Dental Services: Procedural Requirements

01. Administer the Dental Benefit. The managed care contractor is responsible for administering the dental benefit, including dental claims processing, payments to providers, customer service, eligibility verification, and data reporting. (7-1-26) 02. Authorization. The contractor is responsible for authorization of covered dental services that require authorization prior to claim payment. (7-1-26) 03. Grievances. The contractor is responsible for tracking and reporting all grievances to the State’s contract monitor. (7-1-26) 04. Appeals. Appeals are handled by a process between the contractor and the Department as specified by the Office of Administrative Hearings, and in compliance with state and federal requirements. (7-1-26)