VOL 68 | JAN 2023 | QTR 1
TEXAS ROUNDUP
Program Updates for Texas Dentists
IN THIS ISSUE
Electronic Explanation of Benefits
Appeal:
Effective 3/1/2023 full EOBs will no longer be mailed. In lieu of the full EOB, a summary page will be attached to the check. The full EOB can be accessed electronically from DentaQuest’s Provider Portal. If you have not done so, please use the listed website address to create an account on the Provider Web Portal. Not only are you able to view and print your EOBs from the Provider Web Portal, you’re also able to verify member’s eligibility, submit claims and authorizations, verify benefits and much more, all in real-time 24 hours a day, seven days a week.
DentaQuest also offers Electronic Funds Transfer (EFT). Payments can be deposited directly into your bank account. With the combination of both EFT and electronic EOBs, you’ll no longer have to wait for the mail to arrive. If you’re interested in signing up for EFT, have questions regarding electronic EOB’s or need training on the portal, please contact your local Provider Partner via email or phone.
Sealant (D1351) Benefit Update
Effective 3/1/2023 review will no longer be required for D1351 posterior teeth #2-5, 12-15, 18-21, 28-31 for members that are 15 and 16 years of age. Please refer to the Office Reference Manual (ORM) for all benefit details. The ORM can be accessed on the TX Provider resources page.
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 local Provider Partner.
Newly Added Feature to the Provider Web Portal
DentaQuest is excited to announce an added feature to the interactive provider portal. Each registered user will have the capability to resubmit a finalized claim or authorization on the portal. This newly added feature will help simplify the initiations of resubmissions.
The Claim Detail and Pre Auth-Detail screens on the portal now displays the following:
Claims Resubmission:
Authorization Resubmission:
Access and Availability Standards
DentaQuest Dentists are expected to meet minimum standards with regards to appointment availability. Dental appointments are to be made during normal business hours and within a reasonable time from the date of the Member’s request. Appointment Standards are:
- Preventive – 14 calendar days.
- Therapeutic/diagnostic‐ 14 calendar days.
- Urgent‐ 24 hours.
Texas Provider Marketing & Solicitation 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. Dentaquest has observed a recent surge in advertisements like Exhibit A that is being distributed in the Dallas Metro area.
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
EXHIBIT A
Important Reminders
Provider Resource Documents
The following documents are listed on the Provider Resources page:
Office Reference Manuals (ORM)
Visit the Provider Relations Contacts page to locate your regional partner.
