2006-2009 Medicaid Pre-Paid Dental Health Plan Contract: (note, the 2006-2009 Dental contract has been extended through 2011.)
Prior Templates:
2010 Templates:
Financial (148KB, xls)
Enrollee-Dental-User (40KB, xls)
FQHC Report (41KB, xls)
Grievance & Appeals (82KB, xls)
Incentive-Distribution (63KB, xls)
Service Utilization (1.01 MB, xls)
CHCUP-Dental 60% (22KB, xls)
Dental Health CheckUp-CMS416 (24KB, xls)
2009:
Financial (146KB, xls)
Enrollee-Dental-User (37KB, xls)
FQHC Report (36KB, xls)
Grievance & Appeals (78KB, xls)
Incentive-Distribution (59KB, xls)
Service Utilization (1.01MB, xls)
CHCUP-Dental 60%-0708 (19KB, xls)
Dental Health Checkup-0708 21KB, xls)
2004-2006 Medicaid Prepaid Dental Health Plan Contract:
Standard Contract (42KB, PDF)
Attachment 1: PDF file with Interactive Table of Contents (572KB, PDF)
NOTE: Please be advised that the online version of the 2004-2006 Medicaid Prepaid Dental Health Plan Contract does not contain the following general amendments. Each general amendment should be printed along with the contract.
2004-2006 General Amendment 1 (42KB, pdf)
2004-2006 General Amendment 1 Modification (16KB, pdf)
2004-2006 Amendment 2 (494KB, pdf)
2004-2006 Amendment 3 (487KB, pdf)
2004-2006 Amendment 4 (2.55MB, pdf)
2004-2006 Amendment 5 (172KB, pdf)
