Medicaid and SCHIP

Partnering with States

Doral is the sole third-party administrator for dental carve-outs for Medicaid and SCHIP dental programs in three states: Tennessee, Illinois, and Virginia. We are proud of the following service results in these states:

Tennessee Results
October 1, 2002 - Present

• Network: Doral increased network participation by nearly 95%, from 386 to more than 750 dentists. The provider network expanded in the rural areas from 252 to 491, a 94% increase. The 2005 Health Services Advisory Group (HSAG), commissioned by the State of Tennessee, scored Doral's services at 100% (four stars) in virtually all Network Adequacy and Benefit Delivery measures.
• Quality: HSAG's 2005 Annual Quality Survey Report scored Doral's overall rating at 96% (four stars). They rated us 94% on Quality Process Standards and 100% for Performance Activities.
• HEDIS Scores: Access rates have increased from nearly 36% to 51%. This placed the TennCare program among the best in the country.

I believe there's no other state in our nation with a better program than we have here in Tennessee. - Dr. Thomas Underwood, Chair of the TDA's TennCareSM Committee quoted in the June 2004 issue of ADA News

 
Illinois Results
March 1, 1999 - Present

• Network: Doral increased network participation from 869 to 2052 unique dental practitioners at 2965 access points. And Doral's provider retention rate averages 86%.
• HEDIS Scores: Doral has nearly doubled dental access for the children in the Illinois Medicaid Dental Program.
• Claims Processing: Doral processes an average of 108,000 claims a month (1,296,000 a year) for Illinois. Illinois providers use our electronic claims processing option at a significant rate. Between January and April, 2006, Doral processed nearly 62% of Illinois claims electronically.

 
Virginia Results
Launched July 1, 2005

• Network: From July 1, 2005 through April 30, 2006, there were 179 new dentists credentialed and enrolled in the new Smiles for Children program. Several new Medicaid children's dental health centers also opened this year.
• Quality: According to the Virginia Dental Association, the new Smiles for Children program is much improved over the previous programs and appears to be doing very well.
• HEDIS Scores: Dental utilization data for Smiles for Children is being validated as reports are being evaluated and developed further. However, preliminary analysis of the first nine months of claims data indicates an upward trend in the number of children receiving care. According to the Centers for Medicare and Medicaid Services' 416 Report (2004), over 29% of the children who are eligible for dental services received dental care. Later figures now indicate that number has increased to nearly 37% since the program's inception.
• Claims Processing: As of July 1, 2005, only about 50% of enrolled providers were treating Medicaid patients and filing claims. Now under the Smiles for Children program, this percentage increased to about 79%. Since the start of the new program, no complaints related to access of care have been filed.

Source: Smiles for Children Update for Centers for Medicare and Medicaid Services, June 1, 2006

Thank you to the Doral team for working collaboratively with DMAS on the many Smiles for Children start-up related activities. Doral's staff brings knowledge of the dental industry standards, experience with complex Medicaid programs and a resolve to get the job done. -Patrick W. Finnerty Department of Medical Assistance Services (DMAS), Virginia

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