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| # | Weekly Reports | Revision Date | Due Date |
|---|---|---|---|
| 150 | Encounter Data Certification Form - W | 1/4/23 | Every Wednesday by 5pm |
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)
Financial Reporting Requirements
Marketing and Member Education Resources
Member Education Template Checklists
- Handbook (Updated 7/1/2022)
- Welcome Newsletter (Updated 7/1/2022)
Report Templates
| # | Monthly Reports | Revision Date | Due Date |
|---|---|---|---|
| 022 | Third Party Liability (TPL) Report- M | 1/10/23 | Due 15 calendar days of the end of each month except where indicated |
| 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 | 1/9/23 | Due 15 calendar days of the end of each month except where indicated |
| # | Quartely 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 |
| 072 | QAPI PCD Profile Reports - 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 |
| 183 | Claims Processing Interest Payments - Q | 5/26/21 | 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 | 4/9/25 | Due April 30, July 30, October 30, and January 30, except where indicated |
| 225 | Network Summary Dental Report - Q | 5/26/21 | Due April 30, July 30, October 30, and January 30, except where indicated |
| # | Semi-Annual Reports | Revision Date | Due Date |
|---|---|---|---|
| 220 | Network Adequacy Review | 1/26/24 | July 31 & Jan. 31 |
| # | Annual Reports | Revision Date | Due Date |
|---|---|---|---|
| 017 | Key Staff Organizational Chart Listing | 3/5/24 | January 30th |
| 019 | Medical Loss Ratio - A | 9/17/24 | January 15th |
| 053 | NW Provider Development Management Plan - A | January 30th | |
| 068 | Utilization Management Dental Record Review Stategy - A | January 30th | |
| 110 | Marketing Activities Annual Review - A | January 30th | |
| 132 | Member Satisfaction Survey Report (CAHPS) - A | 9/8/23 | April 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 comlete.