Background
The Health Safety Net (HSN) and MassHealth transitioned their Dental Third-Party Administrator (TPA) from DentaQuest to BeneCare in April 2025, then transitioned back to DentaQuest in February 2026. See the MassHealth Dental Program website for more details.
The period from April 1, 2025, to January 31, 2026, is referred to here as the “BeneCare Period.”
Beginning with the June 2025 HSN pay period, HSN has been paying HSN dental providers interim monthly payments based on historic dental utilization, rather than payments based on actual demand, due to the dental TPA changes. These interim payments to providers will be reconciled to actual demand, as described below.
Process and Timeline for Claims Resubmission and Reconciliation
To ensure providers are accurately paid against actual HSN dental services rendered during the BeneCare Period, providers must submit original claims to DentaQuest for all appropriate HSN dental claims that were originally submitted to BeneCare and that were not fully adjudicated. The HSN Office will not use BeneCare claims data for payment purposes to ensure accuracy. HSN dental claims must be submitted to DentaQuest as original claims to be considered for payment reconciliation.
Claims Submission and Reconciliation Timeline
- February 1 - July 31, 2026:
- Providers should submit original HSN dental claims from the BeneCare Period to DentaQuest.
- Providers are strongly encouraged to submit appropriate BeneCare Period HSN dental claims by July 31, 2026. Doing so will ensure a smoother and quicker reconciliation process and reduce potential overpayment findings during the initial month of reconciliation (described below).
- Note, however, that original HSN dental claims from the BeneCare Period can be submitted without individual timely filing reconsideration requests if submitted by March 31, 2027.
- See the "Timely Filing Extension" section of the MassHealth Dental Program website. This policy applies to both HSN and MassHealth dental claims.
- September 2026 HSN payment period:
- Beginning with the September 2026 HSN pay period, the HSN Office will stop making interim payments and begin reconciling any overpayments or underpayments.
- The September 2026 pay period will include reconciliation against total HSN dental demand submitted to DentaQuest through July 31, 2026.
- Overpayment reconciliation will continue across subsequent payment periods, as necessary, until fully resolved.
- Reconciliation for underpayments may continue across subsequent payment periods, if providers submit further HSN dental claims from the BeneCare Period to DentaQuest after July 31, 2026.
Reconciliation of Interim Payments with Actual Demand
Underpayment
If total interim payments were less than a provider's actual submitted demand by July 31, 2026, the HSN Office will attribute the difference as additional HSN dental demand in the September 2026 HSN pay period.
Example:
- Total interim payments paid: $100,000
- Actual demand submitted to DentaQuest: $120,000
- Amount attributed in the September 2026 pay period: $20,000
Note: Due to the HSN shortfall, attributed demand may not equal the actual amount paid for hospitals.
Overpayment
If total interim payments exceeded a provider's actual submitted demand by July 31, 2026, the HSN Office will begin collecting on the difference starting with the HSN September 2026 pay period. The HSN Office will withhold a portion of a provider's total HSN payment each month to apply to the overpayment recovery until the balance is fully recovered.
Example:
- Total interim payments paid: $200,000
- Actual demand submitted to DentaQuest: $150,000
- Amount owed to HSN Office: $50,000
Example Recoupment Schedule of the $50,000:
| Month | Total HSN Payment | Amount Withheld | Remaining Recoupment Balance |
|---|---|---|---|
| September 2026 | $40,000 | $20,000 | $30,000 |
| October 2026 | $48,000 | $24,000 | $6,000 |
| November 2026 | $42,000 | $6,000 | $0 |
Frequently Asked Questions
Q: Will providers need a timely filing extension for claims from the BeneCare Period outside the 90-day submission window?
A: No. See the "Timely Filing Extension" section of the MassHealth Dental Program website. This policy applies to both HSN and MassHealth dental claims.
Q: Some individuals have MassHealth Limited or Children's Medical Security Plan (CMSP) coverage for some circumstances, with HSN paying for dental services. Should providers submit original HSN dental claims for these individuals for the BeneCare Period to DentaQuest?
A: Yes. Providers should submit original claims to DentaQuest for all unadjudicated HSN dental claims, including claims for individuals with MassHealth Limited or CMSP coverage.
Q: If a provider is not sure whether a claim originally submitted to BeneCare was fully adjudicated, should the provider submit a claim to DentaQuest?
A: Yes. If a provider is not sure whether a claim was fully and accurately adjudicated, the provider should submit an original claim to DentaQuest. If the claim was already fully adjudicated, the claim will be denied.
Q: A small number of HSN dental claims were paid by BeneCare in the June 2025 HSN payment period. Should these be resubmitted?
A: No. The HSN Office is aware that a small number of claims with dates of service in April 2025 were paid in the June 2025 HSN payment period. If a provider has already received payment attributed to a claim, resubmission is not necessary.
Q: If a provider has already submitted HSN dental original claims to DentaQuest since the February 1, 2026, DentaQuest transition, do they still need to resubmit?
A: No. Original claims submitted to DentaQuest for HSN since February 1 will be included in the reconciliation — no further resubmission is needed.
Q: Does the HSN Office have a record of the claims submitted to BeneCare for HSN?
A: The HSN Office has some information on the claims BeneCare considered as HSN claims for each facility, but this information may not be comprehensive. If you would like to request this information, please contact the HSN Help Desk at HSNHelpDesk@state.ma.us. Please use the subject line "HSN Dental Claims Submitted to BeneCare Information," and include the relevant claim details requested and your HSN Organization ID in the email.