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.

More States to Offer Ambetter Solutions, an Alternative to Group Insurance

Centene Dental continues to grow in the Ambetter Health marketplace. For 2026, we are adding Ambetter Solutions ICHRA* plans across the country, bringing the total to 13 states in which ICHRA plans are available: Arizona, Florida, Georgia, Indiana, Kansas, Missouri, Mississippi, Nebraska, Ohio, Oklahoma, South Carolina, Tennessee and Texas.

Currently just 56% of small businesses in the U.S. offer health insurance. ICHRAs are a new approach to employer-sponsored health benefits. With options that are affordable and require less hands-on administration, ICHRAs can help more employers provide health and dental insurance coverage. From 2023 to 2024, the number of companies offering an ICHRA grew by nearly 30%.

Rather than being assigned a group insurance plan, each employee chooses their own insurance on the health insurance marketplace, subsidized by a pre-tax employer contribution. Employees also can maintain their healthcare coverage even if they leave the company.

These flexible insurance options are especially appealing for employers that:

• Have a diverse workforce with different healthcare needs
• Employ workers in multiple states without a single-carrier solution
• Want to offer health benefits and more choice to attract talent

In addition to bringing new patients to your practice, Ambetter Solutions plans are easy to understand because they offer the same Ambetter dental benefits you already know. Simply confirm the member’s Ambetter Solutions ID card and eligibility by logging in to our provider portal. Please refer to our most recent Ambetter Health Plan Specific for more details.

Better coverage and perks have made Ambetter Health America’s number one marketplace health insurance. And now, ICHRAs mean we can offer coverage to even more people than ever before. Thank you for being a valued part of our dental network!

*Individual Coverage Health Reimbursement Arrangement

Wellcare Medicare Adds Dental Coverage and New Dual Plans in Three States

As we approach 2026, Wellcare Medicare Advantage is introducing some exciting updates. Centene Dental will now offer dental benefits in three additional states: Delaware, Illinois and Ohio.

We will continue to offer Medicare Advantage plans as usual, but we’re also introducing Dual Aligned plans.

• Wellcare Medicare Advantage plans provide dental coverage under the Wellcare Medicare brand in Delaware, Illinois and Ohio.
• NEW! Wellcare Dual Align plans combine Wellcare Medicare Advantage and state Medicaid dental benefits. To ensure payment for all covered dental services, providers serving these members must be contracted with Centene Dental for both Medicare Advantage and Medicaid. Dual Aligned plans will be available in Delaware, Illinois and Ohio.

For a summary of dental benefits, view our Medicare Benefit Summary Tool. For more detailed coverage and coding information, please use the Dental Code Search online tool. Note that dental codes listed as preventive do not count towards the plan’s benefit maximum.

Providers should always verify eligibility before rendering services. For individual member benefits and eligibility, access our Provider Web Portal (PWP). You may also call Customer Service to reach our automated member eligibility-verification system or a team member.

Wellcare Spendables®: The Wellcare Spendables Card is being offered again in 2026 with a change in administrator. Members will now receive a preloaded CareCredit card that can be used to cover eligible out-of-pocket dental expenses in offices that accept CareCredit. All transactions with the Wellcare Spendables card will need to be processed through CareCredit’s provider portal, called Provider Center. For more information visit carecredit.com/providers.

Check the PWP for 2026 Provider Manual and Plan Spec Updates

As a reminder, yearly updates are made to the Dental Provider Manual, so always check the PWP at centenedental.com/logon for the most updated version. Please refer to the manual, along with the custom Plan Specific for your particular state and product, before providing services to members.

Local Market Reminders

Below are important upcoming changes:

• Medicare-Medicaid Plan (MMP) Terminations: In 2026, MMP plans will be discontinued and replaced by Dual Aligned plans. MMP plans are being terminated in Illinois and Ohio.
• Pennsylvania CHIP: PA Health and Wellness is implementing CHIP. The go-live date is January 1, 2026.

CDT Dental Code Search Tool Now Easier to Use

For 2026, we’ve made several enhancements to the CDT Dental Code Search Tool:

• Faster code search performance
• A new graphic layout for easier product viewing
• Ability to use the Enter key to start a search

To access the tool please visit centenedental.com/cdt.

New CMS Prior Authorization Rule Limits Turnaround Time to Seven Days

Effective January 1, 2026, the Centers for Medicare & Medicaid Services (CMS) Prior Authorization Final Rule (CMS-0057-F) mandates maximum prior authorization turnaround times for Medicaid- and Medicare-covered services. Non-urgent authorizations must be processed in seven calendar days, while urgent prior authorizations must be processed in 72 hours.

States with shorter turnaround times for Medicaid will not see changes. We encourage providers to use the Dental Code Search Tool to make sure prior authorizations contain all required documentation so that authorizations can be processed quickly.

Re-Credentialing Happens Every 36 Months

To comply with NCQA standards, Centene Dental recredentials providers at least every 36 months from the date of the initial credentialing decision (exceptions apply for those states that follow a state credentialing process). This process identifies changes in the practitioner’s licensure, sanctions, certification, competence, or health status that may affect the ability to perform services the provider is under contract to provide. It also includes all providers, primary care providers, specialists, and ancillary providers/facilities currently credentialed to practice within the Centene Dental network.

In between credentialing cycles, Centene Dental conducts ongoing monitoring activities on all network providers. This includes an inquiry to the appropriate state licensing agency to identify newly disciplined providers and providers with a negative change in their current licensure status. This monthly inquiry helps ensure certain providers maintain a current, active, unrestricted license to practice in between credentialing cycles. Additionally, Centene Dental reviews monthly reports released by the Office of Inspector General and other sources, such as VerifPoint, to identify network providers who have been newly sanctioned or excluded from participation in federal and state programs.

A provider’s agreement may be terminated at any time if Centene Dental’s Credentialing Committee determines the provider no longer meets the credentialing requirements. Please call our Customer Service team with any questions.

Improve Scores and Smiles Through HEDIS Measures

Centene Dental Services is committed to improving the health of our community 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 in our members' health, we ask for your help to ensure our pediatric and adolescent members schedule the following services yearly:

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

In support of our commitment to disease prevention and the oral health of our members, here are a few ways our providers can help:

• Educate parents/caregivers on the importance of routine dental care and regular fluoride treatments for children
• Reach out to patients who have not had an oral evaluation and help schedule an appointment
• Schedule six-month appointment while patient is on site and make reminder calls to reduce no-show rates

Clinical Policies Posted Online

Centene Dental takes individual circumstances and the local delivery system into account when determining medical necessity of dental services. As a dental benefits administrator, we founded our objective clinical policy guidelines upon evidence-based dentistry to determine medical necessity when making utilization decisions. Our Utilization Management Committee, which is composed of our dental directors, follows a formal process to develop and evaluate all clinical policy guidelines and procedures for applying criteria. Current policies are available on our secure Provider Web Portal and the public website at centenedental.com/policies.

Dental Care by the Numbers

About Us

Envolve Dental, doing business as Centene Dental Services is a wholly owned Centene Corporation. Our innovative client solutions, education programs, personal attention, and provider support create a comprehensive dental care system that reduces administrative burden for providers and offers quality dental services for our clients’ members. Questions? Please contact our Customer Service team.