Dental Benefit Program Manager Resources | Louisiana Department of Health

Dental Benefit Program Manager Resources | Louisiana Department of Health
For Providers
Medicaid Providers
Dental Benefit Program Manager Resources
Dental Benefit Program Manager Resources
Effective January 1, 2021, the Louisiana Department of Health (LDH) has contracted with
DentaQuest
and
MCNA Dental
to provide dental benefits for qualified Medicaid enrollees. These plans are accountable to LDH and the state of Louisiana. Their contract requires adherence to detailed grievance and appeals requirements. Members have the right to appeal denied services, first to their plan, then to the State. There are also strict marketing guidelines that must adhere to with mandatory prior approval of marketing materials. LDH will monitor all complaints, grievances and appeals to assure that DentaQuest and MCNA Dental are accountable to the enrollees and the state. Complaints and any questions can be submitted by email to
[email protected]
and the appropriate staff will address any issues or concerns.
Manuals and Companion Guides
Dental Benefit Program Manager Manual
Dental Benefit Program Manager Systems Companion Guide
(Updated October 7, 2020)
Medicaid 834 Dental Benefit and Enrollment Transaction Set Companion Guide
(Updated June 15, 2023)
Dental Incentive Payment Program Protocol (DIPP)
DIPP workflow (Appendix A)
DIPP Performance Measure Specifications (Appendix B)
Financial Reporting Requirements
Agreed Upon Procedures
Marketing and Member Education Resources
Marketing Complaint Form
pdf
Member Education Template Checklists
Handbook
(Updated 7/1/2022)
Welcome Newsletter
(Updated 7/1/2022)
Report Templates
Weekly Reports
Revision Date
Due Date
150
Encounter Data Certification Form - W
1/4/23
Every Wednesday by 5pm
Monthly Reports
Revision Date
Due Date
107
Member Service Call Center - M
9/26/23
Due 5 calendar days of the end of each month except where indicated
113
Grievance, Appeal and Fair Hearing Log - M
1/5/24
Due 15 calendar days of the end of each month except where indicated
148
Monthly Debarment/Exclusion Verification Attestation
Due 15 calendar days of the end of each month except where indicated
167
Claims Payment Accuracy Report - M
Due 15 calendar days of the end of each month except where indicated
173
Denied Claims Report - M
1/9/23
Due 15 calendar days of the end of each month except where indicated
181
Provider Call Center - M
10/29/21
Due 15 calendar days of the end of each month except where indicated
182
Provider Complaint & Appeal Summary Report - M
9/13/23
Due 15 calendar days of the end of each month except where indicated
221
Claims Payment Summary - M
11/14/25
Due 15 calendar days of the end of each month except where indicated
Quarterly Reports
Revision Date
Due Date
069
Utilization Management Dental Record Review Report - Q
5/26/21
Due April 30, July 30, October 30, and January 30, except where indicated
082
PCD Linkages - Q
5/26/21
Due April 30, July 30, October 30, and January 30, except where indicated
109
Marketing and Member Education Activities Report - Q
6/24/22
Due April 30, July 30, October 30, and January 30, except where indicated
119
QAPI Committee (minutes) - Q
08/15/17
Due April 30, July 30, October 30, and January 30, except where indicated
145
Fraud and Abuse Activity Report - Q
8/9/23
Due April 30, July 30, October 30, and January 30, except where indicated
147
Sampling of Paid Claims Report
5/2/23
Due April 30, July 30, October 30, and January 30, except where indicated
152
Act 710 Healthy Louisiana Claims Report
11/15/23
Due April 30, July 30, October 30, and January 30, except where indicated
185
Quarterly Unaudited Financial Statement - Q (60 days after QTR)*
2/10/23
Due May 31, August 31, November 30, and February 28
188
PA Summary - Q
4/9/26
Due April 30, July 30, October 30, and January 30, except where indicated
Semi-Annual Reports
Revision Date
Due Date
220
Network Adequacy Review
11/26/25
July 31 & Jan. 31
416
Special Needs Pediatric Dental Incentive Program Achievement
3/31/26
February 5 & August 5
Annual Reports
Revision Date
Due Date
017
Key Staff Organizational Chart Listing
3/31/26
January 30th
019
Medical Loss Ratio - A
12/18/25
January 15th
053
NW Provider Development Management Plan - A
January 30th
068
Utilization Management Dental Record Review Strategy - A
4/22/26
January 30th
110
Marketing Activities Annual Review - A
January 30th
132
Member Satisfaction Survey Report (CAHPS) - A
8/5/25
August 30th
133
Provider Satisfaction Survey Report - A
9/8/23
April 30th
134
Appointment Availability Survey Report
8/17/23
April 30th
138
QAPI Performance Improvement Projects (outcomes)
7/25/24
March 15th
151
Systems Refresh Plan - A
January 30th
157
Emergency Management Plan - A
January 30th
159
Back-up File List - A
5/26/21
January 30th
170
Form CMS 1513 Ownership and Control Interest Statement - A
March 30th
177
Total and OON Claims
1/9/23
July 30th (30 days after the prior SFY)
184
Annual Audited Financial Statement - A
4/2/25
June 30th
189
Independent-Subcontractor EDP Audit (SSAE16) - A ***
Based on Audit Period (45 days after corporate audit complete)
216
QAPI Impact and Effectiveness of QAPI Program Evaluation - A
March 30th
Q/A means Quarterly and Annually
* Template not provided. Will accept Health Plans' corporate standard.
**Draft versions are due 90 days after year end.
***- 45 days after the corporate audit Period is complete.
Surgeon General
Evelyn Griffin, MD
Secretary
Bruce D. Greenstein
Cicero Government