There is no one-size-fits-all approach to Medicaid dental benefits, but the data demonstrates states can successfully increase access to care, lower costs, and improve health with managed care.
For Louisiana, this means your taxpayer-funded Medicaid program focuses on managing the quality, use and cost of dental care so your neighbors in need can get essential oral health care.
Since 2019, Louisiana has had two organizations managing Medicaid dental benefits and working to achieve these outcomes, but one organization has recently taken some heat from dental providers who treat Medicaid patients. I urge my fellow dentists to consider these as growing pains and stick with the program.
Here’s why. The state contracts with dental managed care organizations, such as DentaQuest, that specialize in the management and delivery of Medicaid dental services under set rates based on funding for the program.
Program rules require these DMOs to use taxpayer dollars wisely, covering only dental services that meet specific medical/dental necessity guidelines and have the proper documentation to support the care.
Often, they require Medicaid dental providers to submit treatment records and patient notes, request prior authorizations to perform certain services, or subject claims to clinical review.
I know from my days in private practice that this can be a burden, not to mention how painful it can be to change administrative operations, all to receive some of the lowest reimbursements in the country.
Therein lies the rub for dental providers who have been seeing higher claims denial rates than expected from DentaQuest. The goal is never to make life difficult for the dentists or patients, but rather to ensure a quality experience and outcome for both, while simultaneously honoring the state and federal Medicaid guidelines that govern the contract.
If these dental guidelines are not followed, a state or federal audit will cite the DMO for what’s known as “overpayment” – essentially mishandling taxpayer dollars.
This has happened to previous Medicaid DMOs that paid claims with missing medical/dental necessity documentation. A 2017 legislative audit showed the Louisiana Medicaid dental program overpaid $6.4 million for claims that violated program rules from 2012-2016.
This included “rules that require specific information to be part of the clinical or treatment record.” As part of any logical corrective action plan from this type of finding, a state would likely strengthen its claims review processes to prevent paying out claims that did not meet these requirements.
While the current process has been bumpy, as evident from recent legislative hearings, fixes are in place working with providers to minimize claims submitted without the required information. DentaQuest is doing the right thing by working with providers and the state to ensure a smoother path forward.
And Louisiana is doing the right thing by contracting with DMOs to manage precious dollars while providing access to dental care that improves overall health.
Dr. Todd Gray is a pediatric dentist and experienced leader helping administer Medicaid dental programs in states across the country, with roles including Chief Dental Officer at Liberty Dental and consulting with DentaQuest. He is also a recognized expert in dental care medical necessity.
