DentaQuest Limits General and Pediatric Dentists in Texas Medicaid Network

DentaQuest USA Insurance Company, Inc. will limit new General and Pediatric Dentists to the Texas Medicaid network effective 15 October 2024. The constriction will be in many counties, including Dallas, Fort Worth, Harris, Jefferson Counties, and other counties in Texas. This is intended to create sufficient network adequacy while managing provider capacity for Medicaid members in these regions.

The counties included are:

  • Dallas Service Area: Collin, Dallas, Ellis, Hunt, Kaufman, Navarro, Rockwall
  • Fort Worth Service Area: Denton, Hood, Johnson, Parker, Tarrant, Wise
  • Harris Service Area: Austin, Fort Bend, Galveston, Harris, Matagorda, Waller, Wharton
  • Jefferson Service Area: Chambers, Hardin, Jasper, Jefferson, Liberty, Newton, Orange, Polk, San Jacinto, Tyler, Walker
  • Bexar Service Area: Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina, Wilson
  • Travis Service Area: Bastrop, Burnet, Caldwell, Fayette, Hays, Lee, Travis, Williamson
  • Hidalgo Service Area: Cameron, Duval, Hidalgo, Jim Hogg, Maverick, McMullen, Starr, Webb, Willacy, Zapata
  • Nueces Service Area: Aransas, Bee, Brooks, Calhoun, Goliad, Jim Wells, Karnes, Kenedy, Kleberg, Live Oak, Nueces, Refugio, San Patricio, Victoria
  • El Paso Service Area: El Paso

Under the new policies, more General and Pediatric Dentists will be added to the network to fill in the gaps for providers who left practice within 30 days. All applications by new providers or provider groups will be accepted only with a defined need in the network. DentaQuest will continue processing regular business updates for current providers: provider relocations or practice changes, but there will be no expansion that is not justified.

These exclusions only apply to Medicaid General and Pediatric Dentists in Texas, leaving all other provider applications unscathed – specialists, Medicare, CHIP, and other commercial plans are not affected by these changes.

DentaQuest will cap new providers, including General and Pediatric Dentists so that coverage will be available for Medicaid members, and it always maintains parity in the network regarding the number of providers involved.

Through optimal utilization of networking, it will continue servicing its existing Medicaid members and providers.

The providers based in the affected areas should consider their current practices and level of staffing, given the new provisions. Other than those referred to above would not be accepted except for demonstrable needs.

Providers who need more information about these changes can approach DentaQuest to seek out the specifics of such changes and how they can influence their practices.

 


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