S.D. Admin. R. 67:16:06:03.01

Current through Register Vol. 51, page 57, November 12, 2024

Section 67:16:06:03.01 - Contractor to provide certain services

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.

S.D. Admin. R. 67:16:06:03.01

23 SDR 197, effective 5/26/1997.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.