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PROVIDER POLICIES AND PROCEDURES

Accessibility of Services

Advanced Directives Policy

Adverse Outcomes

Annual Attestations - Certificate of Compliance

Anti-Bribery and Corruption

Appointment Scheduling

Assigning of DCO Enrollees

Availability of the Code of Conduct and Ethics Standard

Buy-ups and Enrollee Fee Responsibility

Billing of Other Preventive Services

Care Coordination

Chart Audits

Chief Ethics and Compliance Officer; Corporate Compliance Committee

Childhood Caries Prevention (CCP)

Code of Conduct

Communication Services

Comorbidity

Compliance Program

Compliance Investigation

Compliance Monitoring and Communication

Confidentiality

Conflict of Interest (Regular Employees)

Corrective Action Plan Management

Credentialing System Controls

Credentialing and Recredentialing

Cultural Responsiveness Training

Delegation Oversite

Dental Records

Development and Execution of Compliance CAP

Disenrollment from DCO

Dismissal of Member from Practice

Duty to Report Non-Compliance; Non-Retaliation

Early Childhood Caries Prevention (ECCP) Protocol

EHR System

Emergency Services

Encounter Data Submission and Audit

Enforcement and Discipline

Enrollee Correspondence

Enrollee Grievance and Appeals

Enrollee Information and Education

Enrollee Rights and Responsibilities

False Claims Act Information

Flexible Services

Health Related Services

Hospital Dentistry

Hospital Emergencies

Inter-Rated Reliability

Mandatory Reporting for Child, Elder and Diabled Abuse

Medicaid Program Integrity-Fraud, Waste and Abuse

Member Rights Communication

Member Services

Moral Objections Policy

Network Adequacy Policy

Non-Discrimination

Non-Discrimination Compliance Program

Notice of Action Benefit Denial

OIG GSA Exlusion Review

Oral Hygiene Instructions and Tobacco Cessation

Out of Network Services

Over and Under Utilization

Pain Medication Policy

Patient Records

Policy and Procedure Development and Version Control

Policy and Procedure Protocol

Practice Guidlines

Pre-Authorization

Privacy

Provider Credentialing Appeal Rights

Provider Directory

Provider Training

Provision of Provider Training

Quality Assurance Program

Record Retention Management

Referrals

Seclusion and Restraint

Second Opinion Request

Teledentistry

Third Party Recovery

Timely Access Monitoring

Tobacco Cessation

Training and Education

Transition of Care

Transportation Services

Treatment Planning and Documentation

Utilization Management Processes to Avoid Conflict of Interest

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Advantage Dental The Advantage Community
Corporate Office
63140 Britta St. Suite D104 Bend, Oregon 97703-9802
P 541 504 3900 | F 541 504 3907

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Advantage Dental Plan ® is a registered trademark of Advantage Dental Plan Inc.

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