| The Dentcare Quality Assurance Program is designed to provide information necessary to monitor all aspects of the dental programs provided by Dentcare. One aspect of the program addresses the Participating Panel of Providers. Monitoring is conducted in the following areas: 1. Credentialing All Participating Providers are credentialed upon acceptance to the panel of Providers and credentials are reviewed every two years. 2. Provider Relations All Participating Providers are audited regularly by personnel with dental background, i.e. dental hygienist and/or certified dental assistant. Site auditors are required to file an audit report which covers many areas, i.e.: a. The dental facility b. Compliance with all health regulations c. Patient records, including x-rays, compliance with patient guidelines and co-payments (if any). 3. Subscriber Relations One of the many duties of Subscriber Relations is to monitor, respond to and record all instances of complaints/questions about benefit guidelines and/or co-payment related issues. 4. Claims All major dental services must be pre-authorized by Dentcare. Claims are reviewed by dental consultants who check for compliance with plan guidelines. The above-cited information is reviewed monthly by the Quality Assurance Committee to assure that the program is meeting the needs of our subscribers.
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