LIBERTY Dental Plan Corporation received full Dental Plan accreditation by URAC as of 7/1/2019

2017
HITRUST Certified

LIBERTY received HITRUST CSF v8.1 certified status for its Health Solutions Plus core application and supporting systems as of 11/20/17

2020
HEDIS NCQA Certified

LIBERTY Dental Plan was presented with a

2020 NCQA-Certified HEDIS^® Compliance Audit™

by AttestHealth Care Advisors, LLC, an NCQA certified audit group.

File a Grievance or Appeal

Language Assistance Information | 語言協助信息 | Información sobre Asistencia en su Idioma

LIBERTY Dental Plan of California Notice of Language Assistance Services PDF Icon

California Exchange Notice of Language Assistance Services PDF Icon

LIBERTY Dental Plan of Florida Notice of Language Assistance Services PDF Icon

Florida Exchange Notice of Language Assistance Services PDF Icon

LIBERTY Dental Plan of Missouri Notice of Language Assistance Services PDF Icon

LIBERTY Dental Plan of Nevada Notice of Language Assistance Services PDF Icon

LIBERTY Dental Plan of New Jersey Notice of Language Assistance Services PDF Icon

LIBERTY Dental Plan of Oklahoma Notice of Language Assistance Services PDF Icon

For additional information, please call a LIBERTY Dental Representative
at 1-888-703-6999.

LIBERTY Dental Forms

(All forms available for download in PDF format)

Member Satisfaction Survey
ADA Claim Form
HIPAA Authorization Medical\Dental Release Form	- Spanish Version
Clinical Criteria and Practice Parameters
HIPAA Privacy Notice

The materials provided to you are guidelines used by this Plan to authorize, modify, or deny care for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and the benefits covered under your contract.

Member Handbooks & Evidence of Coverage (EOC)

California

LDP Individual EOC Booklet Spanish

LIBERTY Dental Plan CA Group EOC Booklet Spanish

Nevada

NV-100 through NV-1000 NV Commercial DHMO - EPO

Patriot NV-100 through Patriot NV-900NV Commercial Patriot Plan

Elite PPO, Signature PPONV Commercial PPO Plans

NV-500 POSNV Commercial Point of Sales Plans

LIBERTY Dental Plan NV Member Handbook Spanish

Florida

Individual FL Individual Plans

Group FL Group Plans

LIBERTY Dental Plan FL Member Handbook Spanish

Missouri

Missouri – EOC Booklet

Medi-Cal

Los Angeles Prepaid Health Plan (PHP) Member Handbook Spanish
Sacramento Geographic Managed Care (GMC) Member Handbook Spanish