Who administers Texas Medicaid dental in 2026?

The Texas Health and Human Services Commission (HHSC) oversees the program, but day-to-day dental benefits for Medicaid and CHIP enrollees are administered by three statewide managed care organizations: DentaQuest, MCNA Dental, and UnitedHealthCare Dental. Each member is assigned to one of these MCOs at enrollment.

What is the difference between DentaQuest, MCNA, and UnitedHealthCare Dental in Texas?

All three are contracted by HHSC to cover the same core benefit set, but they operate separate provider networks, provider portals, fee schedules, and pre-authorization rules. A claim that processes cleanly for one MCO may require additional documentation or pre-auth for another. Practices must verify which MCO a patient belongs to and follow that MCO's specific billing workflows.

Does Texas Medicaid cover adult dental?

Adult dental coverage under Texas Medicaid is very limited. Most adults enrolled in Texas Medicaid receive emergency dental services only. Full coverage, including preventive, restorative, and orthodontic benefits, is available for children enrolled in STAR (Medicaid) and CHIP programs. Confirm current adult benefit details with HHSC or the relevant MCO, as coverage rules can change.

How do I check which MCO a patient is assigned to?

You can verify MCO assignment through the Texas Medicaid and Healthcare Partnership (TMHP) provider portal, by calling the TMHP provider line, or by checking directly with each MCO's eligibility verification system. The patient's Medicaid ID card should also list their plan, but cards are not always current, so a real-time eligibility check before each appointment is the safest approach.

What is the typical denial rate for Texas Medicaid dental claims?

Denial rates vary by MCO, practice, and claim type and are not publicly reported in a standardized way. Common denial triggers include MCO assignment mismatches, missing or expired pre-authorizations, frequency limit violations, and eligibility gaps. Practices with strong verification and pre-auth workflows at the front end generally see fewer denials than those that check eligibility only at billing.

Can a billing company handle all three Texas MCOs?

Yes. An experienced dental billing company familiar with Texas Medicaid will maintain separate workflows for DentaQuest, MCNA Dental, and UnitedHealthCare Dental, including MCO-specific portals, fee schedules, and pre-authorization processes. That separation is the core of clean Medicaid billing in Texas, because treating all three MCOs identically is a reliable path to denials.

What is CHIP dental in Texas?

CHIP (Children's Health Insurance Program) in Texas provides health and dental coverage for children in families that earn too much to qualify for Medicaid but cannot afford private insurance. CHIP dental in Texas runs through the same three MCOs as STAR Medicaid dental and covers a similar comprehensive benefit set for children, including preventive, basic, and some orthodontic services. Benefits and cost-sharing details are confirmed through HHSC.

What is the difference between DentaQuest, MCNA, and UnitedHealthcare dental?

All three are managed care organizations that administer Medicaid and CHIP dental benefits under contract with state agencies. They cover a similar core benefit set, but they run separate provider networks, provider portals, fee schedules, and pre-authorization rules. A claim that pays cleanly for one can require extra documentation or pre-auth for another, so a practice has to know which MCO each patient belongs to and follow that MCO's workflow.

Is credentialing with DentaQuest or MCNA the same as my state Medicaid enrollment?

No. Being on your state Medicaid provider file does not make you an in-network provider with the dental MCO. Each MCO, DentaQuest, MCNA, and UnitedHealthcare, has its own credentialing and contracting process that must be completed before claims will pay.

Which Medicaid dental MCO is hardest to bill?

It depends on your case mix. MCNA is known for strict orthodontic documentation, including an HLD index and full records. DentaQuest is the most widespread, so most practices deal with it first. The real difficulty is running three different portals, fee schedules, and pre-auth rules at once, which is where errors and denials come from.

Which states use DentaQuest vs MCNA vs UnitedHealthcare?

