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

2018
HEDIS NCQA Certified

LIBERTY Dental Plan was presented with a

2018 NCQA-Certified HEDIS^® Compliance Audit™

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

NCQA has reviewed and accredited LIBERTY’s Credentialing and Utilization Management functions only. For complete details on the scope of this review, visit www.ncqa.org.

Texas Provider Resource Library

ADA Claim Form
Clinical Guidelines for Prescribing Fluoride Supplements for Caries Prevention
Electronic Fund Transfer (EFT) Form
Grievance Form - Spanish Version
Informed Consent for Alternative Treatment Form - English
Informed Consent for Alternative Treatment Form - Chinese
Informed Consent for Alternative Treatment Form - Spanish
Justification of Need For Prosthodontics
National Provider Reference Guide
Online Provider Portal User Guide
Opioid Risk Tool
Specialty Care Referral Form

Texas Contracting & Credentialing Documents - Complete Packet

Texas Contracting Packet (all documents) – Medicare
Texas Contracting Packet (all documents ) – Medicaid
Texas Contracting Packet (all documents) – All Lines of Business

Texas Contracting & Credentialing - Individual Documents

Provider Check List
Texas Provider Agreement
Medicare Addendum
Medicaid Addendum
Facility Application
Provider Authorized Signatory Form
Provider Compliance Attestation
W9
Texas State Mandated Credentialing Application

Texas Provider Resource Library

ADA Claim Form
Clinical Guidelines for Prescribing Fluoride Supplements for Caries Prevention
Electronic Fund Transfer (EFT) Form
Grievance Form - Spanish Version
Informed Consent for Alternative Treatment Form - English
Informed Consent for Alternative Treatment Form - Chinese
Informed Consent for Alternative Treatment Form - Spanish
Justification of Need For Prosthodontics
National Provider Reference Guide
Online Provider Portal User Guide
Opioid Risk Tool
Specialty Care Referral Form

Texas Contracting & Credentialing Documents - Complete Packet

Texas Contracting Packet (all documents) – Medicare
Texas Contracting Packet (all documents ) – Medicaid
Texas Contracting Packet (all documents) – All Lines of Business

Texas Contracting & Credentialing - Individual Documents

Provider Check List
Texas Provider Agreement
Medicare Addendum
Medicaid Addendum
Facility Application
Provider Authorized Signatory Form
Provider Compliance Attestation
W9
Texas State Mandated Credentialing Application