2006-2012 Medicaid Pre-Paid Dental Health Plan Contract:

Note: The 2006-2009 Dental contract was extended through 2011.

Prior Templates:

2010-2012:

Financial [148KB, XLS]
Enrollee-Dental-User [40KB, XLS]
FQHC Report [41KB, XLS]
Grievance and 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 [40KB, XLS]
FQHC Report [36KB, XLS]
Grievance and Appeals [78KB, XLS]
Incentive-Distribution [59KB, XLS]
Service Utilization [1.01MB, XLS]
CHCUP-Dental 60%-0708 (19KB, XLS]
Dental Health Checkup-0708 [21KB, XLS]

2006-2011 Medicaid Prepaid Dental Health Plan Contract (ended 2/2/2012)

Note: The 2006-2009 Dental Contract was extended through February 28, 2012.

Standard Contract [63 KB, PDF]
Attachment I: Scope of Services [653 KB, PDF]
Attachment II: Business Associate Agreement [26 KB, PDF]
Attachment III: Lobbying [13 KB, PDF]
Attachment IV: Debarment Form [28 KB, PDF]
Attachment V: Subcontractor Utilization Report Form [50 KB, PDF]

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]