MedicaidCoverageHigh impact
[Ohio] 2026 Delta Dental Policies
CareSource·OH · Dentistry, Oral & Maxillofacial Surgery·Specialty Services
Effective date
Jan 1, 2026
We identified it
May 9, 2026
Summary
CareSource and Delta Dental have implemented 28 new clinical criteria policies for dental services covering Ohio Medicaid and Ohio FIDE members, effective January 1, 2026. These policies establish clinical coverage criteria for specialty dental procedures including periodontal treatment, restorative work, prosthodontics, oral surgery, and endodontics. The billing team must review these policies to understand coverage requirements and apply them to claim submissions for affected Ohio Medicaid and FIDE beneficiaries.
Action Required
By December 31, 2025: Billing team and providers must access and review all 28 Delta Dental clinical criteria policies listed in this notification at www.deltadentaloh.com/Dentist/Our-Plans/Ohio-TriState-Advantage-Network/Clinical-Policies. For each dental procedure submitted for Ohio Medicaid and Ohio FIDE members, verify the service meets the clinical criteria outlined in the corresponding policy (policies 282.15 through 282.42). Update billing software and claim submission workflows to incorporate these clinical criteria requirements. Train providers and clinical staff on the new coverage criteria to prevent claim denials. Beginning January 1, 2026, claims that do not meet the specified clinical criteria will be denied.