Dental Benefit Management Program RFP

The following information is listed for historical purposes only. It will not be updated.

The Louisiana Department of Health (DHH), Bayou Health Program, is reissuing a Request for Proposals (RFP) for qualified proposers to provide dental healthcare services, through a comprehensive network of providers, to eligible clients residing in all 64 parishes in Louisiana.

If you have any questions, please contact the RFP Coordinator Mary Fuentes at Mary.Fuentes@la.gov.

Below are all documents related to this RFP:

Official RFP Document

Significant Traditional Provider (STP) Dental

IBNR Triangles By Rate Cell

Member Count By Parish

Appendices

• Appendix A - Map of Louisiana Parishes
• Appendix B - Reserved
• Appendix C - Dental Provider LOI
• Appendix D - Louisiana Medicaid State Plan Services
• Appendix E - Dental Rate Certification
  • ADDENDUM # 1 Appendix E- Dental Rate Certification
• Appendix F - Dental Benefit Plan Performance Measures
  • ADDENDUM # 10 Appendix F - Dental Benefit Plan Performance Measures
• Appendix G - Health Plan Subcontract Requirements
  • ADDENDUM # 3 Appendix G - Health Plan Subcontract Requirements
• Appendix H - Data Use Agreement
  • ADDENDUM # 2 Appendix H - Data Use Agreement
• Appendix I - Requirements for DBPM Physician Incentive Plans
• Appendix J - Provider Bill of Rights
• Appendix K - Reserved
• Appendix L - Fiscal Intermediary (FI) Payment Schedule
• Appendix M - Member Education Materials Annual Review
• Appendix N - Performance Measurement Goals
  • ADDENDUM # 10 Appendix N - Performance Measurement Goals
• Appendix O - Dental Services Manual
• Appendix P - LDH Marketing Complaint Form
• Appendix Q - Member and Potential Member Bill of Rights
  • ADDENDUM # 5 Appendix Q - Member's Bill of Rights
• Appendix R - Monthly Member Education Reporting Template
• Appendix S - Grievance, Appeal and State Fair Hearing Report
• Appendix T - Performance Improvement Projects
• Appendix U - Coordination of Health Plan Fraud and Abuse Complaints and Referrals
• Appendix V - Network Provider Listing
• Appendix W - Member Disenrollment Form
• Appendix X - EPSDT Reporting
• Appendix Y - Model Attestation Letter for Reports
• Appendix Z - Transition Period Requirements
• Appendix AA - Reserved
• Appendix BB - Rural Parish Map
• Appendix CC - Attestation of Provider Network
• Appendix DD - Person First Policy
• Appendix EE - Provider Incentive Payments Template
• Appendix FF - Reserved
• Appendix GG - State Fair Hearing Companion Guide
• Appendix HH - Systems Companion Guide
• Appendix II - Financial Reporting Guide Instructions
• Appendix JJ - Financial Reporting Template
• Appendix KK - Financial Reporting Guide Appendix A - Annual Disclosures

ADDITIONAL INFO

• Letter of Intent for Dental Providers