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.

Local Market Reminders

Below are important upcoming changes:

• Indiana Medicaid: Effective Oct. 1, 2026, Managed Health Services (MHS) will no longer offer value-added vision benefits beyond the standard Medicaid vision benefit.
• Pennsylvania Medicare: Wellcare Medicare and Applicable Integrated Plans (AIP) available beginning Jan. 1, 2027.

Oral Health and Cognitive Health: Understanding the Connection

Emerging research suggests that older adults with both diabetes and complete tooth loss (edentulism) may be at greater risk for cognitive decline than those with either condition alone. Researchers found that adults ages 65 to 74 with both diabetes and edentulism experienced worse cognitive function and a faster rate of cognitive decline compared to individuals without these conditions.

These findings highlight the important connection between oral health and overall health. Maintaining good oral health, preserving natural teeth when possible and effectively managing chronic conditions such as diabetes may contribute to better long-term health outcomes.

When caring for older adults, encourage patients with diabetes to maintain regular dental visits and follow recommended treatment plans. Explain that oral health is closely linked to overall health and that preventive care may help support their well-being as they age. For edentulous patients, emphasize the importance of ongoing dental evaluations, proper denture care and diabetes management as part of a comprehensive approach to health.

Source: NIH - Diabetes, Edentulism, and Cognitive Decline: A 12-Year Prospective Analysis

False Claims Act

The civil False Claims Act protects the government from being overcharged or sold substandard 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.

Need to Submit a Claim? We've Got Options

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.

Choose the method that works best for your practice and ensure timely, accurate submissions.

Provider Web Portal Tip: Save Time with My Patient Management

If your office sees a high volume of Centene Dental members, My Patient Management can help streamline the eligibility verification process.

When a member schedules an appointment, simply add them to My Patient Management. Once patients have been added, you can verify eligibility for multiple appointments in just a few clicks.

How to Use My Patient Management:

• Add scheduled Centene Dental members to your calendar.
• Select the date you want to verify.
• Review the member roster displayed for that day.
• Click the Verify Eligibility button to instantly check eligibility for all listed patients.

Using My Patient Management can help reduce administrative effort, improve office efficiency and ensure eligibility information is available before the patient arrives for their appointment.

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

Health Literacy: Supporting Better Patient Understanding

Health literacy refers to a patient's ability to find, understand and use health information to make informed decisions about their care. In a dental setting, clear communication can help patients better understand their dental benefits, treatment recommendations and the importance of preventive care and regular dental visits.

Consider using plain language, avoiding dental jargon and providing instructions in a clear, easy-to-understand format. Asking patients to repeat key information in their own words can also help confirm understanding and identify opportunities for additional education.

By promoting health literacy, providers can help improve patient engagement, encourage adherence to treatment plans and support better oral health outcomes. Taking a few extra moments to ensure patients understand their care can make a meaningful difference in their overall healthcare experience and long-term dental health.

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.49 – Surgical Treatment of the Temporomandibular Joint: New policy (Q3 2026 Update).

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.