Over the last year the Texas Health and Human Services Commission (HHSC) Office of Inspector General (OIG) has increased its focus on dental practitioners in Texas serving Medicaid and CHIP patients. The initial focus by the Texas HHSC OIG was related to improper solicitation of Medicaid clients by dentists; however, their focus seems to now include any Medicaid fraud, waste, and abuse. As a result of the increased scrutiny on dentists, the Texas HHSC began holding Quarterly Medicaid Dental Provider Stakeholder Meetings. These meetings are open to all Medicaid dental providers, and allow Medicaid dental providers to provide feedback directly to staff from the Texas HHSC. On April 24, the Texas HHSC held a Quarterly Medicaid Dental Provider Stakeholder Meeting.
The Texas HHSC announced in September 2012 that the agency and Delta Dental agreed to end Delta Dental’s contract to provide children’s Medicaid and Children’s Health Insurance Program (CHIP) dental services on November 30, 2012. Beginning December 1, 2012, members began receiving services through DentaQuest or MCNA Dental. Representatives from MCNA Dental and DentaQuest presented information during the stakeholder meeting. Both entities shared information regarding the creation of provider portals for appeals. Appeals can be submitted electronically through these provider portals. This change came as a result of concerns raised in previous stakeholder meetings regarding the time and complexity needed to file a claim or appeal. MCNA Dental will begin Lunch-and-Learns and a Dental Details Monthly Newsletter to assist dental providers in keeping up with changes in Medicaid. In addition, MCNA Dental and DentaQuest are providing dentists and dental clinics with new provider manuals.