Section 16.03.09.804 - DENTAL SERVICES: PROCEDURAL REQUIREMENTSProviders must enroll in the Idaho Smiles network with the dental insurance contractor and meet both credentialing and quality assurance guidelines of the contractor.
01.Administer Idaho Smiles. The contractor is responsible for administering the Idaho Smiles program, including dental claims processing, payments to providers, customer service, eligibility verification, and data reporting.02.Authorization. The contractor is responsible for authorization of covered dental services that require authorization prior to claim payment.03.Grievances. The contractor is responsible for tracking and reporting all grievances to the State's contract monitor.04.Appeals. Appeals are handled by a process between the contractor and the Department as specified in IDAPA 16.05.03, "Contested Case Proceedings and Declaratory Rulings," and in compliance with state and federal requirements.Idaho Admin. Code r. 16.03.09.804