1. Program Definition and Services

Adult Dental Services in Tennessee delivers preventative, diagnostic, and comprehensive restorative oral healthcare to low-income and disabled adult enrollees. The program operates to enhance nutritional intake, alleviate systemic infection, support communication goals, and maintain overall functional wellness, effectively minimizing emergency department over-utilization. Services include:

• Preventative & Diagnostic Care: Comprehensive oral examinations, digital radiographs (bitewings and panoramic series), prophylaxis cleanings (up to twice per calendar year), topical fluoride applications, and caries-arresting silver diamine fluoride (SDF) treatments.
• Restorative & Surgical Treatment: Composite or amalgam restorations (fillings), endodontics (root canals), crowns, complete or partial dentures, periodontal scaling/root planning, simple or surgical tooth extractions, and post-extraction alveoloplasty bone smoothing.

2. Regulations

The program is governed by the following regulations:

• Rules of the Tennessee Board of Dentistry, Chapter 0460-01 through Chapter 0460-05 (General Rules Governing Dental Practices, Hygienists, and Assistants)
• TennCare Rules and Regulations, Chapter 1200-13-13-.01 (Medicaid Managed Care Benefit Framework Definitions)
• TennCare Rules and Regulations, Chapter 1200-13-01-.31 (Employment and Community First CHOICES Waiver Operations)
• Title 63, Chapter 5 of the Tennessee Code Annotated (Statutes Regulating Dentists, Dental Hygienists, and Registered Dental Assistants)

3. Licensing or Certification

Corporate practices must be registered with the State, and all performing clinicians must hold an active, unencumbered professional license (DDS or DMD) issued by the Tennessee Board of Dentistry. Furthermore, the practice entity must maintain active credentialed status as an approved network provider under the state's contracted Dental Benefits Manager (DBM).

4. Responsible State Agency

The Tennessee Board of Dentistry (under the Tennessee Department of Health) oversees professional provider licensure and scope of practice compliance. The Bureau of TennCare, in conjunction with its designated Dental Benefits Manager (DBM), controls the credentialing, network expansion, clinical policy definitions, and medical necessity reviews for the adult dental benefit.

5. Application Process

The application process is initiated electronically by entering clinician profile metrics into the web-based Provider Application & Credentialing Toolkit (PACT). Once the preliminary credentialing audit is successfully processed by the Dental Benefits Manager, the practice must complete formal electronic synchronization using the web-based TennCare Provider Registration Portal to establish a Medicaid Provider ID.

6. Required Documentation

While specific documentation requirements vary based on the target waiver, providers typically need to submit:

• Valid Tennessee Board of Dentistry individual licenses, current federal DEA registrations, and active CPR/BLS certifications
• Adult Dental Services Policy & Procedure Manual (including OSHA infection control, radiation safety protocols, and emergency medical response algorithms)
• Verified Council for Affordable Quality Healthcare (CAQH) digital profiles for all on-site dental practitioners
• Proof of high-limit professional dental malpractice insurance, general liability policies, and state-mandated workers' compensation insurance

7. Timeline for Approval

The exact timeline for approval fluctuates based on the thoroughness of the submitted PACT files and primary source verification schedules. Providers should contact the Dental Benefits Manager's network onboarding unit for active queue updates; complete processing and commercial credentialing typically spans 2 to 3 months.

8. Pre-Application Process

Prospective providers must complete specific foundation tasks before applying. They must legally form their dental practice corporation, professional association, or mobile clinic entity with the Tennessee Secretary of State, secure an Employer Identification Number (EIN), and establish a corporate Type 2 National Provider Identifier (NPI) to represent the billing clinic location.

9. Pre-Application Training

The state hosts mandatory administrative and compliance training sessions online. Access instructions to complete the mandatory web-based Cultural Competency modules, Fraud, Waste, and Abuse (FWA) training, and specific Employment and Community First (ECF) CHOICES instructional tracks are issued during the secondary phase of network registration.

10. Additional Notes

• Major clinical interventions, including custom crowns, full/partial dentures, deep sedation protocols, and complex periodontal surgeries, require prior authorization (PA) via submission of supporting x-rays and treatment rationales to the DBM portal prior to starting treatment
• Purely cosmetic dentistry procedures, adult orthodontic treatments, and dental implant systems are strictly excluded from standard adult TennCare benefit reimbursement
• Every registered dental hygienist and assistant must maintain up-to-date state radiology certifications and current Board-approved continuing education units (CEUs)
• Providers must maintain highly detailed, chronological treatment records (including comprehensive SOAP notes, localized anesthesia records, and ADA code billing templates) to meet state post-payment clinical audits

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