A Medicaid dental provider with multiple offices in the state contacted TDMR this past week, voicing serious concerns about recent restrictions imposed on their practice by Canadian-owned DMO DentaQuest regarding the use of substitute dentists.
Violation of Texas Administrative Code
According to the provider, DentaQuest denies substitute dentist requests unless the absence qualifies as a “leave of absence” per the company. This is despite the Texas Administrative Code (rules §354.1121 and §354.1221) explicitly permitting substitute dentists for absences of up to 90 days without specifying acceptable or unacceptable reasons.
DentaQuest representatives explicitly told the provider that substitute dentists should not be utilized for temporary coverage of short-term absences like emergencies, vacations or personal days. This hampers the practice’s ability to manage daily staffing shortages due to vacations, personal days, or unexpected call-ins.
DentaQuest already takes two weeks to review and approve such applications per the provider.
Treatment disruptions
The provider described significant operational disruptions, noting that one of their clinics had to close its doors to DentaQuest patients for an entire week due to a dentist’s scheduled vacation. DentaQuest refused to approve substitute coverage.
Furthermore, the two-week approval timeline for substitute dentists exacerbates emergency staffing situations, forcing offices to close temporarily if coverage cannot be promptly arranged.
Credentialing still broken
As TDMR has noted in numerous articles, credentialing is still a major issue. The provider told us that DentaQuest takes up to four months to credential new dentists and another month for providers to appear on DentaQuest’s online portal.
These delays prevent practices from performing pre-authorizations or submitting claims, further complicating operations, all to the detriment of Texas children.
Moreover, the provider noted that DentaQuest has closed credentialing in many locations across Texas, severely limiting staffing flexibility.
Foreign-owned company profiting at the expense of Texans
Again, should a foreign-owned company be in the position to make it difficult for Texas children to get their needed and approved healthcare coverage?
The answer is no.