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ADULT DENTAL SERVICES PROVIDER IN TENNESSEE

  • Writer: Fatumata Kaba
    Fatumata Kaba
  • 3d
  • 3 min read

PROMOTING ORAL HEALTH, FUNCTIONAL WELLNESS, AND QUALITY OF LIFE FOR TENNESSEE’S MEDICAID-ELIGIBLE ADULTS

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Adult Dental Services in Tennessee offer critical preventive, diagnostic, and restorative oral health care to low-income adults through TennCare Medicaid, including enrollees in Employment and Community First (ECF) CHOICES, 1915(c) Waivers, and Katie Beckett programs. As of 2023, TennCare now covers routine and emergency dental care for most adult enrollees, expanding access and improving whole-person health outcomes.

 

1. GOVERNING AGENCIES

Agency: TennCare (Tennessee Medicaid)

Role: Oversees the adult dental benefit under State Plan Medicaid and waiver programs.

Agency: DentaQuest (TennCare Dental Benefits Administrator)

Role: Manages the TennCare dental provider network, claims processing, credentialing, and member education.

Agency: Tennessee Board of Dentistry (under the Department of Health)

Role: Licenses dentists and dental hygienists, regulates scope of practice, and ensures compliance with professional standards.

Agency: Centers for Medicare & Medicaid Services (CMS)**

Role: Approves State Plan amendments and oversees federal Medicaid program compliance.

 

2. ADULT DENTAL SERVICES OVERVIEW

Covered dental services for adults include both preventive and restorative care, as well as emergency and medically necessary procedures.

Typical covered services:

  • Preventive Care: Exams, x-rays, cleanings, fluoride

  • Restorative Services: Fillings, crowns, partial and full dentures

  • Periodontal Services: Scaling and root planing, deep cleanings

  • Oral Surgery: Extractions, infection drainage

  • Emergency Dental Care: Pain management, infection control

  • Dental Services for Waiver Participants: Related to safety, nutrition, or communication (e.g., dental appliances)

All services must be medically necessary, prescribed or approved by a licensed dentist, and meet TennCare or waiver-specific clinical coverage guidelines.

 

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

  • Dental practice must be registered with the TN Secretary of State

  • Active license from the Tennessee Board of Dentistry (for dentists and hygienists)

  • Register with DentaQuest as a participating TennCare dental provider

  • Obtain an NPI (Type 2 for organizations) and EIN

  • Maintain liability/malpractice insurance

  • Develop an Adult Dental Services Policy & Procedure Manual

 

4. TENNESSEE PROVIDER ENROLLMENT PROCESS

Step 1: Form dental entity or verify existing licensure and EIN/NPI

Step 2: Apply to DentaQuest via the TennCare Dental Provider Portal

Step 3: Complete credentialing (licensure, malpractice, DEA number, etc.)

Step 4: Enroll with TennCare if delivering waiver-specific services

Step 5: Begin accepting TennCare-covered adults and receive referrals

 

5. REQUIRED DOCUMENTATION

  • Business registration, EIN, NPI

  • Tennessee dental license, DEA registration, malpractice insurance

  • Credentialing documents for DentaQuest

  • Adult Dental Services Policy & Procedure Manual including:

    • Intake and treatment planning process

    • Emergency dental protocols and pain management

    • Infection control and OSHA procedures

    • Consent, privacy, and HIPAA compliance

    • TennCare billing templates and pre-authorization guides

    • Participant education and dental care maintenance tools

 

6. STAFFING REQUIREMENTS

Role: Dentist (DDS or DMD)

Requirements: Tennessee license, DEA registration, malpractice insurance

Role: Dental Hygienist

Requirements: Tennessee hygiene license, radiology certification if applicable

Role: Dental Assistant

Requirements: X-ray certification if taking radiographs, trained in OSHA and infection control

All staff must complete:

  • HIPAA and TennCare compliance training

  • Infection prevention and cross-contamination protocols

  • Emergency response drills

  • Documentation and claims submission procedures

 

7. MEDICAID WAIVER PROGRAMS

Adult Dental Services may be covered under:

  • TennCare Medicaid (State Plan) – Preventive and restorative services for most adults as of 2023

  • ECF CHOICES – Dental services to improve nutrition, communication, or general health

  • 1915(c) Waivers – Based on ISP and individual needs (e.g., dentures to improve oral intake)

  • Katie Beckett Part B – May include dental supports tied to medically necessary interventions

  • EPSDT (under 21) – Offers full pediatric dental coverage

 

8. TIMELINE TO LAUNCH

Phase: Business Formation & Licensure

Timeline: 1–2 months

Phase: TennCare & DentaQuest Credentialing

Timeline: 2–3 months

Phase: Staff Training & System Setup

Timeline: 30–60 days

Phase: Accepting TennCare Adults & Billing

Timeline: Upon approval and patient scheduling

 

9. CONTACT INFORMATION

TennCare (Tennessee Medicaid Program)

Tennessee Board of Dentistry (Health Licensure)

DentaQuest (TennCare Dental Provider Portal)

Centers for Medicare & Medicaid Services (CMS)

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ADULT DENTAL SERVICES PROVIDER IN TENNESSEE

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TN ADULT DENTAL PROVIDER

WCG assists dental providers, mobile dental clinics, and multi-specialty clinics in enrolling with TennCare and designing dental care pathways for Medicaid and waiver-eligible adults.

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Scope of Work:

  • DentaQuest credentialing and TennCare enrollment

  • Adult Dental Services Policy Manual development

  • Consent forms, SOAP note templates, and progress tracking logs

  • Dental billing support and authorization toolkits

  • Staff orientation on waiver service coordination and claims

  • Participant communication and preventive care education materials



Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements. 

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