It varies by state and changes with each contract cycle. DentaQuest is the largest and operates in the most states. MCNA has a strong presence in states like Texas, Florida, and Louisiana. UnitedHealthcare administers Medicaid dental in select states through its community plans. Always confirm the current MCOs for your state and each patient's specific plan.

What is the mailing address for MetLife dental claims?

Paper MetLife dental claims go to the MetLife Dental Claims Unit, P.O. Box 981282, El Paso, TX 79998-1282, and the dental claims fax is 859-389-6505. Electronic submission through your clearinghouse is faster and is the recommended method. Always confirm the current address on MetLife's provider materials, since payer addresses change.

How do I submit MetLife dental claims electronically?

Submit MetLife dental claims electronically through your clearinghouse using MetLife's dental payer ID (commonly 65978 across major clearinghouses, confirm it in your clearinghouse's payer list). Providers also manage eligibility, claim status, and pre-treatment estimates through the MetDental provider portal at metdental.metlife.com.

What is MetLife's dental provider portal?

MetDental (metdental.metlife.com) is MetLife's provider portal for dental offices. You use it to check eligibility and plan maximums, submit and track claims, and request pre-treatment estimates. MetLife's main dental network is PDP Plus.

What is the timely filing limit for MetLife dental claims?

Timely filing windows are set by the specific plan and group, so confirm the deadline in the patient's plan documents or on MetDental. Filing late is one of the most common, and most avoidable, reasons a dental claim is written off.

Aetna Dental Claims: Address, Payer ID, Fax & How to Submit

Aetna dental claims: where and how to submit

Submit Aetna dental claims electronically for the fastest payment (payer ID 60054), or by mail to Aetna Dental, P.O. Box 14094, Lexington, KY 40512-4094. Providers submit and manage claims through Availity. Here is the full reference, plus how to stop chasing Aetna claims.

Last updated September 2026 · Reviewed by the PracticeAlpha billing team · Source: Aetna dental provider materials

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Aetna dental claims quick reference

Addresses and payer IDs change, so confirm the current details on Aetna's provider materials before you rely on them.

Detail	Aetna dental
Claims mailing address	Aetna Dental, P.O. Box 14094, Lexington, KY 40512-4094
Electronic payer ID	60054
Electronic submission	Availity, or via your clearinghouse to payer ID 60054
Provider portal	Availity (availity.com) / Aetna Dental provider site
Networks	Aetna Dental PPO and Aetna Dental DMO
Provider line	1-800-451-7715
Timely filing	Plan- and group-specific, confirm in the patient's plan or on Availity

How to submit Aetna dental claims

Electronic submission is the fastest way to get Aetna dental claims paid. Send them through Availity or your clearinghouse to payer ID 60054. Paper claims go to Aetna Dental, P.O. Box 14094, Lexington, KY 40512-4094. Aetna Medicare dental claims route separately, so confirm the plan type before you file.

Verify eligibility and benefits on Availity before the visit. Checking the plan type (PPO vs DMO), remaining maximum, and covered services up front is the simplest way to avoid a denial or a bad patient estimate.

Aetna dental claims FAQ

What is the mailing address for Aetna dental claims?

Paper Aetna dental claims go to Aetna Dental, P.O. Box 14094, Lexington, KY 40512-4094. Electronic submission to payer ID 60054 is faster; Aetna Medicare dental routes separately. Confirm the current address on Aetna's provider materials.

What is Aetna's dental payer ID?

Aetna's dental payer ID is 60054 for electronic submission. Confirm it in your clearinghouse's payer list.

What is Aetna's dental provider portal?

Aetna dental providers manage eligibility, claims, and status through Availity (availity.com). The provider line is 1-800-451-7715.

What is the timely filing limit for Aetna dental claims?

It is set by the specific plan and group, so confirm the deadline in the patient's plan or on Availity. Late filing is a common, avoidable write-off.

Aetna dental claims: where and how to submit

Aetna dental claims quick reference

How to submit Aetna dental claims

Aetna dental claims FAQ

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