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IntroductionProgram ObjectiveThe primary objective of the DentaQuest Louisiana Medicaid Dental program is to create acomprehensive dental care system offering quality dental Covered Services that areMedically Necessary to eligible Louisiana residents. We emphasize early intervention andpromote access to necessary dental care, thereby improving health outcomes forLouisiana residents.Are you building a “Dental Home” for your members?Effective January 1, 2021, DentaQuest USA Insurance Company, Inc. (DentaQuest) will beimplementing the Dental Home program in Louisiana for Medicaid Members.The Main Dental Home is a place where a child’s oral health care is delivered in acomplete, accessible and family-centered manner by a licensed dentist. This concept hasbeen successfully employed by primary care physicians in developing a “Medical Home” fortheir Members, and the “Dental Home” concept mirrors the “Medical Home” for primarydental and oral health care. If expanded or specialty dental services are required, thegeneral dentist is not expected to deliver the services, but to coordinate the referral and tomonitor the outcome.Provider support is essential to effectively employ the Dental Home program for MedicaidDental Program Members. With assistance and support from dental professionals, asystem for improving the overall health of children in the Medicaid Program can beachieved.Dental Home InitiativeProviders who are contracted with DentaQuest for the Louisiana Medicaid Dental Programwill automatically be included in the Dental Home Initiative.For additional information regarding the Dental Home program, please connect to theDentaQuest Provider Web Portal www.dentaquest.com under Related Documents – DentalHome.Assigning members to a Dental HomeDentaQuest’s Dental Home auto-assignment function follows the below hierarchy whenassigning members to a dental home: If the member has history with a provider office, the member is assigned to theprovider office with which they have history in order to support the continuation of anexisting provider/member relationship. If the member does not have history with a provider office, but they have a familymember that is assigned to a provider office, the member is assigned to the sameprovider office that their family member is linked to. This ensures family members arekept together. If the member does not have history or a family member assigned to a dental home, themember is assigned to the closest higher-performing provider office that is acceptingnew members and has open capacity.Member choice:7DentaQuest LLC December 20, 2020Current Dental Terminology American Dental Association. All Rights Reserved.

A member may change their Dental Home at any time by calling the Customer Careteam.Provider OptimizationThe intent of Provider Optimization is to increase access to care, ensure quality and reducecosts.To support Provider Optimization, DentaQuest: Monitors provider performance on a regular basis and delivers the ProviderPerformance Report which measures provider performance in these areas: a) SilverDiamine Fluoride, b) Sealants, c) Fluoride Treatments and identifies those providersthat consistently deliver higher-quality care at an appropriate price point and thoseproviders that need to improve. Reserves the right to move members away from their currently assigned dental hometo a dental home providing higher-quality, lower-cost care if their current dental homehas a history of performing lower-quality, higher cost care.Providers are strongly encouraged to attend a minimum of one patient centered dental homewebinar annually. The patient centered dental home is an important part of our partnership withyou to enhance member participation and improve quality of care. Webinars will include helpfulhints and practical information on how to increase your recalls and use the resources such aspanel rosters in your practice patient outreach. DentaQuest requires that all patientcommunications maintain the upmost professional integrity, including but not limited to serviceswhich are related to network incentive plans.Outreach and Wellness Initiatives – for EPSDT membersThrough collaborative efforts with dental providers DentaQuest will work to improve theoverall oral health of the Members served through the Louisiana Medicaid Dental program,increase access to care, and assess, prevent and manage oral disease. AnnuallyDentaQuest will launch a comprehensive outreach program to reach Membersencouraging them to establish a dental home, have regular preventive check-ups and takean active role in oral health care.Our It Takes Two dental home program emphasizes the many benefits of establishing adental home, developing a PCD relationship and regular preventive care (EPSDT) includingsealants and fluoride treatments. Dental Homes will be established for Members throughan assignment process as stated on page 5.We connect with Members to stress that preventive care is one of the best ways to achieve good oraland overall health. We disseminate this message to Members and their parents or authorizedrepresentative by employing multiple communications channels. These include; as part of theDentaQuest Louisiana Medicaid Dental Annual Access Proposal: Member handbook Provider directory Welcome packets Annual appointment reminder (EPSDT) Broken appointment postcard Non-compliant reminders Member newsletters Grassroots rural, community and screening outreach events statewide8DentaQuest LLC December 20, 2020Current Dental Terminology American Dental Association. All Rights Reserved.

Oral Health Matters – an educational series on important oral health topics Through providers via prevention-based programs, provider web portal and provider newsletters.As the initiatives are launched dental providers will receive additional information aboutthe It Takes Two Dental Home and Preventistry programs.Becoming a Dental Outreach VolunteerWant to help children learn how important their teeth are? Do you want to do somethingsatisfying and of great service to your community? Then become a Dental Outreachvolunteer!Volunteers are wanted across Louisiana to assist with a variety of outreach eventsregarding the importance of children’s oral health. Licensed dentists are needed toprovide brief dental screenings and general volunteers to assist with registration and oralhealth education.Each outreach event only lasts a few hours but is extremely beneficial to children andfamilies. All dental screening supplies are furnished, and outreach staff is alwaysavailable to support volunteers in any way necessary.Medically Necessary Covered ServicesDentaQuest is responsible for administering Louisiana Medicaid Dental Program-covereddental benefits as medically necessary for Medicaid eligible Members. A comprehensive listof the Covered Services codes can be found in Exhibit A of this manual. DentaQuest mustprovide coverage in a manner which satisfies all regulatory rules and regulationsestablished through Louisiana’s Medicaid Managed Care Program by The State ofLouisiana, Department of Health.9DentaQuest LLC December 20, 2020Current Dental Terminology American Dental Association. All Rights Reserved.

