Evidence record
Dental Value-Added Services—Wellpoint
- Jurisdiction
- Texas
- Publication date
- February 20, 2026
- Source record
- Original document linked
Findings
1
Recommendations
6
Overall conclusion
Wellpoint did not consistently submit dental value-added services encounters with the correct financial arrangement code.
Scope
Scope covered September 1, 2022 through August 31, 2023, focusing on dental value-added services encounters within the STAR+PLUS program.
Findings (1)
Each finding has a stable link.
- F-1142
Wellpoint did not consistently submit dental value-added services encounters with the correct financial arrangement code; 2,529 of 8,427 encounters (30%) were coded as payable dental services (financial arrangement code 04) instead of value-added services (financial arrangement code 11), totaling $105,942.
Recommendations (6)
- R-1007
Implement controls to verify it reports STAR+PLUS dental value-added services encounters with the correct financial arrangement code.
Related finding F-1142 - R-1008
Ensure its encounter system accurately identifies members enrolled in a STAR+PLUS HCBS waiver.
Related finding F-1142 - R-1009
Correct the encounters and paid claims submitted with the incorrect financial arrangement code as applicable.
Related finding F-1142 - R-1010
Review its state fiscal year 2023, 2024, and 2025 FSRs to determine whether any reported dental value-added services expenses were included in the medical expenses.
Related finding F-1142 - R-1011
Contact HHSC Financial Reporting and Audit Coordination to receive guidance on the correction of any misreported medical expenses.
Related finding F-1142 - R-1012
Review its state fiscal year 2026 encounters to verify financial arrangement code 11 was used as applicable until a control is implemented.
Related finding F-1142