA Insurance Company, Inc. (“DentaQuest*”) will be limiting
    the number of additional General and Pediatric Dentists in its Texas Medicaid network in the following counties:
    • Pols Serie Arce rea: Deatas, Eld, Hun, Kaufman, Navaro, Rockwall
Fort Worth Service Area: Denton, Hood, Johnson, Parker, Tarrant, Wise Harris Service Area: Austin, Fort Bend, Galveston, Harris, Matagorda, Waller, Wharton
    * Jefferson Service Area: Chambers, Hardin, Jasper, Jefferson, Liberty, Newton, Orange, Polk, San Jacinto, Tyler, Walker
    * Bexar Service Area: Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina, Wilson
    * Travis Service Area: Bastrop, Burnet, Caldwell, Fayette, Hays, Lee, Travis, Williamson
    * Hidalgo Service Area: Cameron, Duval, Hidalgo, Jim Hogg, Maverick, McMullen, Starr, Webb, Willacy, Zapata
    * Nueces Service Area: Aransas, Bee, Brooks, Calhoun, Goliad, Jim Wells, Karnes, Kenedy, Kleberg, Live Oak, Nueces, Refugio, San Patricio, Victona
    * El Paso Service Area: El Paso
    In the counties listed above, DentaQuest presently has an adequate network of General and Pediatric Dentists to meet the dental care needs of our Medicaid Members. Accordingly, DentaQuest will accept additional Medicaid network applications from General and Pediatric Dentists only on an as-needed basis, as determined by DentaQuest. In particular, in the above-listed counties:
    1. Additional General & Pediatric Dentists may be added to an already-participating provider’s Medicaid roster only if they are replacing a dentist who has left the practice within the past 30 calendar days.
    2. DentaQuest will not accept Medicaid network applications from new providers or provider groups unless there is an identified network need, as determined by Denta Quest.
DentaQuest will continue to accept and process routine business updates from already-participating providers; specifically, practice relocations, practice name changes, and changes in ownership/control/TIN. However, already-participating providers may not add new and additional locations in the counties above, unless there is an identified Medicaid network deficiency, as determined by DentaQuest.
    DentaQuest will continue to monitor access and network adequacy in these areas to ensure the needs of Texas Medicaid members continue to be met.
    Please note that these network limitations apply only to General and Pediatric Dentists. DentaQuest will continue to accept and process Medicaid network applications from other specialists in ordinary course. Further, these limitations apply only to DentaQuest’s Texas Medicaid provider network. At this time, we are not limiting new provider participation in our Texas CHIP, Medicare Advantage, or commercial networks, or our networks servicing Texas health plans.
    If you have any questions or need assistance, please contact your Provider Engagement Representative. We look forward to continuing to partner with you to serve the Texas menbers in your community.
    Sincerely,

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