Effective Date: Immediately

Health Plans Affected: Priority Partners 

Type of Change: Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Measures

Explanation of Change:

As a Priority Partners participating provider, your role is essential in helping our members access quality dental care and ensuring we meet the standards established by the Maryland Department of Health (MDH) and the National Committee for Quality Assurance (NCQA).

Maryland HealthChoice Managed Care Organizations (MCOs) are required to track and report standardized dental metrics to both NCQA and MDH. These measures help evaluate the quality and accessibility of dental services for our youngest members.

Together, we can ensure every Priority Partners member has access to the dental care they need for a healthy smile.

Understanding the Key Dental Metrics

• Annual Dental Visit (ADV): Measures the percentage of enrolled children (ages 2 to 20) who received at least one comprehensive or preventive dental visit with a dental practitioner during the measurement year.
• Preventive Dental Services (PDS): Specifically tracks the subset* of children who received preventive dental treatments, such as cleanings, fluoride applications or sealants.
• Oral Evaluation, Dental Services: Assesses the utilization of specific dental exams and oral health evaluations under the Maryland Healthy Smiles Program. (See link to website below.)

Resources for Providers and Members

• Visit the Priority Partners website for comprehensive dental care resources, including access to the dental provider directory.
• To help members find a dentist, replace a member ID card or handbook, or learn more about covered services, direct them to contact Maryland Healthy Smiles Member Services.
  • Email: [email protected] (Please do not include personal health information in your email.)
  • Phone: 855-934-9812 (TTY for the hearing impaired: 711)
• Members can access valuable resources through the Maryland Healthy Smiles Dental Program. From this website, members can:
  • Find a dental provider (Dental Home) near their home or work using the Provider Quick Search box.
  • View a copy of the Member Handbook - Spanish language information is available on the website.
  • Access the Provider Directory for Pregnant Women.
  • Find transportation assistance: phone numbers for help getting to and from dental appointments
  • Review the “Oral Health Resource Guide.”
• SKYGEN remains the administrator of dental benefits for 2026.

Important reminders to give to your patients who are Priority Partners members:

• Phone: 855-934-9812 (TTY: Maryland Relay dial 711)
• Email: [email protected]
• Web Portal: member.mdhealthysmiles.com
• When providing information to a provider, they need to use their Maryland Healthy Smiles Dental Program identification number.
• Additionally, please remind your Priority Partners patients if a dentist asks them to pay for services out of pocket, they should call Customer Service to verify whether services are covered by the plan before paying.
  • Maryland Healthy Smiles Dental Program Contact Information
    Customer Service: 855-934-9812
    TDD (for hearing impaired) Relay 711
    Website Assistance: 855-434-9239

By focusing on these measures, we can work together to improve oral health outcomes for children and adolescents throughout Maryland.

*Refers to the smaller group of children who are included within the broader Annual Dental Visit (ADV) population and who specifically received preventive dental services during the measurement year.

• ADV = all enrolled children ages 2–20 who had at least one qualifying dental visit
• PDS = the subset of those children who received preventive treatments such as cleanings, fluoride applications and sealants

In other words, PDS is a subset of the ADV-eligible children, focusing only on those whose dental visits included preventive care.