Dental Services | Louisiana Department of Health

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Dental Benefit Plan Independent Review

Independent Review Process

This process was established by revisions La-RS 46:460.90, et seq. to resolve claims disputes when a provider believes a Dental Benefit Plan Manager (DBPM) has partially or totally denied claims incorrectly. A DBPM’s failure to send a provider a remittance advice or other written or electronic notice either partially or totally denying a claim within 60 days of the DBPM’s receipt of the claim is considered a claims denial.

Effective August 1, 2018, there will be a $250 fee associated with an independent review request. If the independent reviewer decides in favor of the provider, the DBPM is responsible for paying the fee. Conversely, if the independent reviewer finds in favor of the DBPM, the provider is responsible for paying the fee.

The independent review process is only one option a provider has to resolve claims payment disputes with a DBPM. In lieu of requesting independent review, a provider may pursue any available legal or contractual remedy to resolve the dispute.

Remember to send in the Provider Appeal and Reconsideration Form to the DBPM before you ask LDH for an Independent Review. To access the form visit the appropriate DBPM’s website or download the appeal form using the links below.

LDH Independent Review Request Forms for Mailing:
Dental Benefit Plan Independent Review Request Form

Mail to:
LDH/Program Operations and Compliance
P.O. Box 91283, Bin 32
Baton Rouge, LA 70821-9283
Attn: Dental Benefit Plan Independent Review

Submit Electronically

The Louisiana Department of Health (LDH) administers the independent review process, but does not perform the review of the disputed claims. When a request for independent review is received, LDH determines that the disputed claims are eligible for independent review based on the statutory requirements. If the claims are eligible, LDH will forward the claims to a reviewer that is not a state employee and is independent of both the DBPM and the provider. The decision of the independent reviewer is binding unless either party to the dispute appeals the decision to any court having jurisdiction to review the independent reviewer’s decision.