Medicaid Prepaid Dental Health Plan Contract

Note: The 2006-2009 Dental Contract was extended through 2010 and into 2011.

Standard Contract [63KB, PDF]
Attachment I: Scope of Services [635KB, PDF] 
Attachment II: Business Associate Agreement [26KB, PDF]
Attachment III: Lobbying [13KB, PDF]
Attachment IV: Debarment Form [28KB, PDF]
Attachment V: Subcontractor Utilization Report Form [50KB, PDF]

2011 Templates:

Financial[194KB, XLS]
Enrollee-Dental-User[46KB, XLS]
FQHC Report [47KB, XLS]
Grievance [87KB, XLS]
Incentive-Distribution[69KB, XLS]
Service Utilization [1.02MB, XLS]
CHCUP-Dental 60%[28KB, XLS]
Dental Health CheckUp-CMS416 [61KB, XLS]