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.

Double Billing: Avoid Duplicate Claims

As a reminder, submitting a claim for payment to both a health plan and Centene Dental — also known as double billing — for the same dental service is not permitted and may be considered fraudulent. Centene Dental monitors billing practices, and if duplicate claims are identified, the health plan and/or Centene Dental Services may take corrective action, including termination of the provider’s Participating Provider Agreement.

Share Your Feedback: Provider Survey Now Open

The annual Provider Satisfaction Survey has been emailed to all provider offices. Your feedback helps us better understand how we are doing and where we can improve.

We encourage you to share input on credentialing, customer service, utilization management, claims, care coordination, quality of care and overall experience.

Surveys were sent to the email address on file for your office. Please check your spam or junk folders, as the email will come from an external source (Qualtrics). We look forward to hearing from you!

Local Market News

Below is an important reminder for Ohio:

Effective Jan. 1, 2026, the Ohio Department of Medicaid (ODM) introduced a new orthodontic evaluation form, ODM Form 03630. This form replaces the previous version and must be submitted with every orthodontic prior authorization request. It can be found on our website at centenedental.com/forms.

Submit the following documentation with ODM Form 03630:

• Eight required diagnostic-quality photos
• Diagnostic panoramic radiograph
• Diagnostic-quality lateral cephalometric radiograph
• Supporting documentation from other providers, as requested

Photos used to validate measurements—such as overjet, reverse overjet, deep impinging overbite, labio-lingual spread, and excessive spacing—must include a calibrated measuring device, such as a plastic millimeter (mm) ruler or Boley gauge, to confirm measurements accurately. When using a plastic ruler, ensure it is not bent, as this may distort measurements.

ODM, the Ohio Dental Association (ODA), and participating health plans collaborated to develop a scoring guide. This guide provides detailed instructions on how to understand, measure, and score ODM Form 03630. It also includes photographic examples to support accurate form completion.

A Centene Dental orthodontist (plan reviewer) will score each case upon submission. The scored form will be added to the Documents section of the Provider Web Portal. This review supports the plan reviewer’s determination and serves as the basis for any peer-to-peer discussion.

Supporting Patients with Chronic Kidney Disease

Emerging research highlights the vital role dental providers can play in supporting patients with chronic kidney disease (CKD). Integrating dental care into broader healthcare teams has been shown to improve patient outcomes, quality of life, and overall care coordination.

Patients with CKD are at increased risk for oral health issues, including periodontal disease and inflammation, which may contribute to worsening systemic health. Understanding a patient’s overall health can help inform dental care, support preventive measures, and guide treatment plans tailored to each patient’s needs.

By taking an active role in care coordination, dental providers can help support whole-person health and improve outcomes for patients managing chronic kidney disease.

Source: NIH - Periodontal disease and chronic kidney disease: mechanistic insights and novel therapeutic perspectives

U.S. Dental Opioid Prescribing Still Higher Than Peers

A recent study found that U.S. dentists continue to prescribe opioids at significantly higher rates than their peers in other developed countries. While prescribing rates have declined in recent years, the U.S. still leads by a wide margin.

From 2021 to 2024, opioid prescriptions tied to dental care decreased by 27% in the U.S., reflecting progress toward improved prescribing practices. However, by the end of 2024, the U.S. still had the highest rate among the countries studied.

This ongoing gap suggests that prescribing practices in the U.S. have not fully aligned with current evidence. Clinical guidance increasingly recommends non-opioid alternatives for managing dental pain due to the risks associated with opioid use, including dependence, overdose and long-term use.

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.

Source: Study: U.S. dentists prescribe opioids 24 times higher than peer nations

Stay Compliant: Avoid Common FWA Issues

Centene Dental Services conducts regular audits and uses systems to analyze claims to identify possible Fraud, Waste and Abuse (FWA). If any FWA is detected, the Centene Dental Special Investigation Unit will conduct a review that may result in actions against those who are found to have committed FWA. Actions may include:

• Provider education
• More rigorous Utilization Review requirements
• Recovery of monies previously paid
• Extrapolated overpayment calculation
• Reporting to appropriate payor and/or regulatory agencies (OIG)
• Termination from the Centene Dental Network

The most common submissions of FWA:

• Unbundling of codes
• Upcoding
• Misrepresentation of services
• Claims for services not rendered

If you suspect another provider is inappropriately billing Centene Dental Services or if a member is receiving unnecessary services, please contact Centene Dental Services Fraud, Waste and Abuse hotline as indicated below. We take all reports of potential FWA seriously and investigate all reported issues.

Member Transportation Services

Non-emergency transportation is a covered benefit for eligible members when traveling to medically necessary services. Members seeking transportation assistance should review their health plan’s member handbook to determine whether coverage is available and contact the listed transportation provider in advance to schedule a ride.

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 an integral 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 public website at centenedental.com/policies.

No Referrals Needed

When scheduling dental exams for patients, referrals from primary care physicians (PCPs) are not required when seeing a participating dentist.

Questions? Please contact Customer Service.

Appointment Wait Times

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.