DENTAL PROVIDERS - Continuous Quality Improvement Program

All participating Family Dentists and Specialists are subject to a credentialing process to ensure their qualifications meet our high standards. The program provides that Beta Health Association should:

• Perform background checks with the State Board of Dental Examiners
• Validate proof of current dental license
• Validate proof of current DEA and Radiology Certification where applicable
• Validate proof of professional liability insurance
• Review information regarding any past malpractice history, including past or present license sanctions

The Quality Improvement Program provides that Beta Health Association carefully screen each contracted provider in order to ensure our continuous quality improvement standards are met. All providers are subject to an initial credentialing which closely evaluates their professional training and identifies the range of Dental Services they are approved to render. Each prospective provider is required to submit a Dentist Application that contains information on education and professional background, current permits to practice dentistry, Drug Enforcement Agency license, and applicable certificates to dispense controlled substances.

All providers must have a current dental license, which is screened for sanction status and malpractice history. This is verified with the State Board of Dental Examiners. Additionally, all providers must have current professional liability insurance. If a prospective provider meets these tough standards, he/she may be admitted into the provider network.

Upon successful completion of the credentialing process, an initial training session will be scheduled. The provider and all appropriate dental office personnel will be trained on how to comply with Beta Health Association’s various administrative procedures. A Dental Office Reference Manual will be distributed, and any questions which the provider or his staff may have will be addressed.

The Quality Improvement Program provides that the recredentialing process occur every year. It includes a reverification of credentialing documents (such as the dental license, liability insurance, and DEA registration certificate) and an on-going evaluation of provider’s performance with Beta Health Association.

The Quality Improvement Program provides that Beta Health Association will monitor the quality of dental services rendered by its providers on an on-going basis. Beta Health Association’s continuous Quality Improvement Program insures that all contracted providers provide convenient and accessible dental care to members on a consistent basis and in a cost-effective manner. The performance of our network dentists is evaluated through the following mechanisms:

Accessibility of Dental Services

1. Providers are available for emergency care after normal business hours.
2. Members clearly understand how to access emergency care.
3. Emergency care is available 24 hours a day, 7 days a week.
4. Appointments for routine and preventive treatment are available within a reasonable time frame.
5. Members can access their dentist via telephone.

In addition, the geographic distribution of providers to members is evaluated to help maintain that a sufficient number of providers are available in the network to meet the needs of the enrolled membership.

If needed, Beta Health Association will take the actions necessary to ensure that the highest quality of dental services are offered to our members.