Respondents must provide a response describing how the offeror intends to meet each of the following requirements. Respondents are strongly encouraged to propose innovative solutions targeted at meeting South Dakota Medicaid recipient needs in alignment with Department-specified objectives for the dental program. The anticipated cost of any innovative solutions must be included in the cost proposal. 3.1 Receive South Dakota Medicaid dental claims directly from South Dakota Medicaid dental providers: • Approximately 8,000 IHS dental claims annually; • Approximately 12,000 FQHC dental claims annually; and • Approximately 107,000 private practice claims annually. 3.2 Adjudicate and pay South Dakota Medicaid dental and orthodontic claims using an automated processing system. Utilize the most updated dental claim form. 3.3 South Dakota prefers a system that is certified by the Centers for Medicare and Medicaid Services. If certified in South Dakota, the offeror should include a verification of certification. If not yet certified in South Dakota, offerors should include a description of the states the system has been certified in and a plan to achieve certification within 18 months of implementation of the contract. 3.4 Adjudicate and pay South Dakota Medicaid dental and orthodontic claims in accordance with Federal and State regulations and according to the South Dakota Medicaid State Plan. 3.5 The offeror must adjudicate and pay claims, on average, within seven (7) business days of receipt. 3.6 Provide remittance advice or other appropriate written notice specifically identifying all information and documentation that is required when a claim is partially or totally denied.
