Definitions

Here are the definitions for important words and phrases you may see on this website or in your Member Handbook:

Appeal is one way to fix mistakes in TennCare. When you appeal, you’re asking to tell a judge the mistake you think TennCare made. It’s called a fair hearing. Your Member Handbook tells you how to file an appeal. Click here to get the Member Handbook.

Copayment (copay) is the part of the bill you need to pay. Not everyone has a copay. There are no copays for preventive care. Click here to learn more about copays.

Dentist is a person licensed to practice dentistry.

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)

Early means you should start going to the dentist when you are young so you can start taking care of your teeth.

Periodic Screening means you should go to the dentist every 6 months. The dentist will make sure your teeth are healthy.

Diagnosis means the dentist will find out if there is anything wrong with your mouth or teeth.

Treatment means if something is wrong with your teeth the dentist will try to fix it.

Click here for more information about TENNderCare and EPSDT.

Handbook is the booklet you should have received in the mail. It tells you about the TennCare dental benefits program and TennDent. It also tells you how you can get the care you need. You can also click here to see the Handbook.

Medically Necessary: To be medically necessary, a medical item or service must satisfy each of the following criteria:

a. It must be recommended by a licensed physician who is treating the member or other licensed healthcare provider practicing within the scope of his or her license who is treating the member;

b. It must be required in order to diagnose or treat a member’s medical condition;

c. It must be safe and effective;

d. It must not be experimental or investigational; and

e. It must be the least costly alternative course of diagnosis or treatment that is adequate for the member’s medical condition.

Member is someone who is enrolled in TennCare and eligible for dental benefits.

Preventive Care is dental treatment that helps keep your mouth healthy. Click here to learn more about Preventive Care.

TennDent Dentist is a Tennessee dentist who has agreed to join the TennDent Network. You may go to any TennDent Dentist. Your benefits will be paid only when you see a TennDent Dentist, unless you have an emergency, or in special cases. Click here to find a TennDent Dentist.

TennDent is the dental care program for children under age 21 enrolled in TennCare.

TennDent Network is all the dentists who can accept TennCare.