Full Medicaid Pricing (FMP) Program Initiative for Dentists

Medicaid FMP Contracts for NEXT Fiscal Year

If you are a Medicaid provider who initially chose not to submit a Letter of Intent to participate in the Louisiana Full Medicaid Pricing (FMP) program for dental Medicaid providers (or if you were not a Medicaid provider at that time), the Louisiana Department of Health (LDH) is allowing us to contract new providers with a starting date of July 1, 2020.

However, the caveat is that a contract must be submitted immediately. If you submitted a contract already, you DO NOT NEED TO RESEND A CONTRACT. You will automatically stay in the program for the next fiscal year.

Please complete and sign the attached by Wednesday, May 27, 2020, to participate. Below are instructions for completion of the attached Dental Services Agreement between each dental provider and the Louisiana Medicaid Dental IPA, Inc. (“IPA”), and a brief summary of the program. The LDA is assisting the IPA with disseminating these agreements to you.


  1. Insert the provider’s name on page 1 – this should be the name of the person or entity that receives Medicaid payments.
  2. Please complete Exhibit 1.5 with your identifying information. If you have multiple providers who bill under a single Medicaid provider number, you should list the primary billing entity/individual, the number and the other providers who also bill under that number.
  3. Attach the provider’s W9 (for Exhibit 2.3.9).
  4. Sign, date and give the provider’s address on page 10.
  5. Return the signed contract including exhibits to Emily Black Grey, JD at Breazeale, Sachse and Wilson, LLP via email This email address is being protected from spambots. You need JavaScript enabled to view it. or fax 225-381-8029.

Please contact Emily at 225-381-8011 to address any issues with transmitting the agreement.


The IPA is working with the Louisiana Department of Health (“LDH”) on the final stages of implementation of the Dental Full Medicaid Pricing (“Dental FMP”) Program. One requirement of participation in the Dental FMP program is affiliating with the LSU School of Dentistry (“LSUSD”). The LSUSD has authorized the IPA exclusively to affiliate dentists with the LSUSD, as set forth in Louisiana Medicaid State Plan Amendment No. 17-0011. The attached Agreement accomplishes the LSUSD affiliation and assists LSUSD in meeting its obligations under its agreement with the dental Medicaid managed care organization(s) including as MCNA, including its obligation to increasing access to oral health.

In addition to the affiliation with LSUSD, the Agreement also sets forth the initial criteria that will be used in calculating the quarterly FMP payments to dentists known as “Payment Enhancement Protocols” or “PEP.” It is important to note that the FMP Payments do not replace the payments or existing obligations between dentists and the dental managed care organization (currently MCNA). The FMP payments are different in character than payments for services to the managed care organization’s Medicaid enrollees.

The Agreement also outlines obligations of the providers, including reporting data when necessary and other provider representations.

If you are already a provider or just signed up, please click here to let the LDA know so that we can maintain updated records.

For the most recent updates and information from the Department of Health and Hospitals, visit the Louisiana Medicaid Web site at

Dental Benefits Covered by Each of Healthy Louisiana's 5 Health Plans

Healthy Louisiana (previously called Bayou Health) is the way most of Louisiana's Medicaid and LaCHIP recipients receive health care services. In Healthy Louisiana, Medicaid recipients enroll in a Health Plan. These Plans differ from one another in several ways, including their provider networks, referral policies, health management programs and extra services and incentives offered. Each of these Plans is accountable to the Louisiana Department of Health (LDH).

Healthy Louisiana features five health plans, and each offers dental benefits for Adults 21 years and older, beyond the traditional adult denture services and dental care for children and adolescents that have been available under Medicaid in Louisiana previously.

The five Healthy Louisiana plans are:
  • Aetna Better Health
  • Healthy Blue (formerly Amerigroup Real Solutions)
  • Amerihealth Caritas Louisiana
  • Louisiana Healthcare Connections
  • UnitedHealthcare Community Plan

A dentist is NOT required to be a certified provider with MCNA (broad coverage to children under 21 years of age) to enroll as a Healthy Louisiana dental provider. Because of this, there is an opportunity for dentists to participate in one or more of these Healthy Louisiana plans.


HOW TO CONTRACT WITH MCNA DENTAL (Louisiana's dental benefit program manager)

In 2014, MCNA Dental was selected by the Louisiana Department of Health and Hospitals to administer its Medicaid and CHIP dental programs statewide. MCNA would like to invite all Louisiana dentists to join the MCNA network of dentists. For your convenience, the documents that must be completed and submitted for credentialing are available on our website

• Credentialing Application (Please submit one application per dentist)
• W-9 Form
• Direct Deposit EFT Form

In order to ensure your facility is listed in their provider directory, please complete each of the documents and fax them to 1-504-335-2263, or email them to This email address is being protected from spambots. You need JavaScript enabled to view it..

HOW TO CONTRACT WITH HEALTHY LOUISIANA (Louisiana's medical Medicaid program managers, updated 10/23/19)

All five Healthy Louisiana plans offer a limited dental benefit in addition to the current Medicaid Dental Benefit managed by MCNA.

Amerigroup and Aetna contract with DentaQuest to manage the dental benefit. Information relative to credentialing and benefits offered can be found on the Dentist Page link at or by contacting the credentialing hotline at 1-800-233-1468.

AmeriHealth Caritas of Louisiana (ACLA) contracts with FCL Dental d/b/a DINA Dental. Contact 1-877-587-9331, visit, or e-mail This email address is being protected from spambots. You need JavaScript enabled to view it. to receive additional information on joining FCL as a partnering provider.

Louisiana Healthcare Connections contracts with Envolve Dental to manage their dental benefit. For information relative to credentialing and benefits offered, go to or contact the Envolve Dental contracting team at 1-855-688-6589 or This email address is being protected from spambots. You need JavaScript enabled to view it..

United Healthcare Community Plan of Louisiana (UHC) ask interested dental providers to contact the United Healthcare Dental Provider Services line at 1-844-275-8751.


Health Professional Shortage Area (HPSA)

HPSAs are defined service areas that demonstrate a critical shortage of primary care physicians, dentists, or mental health providers. An HPSA can be a distinct geographic area such as a parish or grouping of census tracts, a specific population group within a defined geographic area (such as a population under 200% poverty), or a specific public or non-profit facility such a state hospital. You can learn more about HPSAs by visiting the Louisiana Department of Health and Hospitals (DHH) website.

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5637 Bankers Ave.
Baton Rouge, LA 70808
(225) 926-1986  |  (800) 388-6642
(225) 926-1886  Fax

Links with this symbol are password protected for LDA members only.
5637 Bankers Ave.
Baton Rouge, LA 70808
(225) 926-1986  |  (800) 388-6642
 Fax (225) 926-1886