ARSD 67:16:06:03.01. Contractor to provide certain services

A contractor must provide the following services: (1) At a minimum, the dental services contained in this chapter; (2) An automated claims processing and payment system capable of providing data on the claims encountered; (3) A provider support unit which, at a minimum, provides eligibility information, responds to claim inquiries, and responds to questions about covered benefits; (4) A toll-free telephone service for recipients to register complaints, identify problems, and inquire about benefits; (5) A system of provider recruitment and retention; (6) A quality assurance program which provides for pre- and post-treatment reviews; and (7) A grievance process for providers and recipients. The provider or recipient must exhaust this process before requesting a fair hearing from the department.