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.
Source: 23 SDR 197, effective May 26, 1997.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.