UPDATE: We now have a copy of the letter from Delta Dental to Texas dentists regarding joining their “Texas Medicaid network.” (see below)
TDMR received an interesting email after our recent story on dental managed care and the possibility of a new request for proposals for dental maintenance organizations (DMOs) for Texas Medicaid coming up in the near future.
Delta Dental announces “Texas Medicaid dentist network”
The email came from a Medicaid dentist who informed us that she had already received an invitation letter in September from Delta Dental to join their new “Texas Medicaid dentist network.”
One of original three approved by the state
Delta Dental, of course, is one of the original three DMOs that started with dental Medicaid managed care in March of 2012. However, they exited the program and stopped providing services on December 1 the same year. It still says so on their website.
Looking for dentists to apply right now
However, per our friendly dentist, the letter referred her to a web page (deltadentalins.com/group_sites/gov/providers.html) so she could start the credentialing process by downloading their “Application Package.” There is no mention on the page about Texas or the start of a Texas Medicaid dentists network.
But she also mentioned that a schedule of fees that are higher than the current Texas Medicaid fees was included with the letter – a good reason to apply.
Imminent RFP being taken seriously
So it does appear that the rumor of a new Texas RFP is being taken very seriously by DMOs such as Delta Dental.
Why we dentist are now the HMO bull eye of these $$$ target?
My understanding . Three HMO options are to be given and It is writing somewhere in the providers agreement. Meaning a breach of contract have happened and still since delta dental was out,
DentaQuest and MCNA have been severely arbitrary. DQ is breaching the contacts as well. penalizing providers for documentation no needed for payment and claiming no medical necessary recoups when payments had been already issue under the protocols set in the agreement.. The providers agreement rules and the definition of medically necessary has been disregard and penalize when providers performing procedures consider medically necessary and with out the need of documentation.
MCNA do not stay behind the fence when ,the field providers relation representatives disregard the agreement terms true facts , when in the field the rep. are crossing the line into the providers practices with all sort wrong practices out of the agreement and incorrect statements that defame providers when manipulating the providers staff against practitioners. All when providers intervene trying to set the limits between their practices and the HMO.
The HMO\’s threaten common practices of their audits protocols; the out number of file charts, without affidavit and mail delivery makes the documentation information no accountable, no verifiable , no reliable and no true. The use of subjective diagnostics as objective when they need to invalidate a medical necessity procedure where the only verifiable means is a visual clinical provider diagnostic evaluation and documented charting.
Why we did not have all this persecution from HHDC and the HMO when the compensations were half of what is today and there were no third parties ?? Are they are trying to make us pay for their mistakes and legal accountable for the moneys no paid years past to fit their budget??