The Facts

Some false claims have been made recently about DentaQuest and the TennCare dental program and we want you to know the facts. Here are some of those claims and our response:

Claim: “Kids with TennCare benefits can’t get dental care.”
Response: No child with TennCare benefits has lost access to dental care. In fact, more TennCare members are receiving dental care as utilization of services, including the number of dental screenings, has increased year-over-year. TennCare members have access to care when they need it. The average scheduling time to obtain a routine appointment is only 11 days as compared to the contract’s requirement of 21 days. For urgent care appointments, the average scheduling time is 23 hours, whereas the contract requirement is 48 hours.
Claim: “People are having trouble finding a dentist, especially those who have seen a provider that is not in new provider network.”
Response: DentaQuest has made proactive efforts to communicate with every child with TennCare benefits who had received dental care in the past 18 months and had visited a dentist not invited into the newly constructed network. These patients were notified in December 2013 and provided with alternative choices of dentists who accept TennCare patients in their area. DentaQuest’s phone number and web site were also included and recipients were encouraged to contact us if they needed assistance with identifying another dentist, if they needed help with receiving care or if they had questions. DentaQuest’s call center also conducted proactive outbound calls to TennCare recipients who had visited a dentist no longer in the network. The purpose of these calls was to notify them of where they could go for care and a phone number to call for assistance in meeting their dental health needs. We invite members and their guardians to contact us if they need assistance with identifying another dentist or help with receiving care or if they have questions. Call us toll-free at 1-855-418-1622 or use this site to find a dentistlocate member information or submit a question.
Claim:  “DentaQuest purged dentists from its network, including 200 black dentists.”
Response:  TennCare charged DentaQuest with establishing a completely new provider network, which was built from the ground up. Our network is designed to meet the state’s requirements for access, while also ensuring maximum quality and efficiency in how members receive, and providers deliver, dental care. DentaQuest invited providers into the new network who completed re-validation with TennCare, satisfied peer-reviewed criteria, including care quality and efficiency performance criteria, and met geographic access requirements to ensure care is provided close to home. Our criteria align with Dental Quality Alliance recommended dental performance measures initiated by the American Dental Association at the request of CMS to create benchmarks for dentistry. 

Racial and ethnic information is not available to us, so it has never been reviewed nor was it a part of the process of inviting and contracting with dentists into the new network. We are deeply committed to health equity and are involved in several ways in the national movement to end racial and ethnic health disparities. For example, some of our efforts to achieve oral health equity, especially racial justice, include, representation on the US Department of Health & Human Services Health Equity Council as part of the National Partnership to Eliminate Racial and Ethnic Health Disparities, participation in the launch of the National Office of Minority Health new e-curriculum on CLAS standards for oral health providers and our involvement in National Dental Association and Hispanic Dental Association conferences and programs over the past eight years.
Claim: “DentaQuest is incentivized to cut access to care in order to receive a bonus from the state of up to $8 million.”
Response:  For the first time with dental benefits, the State of Tennessee has shifted the TennCare program from an administrative services-only contract to a partial risk-sharing contract. TennCare’s contract is designed so any cost savings come from more efficient, more streamlined management of the program – not from a reduction in the number of enrollees receiving services. The partial risk-sharing contract brings about greater accountability to the dental benefits manager. Managing dental care for TennCare beneficiaries now goes beyond processing claims by ensuring children have access to needed preventive and treatment services, while striving for high quality and efficiency in dental care.
It is important to note that in partial risk-sharing contracts, there is both positive and negative risk in sharing in potential savings or in financial loss. There is no guaranteed payment. Shared savings are only possible if the participation ratio set by the state is exceeded and are contingent upon DentaQuest meeting all TennCare specified benchmarks related to member access, utilization and outreach and program quality and budget. The level of shared savings would then depend on the amount of savings and the degree to which the participant ratio is exceeded. At the same time if unsuccessful, DentaQuest must share in any program cost overruns.
Claim:  “Patients are being asked to drive great distances to receive basic care and sometimes 400 miles to see a specialist. “
Response:  TennCare members have adequate access to dental providers close to home. TennCare certified our network in December 2013 as meeting or exceeding its network requirements, including geographic access.