North Dakota Code 26.1-47-02.2 – Dental networks
1. As used in this section:
Terms Used In North Dakota Code 26.1-47-02.2
- Contract: A legal written agreement that becomes binding when signed.
- following: when used by way of reference to a chapter or other part of a statute means the next preceding or next following chapter or other part. See North Dakota Code 1-01-49
- Individual: means a human being. See North Dakota Code 1-01-49
- Person: means an individual, organization, government, political subdivision, or government agency or instrumentality. See North Dakota Code 1-01-49
a. “Affiliate” means a person that directly or indirectly through one or more intermediaries controls, or is under the control of, or is under common control with, the person specified.
b. “Contracting entity” means a person that enters a direct contract with a dental provider for the delivery of dental services.
c. “Network” means a group of preferred dental providers providing services under a network plan.
d. “Network plan” means a dental benefit plan that requires a covered individual to use, or creates incentives, including financial incentives, for a covered individual to use a dental provider managed by, owned by, under contract with, or employed by the dental insurer.
e. “Third party” means an entity that is not a party to a contracting entity’s dental provider network.
2. A contracting entity may grant a third party access to a dental provider network contract, or a provider’s dental services or contractual discounts provided pursuant to a dental provider network contract, if all of the following are met:
a. The contract specifically states the contracting entity may enter an agreement with a third party allowing the third party to obtain the contracting entity’s rights and responsibilities as if the third party were the contracting entity.
b. If the contracting entity is a dental insurer, the dental provider may opt out of the third-party access at the time the dental provider network contract was entered or renewed.
c. The contracting entity identifies, in writing or electronic form to the dental provider, all third parties in existence as of the date the contract is entered or renewed.
d. The contracting entity notifies dental network providers that a new third party is leasing or purchasing the network at least thirty days in advance of the relationship taking effect.
e. The contracting entity makes available a copy of the dental provider network contract relied on in the adjudication of a claim to a participating dental provider within thirty days of a request from the dental provider.
3. A dental provider’s refusal to agree in writing to the third-party access to the dental provider network does not permit the contracting entity to end the contractual relationship with the dental provider.
4. The provisions of this section do not apply if access to a provider network contract is granted to a dental carrier or an entity operating in accordance with the same brand licensee program as the contracting entity or to an entity that is an affiliate of the contracting entity.