Centene Dental Services is a leader in exceptional, tailored dental benefits and services for Medicaid, Medicare, and Marketplace member products. Each quarter we give you key information you can use to best serve your patients.

A BRIGHTER, HEALTHIER FUTURE. ONE SMILE AT A TIME.

TAKE ACTION: Electronic Payment System Changing

Centene Dental is changing platforms for electronic claims payments. You need to enroll in the new system to continue receiving electronic payments. Your information will NOT be transferred over automatically; you must take action to avoid payment delays. To receive no-cost electronic claim payments visit centene-dental.epayment.center and click “Sign Up Now!”

Reasons to sign up:

• Avoid receiving payment by check. Check fraud happens 2.5 times more than ACH payments.
• Electronic payments have no fees or costs attached.
• Get paid faster!

For more information visit centenedental.com/getpaid.

Local Market Reminders

• Pennsylvania CHIP: Beginning January 1, 2026, Centene Dental will be administering dental benefits for PA Health and Wellness CHIP members.

Claims Filing Made Simple: Online or by Mail

Providers have three easy options for submitting claims: online, electronically, or by mail.

• Online: Use the Provider Web Portal (PWP) at centenedental.com/logon to submit your claims directly into our claims system. This method is the fastest way for claims to be processed and paid.
• Electronic: Submit claims electronically through selected clearinghouses. Check with your preferred vendor to see if we participate. Our payor ID number for all clearinghouses is 46278.
• Mail: Send claims on a current ADA original claim form. Ensure all information is complete and legible for processing, including all required identifiers (quadrants, tooth numbers, and surfaces). Mail to the address listed within the appropriate Plan Specific.

Can Your Patients Find Your Practice?

Incorrect or missing details on the Find a Provider tool can make it harder for patients to locate your practice, schedule appointments, or confirm that you’re in-network.

Take a few minutes to look yourself up:

• Search for your name and practice location.
• Review your contact details, address, and office hours.
• Confirm that your specialties are correct.

If you notice any errors, update your information using the Provider Data Request Form.

Dental Pain and Pregnancy

Dental pain during pregnancy is a common issue. This discomfort may be linked to increased estrogen levels, which can raise the risk of Porphyromonas gingivalis, or to frequent vomiting, which can erode tooth enamel.

Managing dental pain during pregnancy is often easier than patients expect. Many dental procedures or treatments are considered safe for pregnant individuals. Encourage healthy habits such as rinsing the mouth after vomiting and seeking care to reduce its frequency. Also advise limiting sugary foods and addressing underlying conditions such as diabetes and acid reflux.

Source: Dental Pain During Pregnancy & How to treat it

Improve Scores and Smiles Through HEDIS® Measures

Centene Dental Services is committed to improving community health by helping members live healthier lives. Oral health is a vital part of a child’s tooth and gum development and overall well-being.

Because of your vital role, we ask for your help ensuring pediatric and adolescent members schedule these services yearly:

• Oral Evaluation, Dental Services (OED): Medicaid members under 21 who received a comprehensive or periodic oral evaluation.
  Applicable CDT Codes: D0120, D0145, D0150
• Topical Fluoride for Children (TFC): Medicaid members one to four years old who received at least two fluoride varnish applications.
  Applicable CDT Code: D1206

How providers can help:

• Educate parents and caregivers on routine care and fluoride treatments.
• Reach out to patients who have not had an oral evaluation.
• Schedule six-month appointments while patients are on site and make reminder calls to reduce no-shows.

False Claims Act

The civil False Claims Act protects the government from being overcharged or sold shoddy goods or services. It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent. Filing false claims may result in fines of up to three times the program’s loss plus $11,000 per claim filed.

Compliance with the False Claims Act:

Submitting a claim with “Statement of Actual Services” checked and service dates entered is your sworn statement that services were completed as reported. Ensure CDT codes match the actual service provided. Violations include misreporting implant-supported denture codes (D5863/D5865) when D6110/D6111 are correct.

For details and full policy access, log into the Provider Web Portal (PWP) and visit the Documents section.

Be Cautious of Prescribing Opioids in Dental Offices

Dentists may be the first to prescribe an opioid to adolescents after third molar extraction. Research shows medical use of prescription opioids is linked with non-medical use among teens. Consider using non-opioid analgesics first.

When prescribing opioids:

• Ask about current medications and any family substance abuse history.
• Explain risks and usage instructions.
• Never combine opioids with alcohol.
• Register with and use your state’s PDMP to deter misuse and abuse.

Centene Dental’s patient safety program tracks dentists providing over three opioid prescriptions per month or exceeding ADA’s seven-day supply guideline. Request a copy at dentalproviderrelations@centene.com.

Clinical Policies Posted Online

Centene Dental bases medical necessity determinations on evidence-based dentistry through its Utilization Management Committee. Updated policies are posted online at centenedental.com/policies.

• CP.DP.48 – Radiographic and other Imaging: New policy (Q3 2025 Update).

Dental Care by the Numbers

About Us

Envolve Dental, doing business as Centene Dental Services, is a wholly owned Centene Corporation company. Our innovative client solutions, education programs, and provider support create a comprehensive dental care system that reduces administrative burden for providers and offers quality dental services for members.

Questions? Please contact our Customer Service team.