Electronic Information Requests – June 30
Beginning June 30, offices using Renaissance Dental Office Toolkit (RDOT) will receive and respond to all Information Requests electronically through RDOT. By streamlining this process, we aim to provide an improved user experience with anticipated benefits including:
- Centralized communications
- Ability for electronic information requests and documentation upload
- Expedited claims processing
We’re here to help. If you have questions, including how to create an RDOT account, you can visit TennCare.RenaissanceBenefits.com/Providers or reach out to our provider service team at 866-864-2526.
CoverKids Coordination of Benefit update
Previously, communication indicated that Renaissance would no longer process secondary insurance when a member had CoverKids. Please be advised that this guidance has been updated in collaboration with TennCare. Renaissance will now process secondary insurance for members who have CoverKids. All secondary CoverKids claims submitted for dates of service after Jan. 1, 2026, will be reprocessed no later than August 31.
Please note: Renaissance will reach out to you directly if any additional information is needed. There is no need for you to resubmit claims or request adjustments.
Provider manual updates now live
Please be advised that updates to all provider manuals are now live. A summary of all changes is available in the Revision section of each manual. Please review the updates below:
- Prior authorization required for Code D7210 (effective Oct. 1, 2026).
- PPR for all endodontic codes- D3310, D3320, D3330
- Code D1354 benefit updates:
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- Two of (D1354, D2991) per lifetime per patient tooth. Limit of 4 teeth per DOS. A secondary application may not be submitted sooner than 2 months after the first. Not allowed to have D2000 series code on the same tooth. Not allowed for 6 months after D1354 or D2991.
- Code D2991 benefit updates:
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- Four-(D1354, D2991) per lifetime per tooth. Four (D1354, D2991) per 1 day per patient. Not allowed if had D2000 series codes on same tooth in prior 12 months. D2000 series code on same tooth not allowed for 6 months after D1354 or D2991
- MSA form and Cephalometric now required for Orthodontic Submissions
Scheduling requirements for TennCare members
When you provide care to TennCare members, you have the opportunity to address critical gaps in their oral health and make a positive impact on their overall health.
If you are scheduling members, remember that they must be seen or scheduled within a set time frame. These benchmarks are based on treatment urgency and are required by the State of Tennessee Division of TennCare. Find these benchmarks in your participation agreement or TennCare Provider Manual for general practitioners or pediatric dentists:
- Emergency services – Provider must be available immediately, 24/7 when medically necessary.
- Urgent care – Provider office must see the enrollee within 48 hours.
- Routine care – Provider office must schedule the enrollee within three weeks.
- Office wait time – Provider office must ensure that Enrollee is seen in a timely manner, with office waiting times not exceeding forty five (45) minutes.
Annual Compliance, Cultural Competency and Fraud, Waste and Abuse Training
All Renaissance participating staff and dentists must complete this training once each calendar year. Ensuring we comply with these standards allows us to operate better as a team and is mutually beneficial.
Follow the steps below to complete the annual training. Please note that your Renaissance participation agreement may be terminated if your business does not complete the required training.
If your office has multiple providers with different tax identification numbers (TIN), an acknowledgment form must be submitted for each TIN.
Follow the steps below to complete the annual training.
Follow the link below to the Renaissance website.
- Tennessee: tenncare.renaissancebenefits.com/providers/
Provider directory updates
As a contracted provider, it is important to ensure that your demographic information in the provider directory is accurate. As part of Renaissance’s quarterly provider records audit, please review your demographic information and submit any necessary updates. Watch for a quarterly communication from the provider records team with additional information and instructions.
Provider webinars
Renaissance will host a variety of webinars throughout the year that all providers can join. In the event you are unable to join, all recorded webinars are now housed on our main website via the link below.
Dental Provider Resources | TennCare Dental
Be on the lookout for an upcoming webinar in Q4.
Prior authorizations
To help ensure timely reviews for all members, we would like to provide a reminder about when an urgent (expedited) prior authorization review is appropriate.
Under Renaissance and CMS guidelines, a request qualifies for expedited review only when a delay in treatment could seriously jeopardize a member’s life, health, or ability to regain maximum function. Urgent review is intended for medically necessary, time-sensitive situations and should not be used for routine or non-emergent treatment needs.
Because of these criteria, dental services rarely qualify for urgent prior authorization review. Most dental procedures, including restorative treatment, crowns, extractions, sedation and other commonly requested services, can be safely reviewed through the standard authorization process. Scheduling considerations alone, including treatment planned for the same day, do not automatically qualify a request for expedited review.
Please note the following reminders:
- Standard prior authorization reviews are completed within seven (7) calendar days, providing timely determinations for non-emergent cases.
- Terms such as “URGENT,” “ASAP” and “EMERGENCY” entered in the remarks section are recognized by our system as requests for expedited review.
- Requests will only be processed as urgent if they meet the established emergency criteria.
- Treatment scheduled for the same day does not automatically qualify a request for expedited review.
Submitting non-emergent requests as emergencies can unintentionally impact the review process for members with truly critical and time-sensitive healthcare needs. By reserving urgent requests for cases that meet the established criteria, you help ensure that members with genuine emergency needs receive the immediate attention they require.
Member service
Did you know the Renaissance member service team is a great resource for assistance with claims and appeals?
If you have submitted a provider appeal and would like an update on its status or outcome, our member service representatives are available to help. They can also assist with questions regarding claim corrections, cancellations and other claim-related inquiries.
Our knowledgeable member service team is committed to providing timely support and helping resolve issues.
📞 Member service: 866-864-2526
Provider appeals
If you have submitted a provider appeal and are waiting for a response, please allow up to 60 days for the review process to be completed. Once a decision has been made, a new Explanation of Benefits (EOB) will be issued outlining the appeal determination.
The updated EOB will be:
- Available in the RDOT
- Mailed directly to your office for your records
Need information on how to submit a provider appeal? Appeal submission instructions can be found on page 106 of the Children’s Provider Manual and page 122 of the Adult Provider Manual. Provider manuals are available in RDOT for easy reference.