1.00General Information1.01 Member Rights and ResponsibilitiesA. IntroductionThe mission of DentaQuest is to expand access to high-quality, medically necessary,and compassionate health care services within the allocated resources.DentaQuest is committed to ensuring that all Louisiana Medicaid Dental ProgramMembers are treated in a manner that respects their rights and acknowledgesMembers’ responsibilities. Members have the right to receive medical services andhave certain responsibilities to aid in receiving them in accordance with theLouisiana Medicaid Dental Program. The following is a statement of Member Rightsand Responsibilities.B. Member RightsAs a Member of the Louisiana Medicaid Dental Program, Member rightsinclude but are not limited to the following: to be treated with respect and recognition of their dignity and need forprivacy; to be provided with information about the organization, its services, thepractitioner providing care, and Member rights and responsibilities; to be able to choose dentists within the limits of the plan network, includingthe right to refuse care from specific practitioners; to participate in decision-making regarding their dental care; to voice complaints or appeals about the organization or care provided; to be guaranteed the right to request and receive a copy of his or her dentalrecords and to request that they be amended or corrected as specified in45CFR part 164; to be guaranteed the right to be free from any form of restraint or seclusionused as a means of coercion, discipline, convenience, or retaliation; to be free to exercise his or her rights, and that the exercise of those rightsdoes not adversely affect the way the DBPM and Its providers or The Stateagency treat the Member, and; to be guaranteed the right to receive information on available treatmentoptions and alternatives presented in a manner appropriate to the Member'scondition and ability to understand.Additional Member rights are as follows:ConfidentialityAll dental information about Louisiana Medicaid Dental Program Members isconfidential. Members have the right to be treated with respect and recognition oftheir dignity and need for privacy when receiving their dental care. Provider andDentaQuest will ensure that patient care offices/sites have implementedmechanisms that guard against the unauthorized or inadvertent disclosure ofconfidential information to persons outside of the dental care organization.Provider and DentaQuest shall hold confidential all information obtained by itspersonnel about Members related to their examination, care and treatment and10DentaQuest LLC December 20, 2020Current Dental Terminology American Dental Association. All Rights Reserved.

shall not divulge it without the Member's authorization, unless: it is required by law; it is necessary to coordinate the Member's care with physicians, hospitals, orother health care entities, or to coordinate insurance or other matterspertaining to payment; or it is necessary in compelling circumstances to protect the health or safety ofan individual.Release of information shall be reported to the Member prior to disclosure to give theMember sufficient time to object should the Member wish to. Member records maybe disclosed, whether or not authorized by the Member, to qualified personnel forthe purpose of conducting scientific research that has been approved by anInstitutional Review or Privacy Board, but these personnel may not identify, directlyor indirectly, any individual Member in any report of the research orotherwise disclose participant identity in any manner.DentaQuest and the Provider shall ensure all materials and information directly orindirectly identifying any current or former Member which is provided to or obtained byor through DentaQuest’s performance of its contract with LDH, whether verbal, written,taped, or otherwise, shall be maintained in accordance with the standards ofconfidentiality of LA. Admin. Code Title 46 § XXXIII, Title 42, Part 2, Code of FederalRegulations, the Privacy Act of 1974, 5 USC 552a, the Medicaid regulations, 42 Codeof Federal Regulations 431.300 et seq., IRC Section 6103(p), and the Health InsurancePortability and Accountability Act of 1996, (“HIPAA”) as amended, and, unless requiredby applicable law, shall not be disclosed except in accordance with those Titles or toLDH, and the Centers for Medicare and Medicaid Service of the United StatesDepartment of Health and Human Services, or their designees.Informed ConsentA Member’s consent is required for all treatment, unless there is an emergency andthe Member’s life is in serious danger. Members have the right to participate indecisions regarding their health, including consent to have invasive treatment. Ifwritten consent is required for special procedures, such as surgery, Members mustunderstand the procedure and why it is advised. Should Members not want aparticular treatment, they have the right to discuss their objections with theirProvider, who will advise and discuss options. The final decision is up to theMember.Emergency ServicesA member can access a DentaQuest dentist for emergencies 24 hours a day, sevendays a week. An enrollee should ask their provider how to contact him or her in anemergency. Their provider may have a different telephone number to call in anemergency.Dental RecordsMembers have the right to request access to their dental records as provided byState and federal laws. When transferring to another dental provider, Members havethe right to request access to their dental records free of charge.11DentaQuest LLC December 20, 2020Current Dental Terminology American Dental Association. All Rights Reserved.

Members have the right to request restriction of uses and disclosures. Provider mustaccommodate reasonable requests by Members to receive communications of PHIfrom the provider by alternative means or at alternative locations.Provider must permit Members to request that the provider amend the PHI in theMember’s record. Provider may require that Members make the request in writingand provide a reason to support a requested amendment.Members have the right to receive an accounting of disclosures in the ten (10) yearsprior to the date the Member requests the accounting.For the most up to date and detailed information regarding HIPAA and Memberrights go to ationNot being discriminated against by your health care Provider on the basis of yourage, sex, race, color, religion, physical or mental handicap, national origin, economicstatus or payment source, type/degree of illness or condition, or any otherclassification protected by federal and state laws and regulations.Providers shall agree to cooperate with LDH and DentaQuest during discriminationcomplaint investigations. In addition, the Provider must assist Louisiana MedicaidDental Program enrollees in obtaining discrimination complaint forms and assistancefrom

Jan 08, 2020 · 4 DentaQuest LLC December 20, 2020 Current Dental Terminology American Dental Associat