Coordination of Benefits

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.

If you have other insurance that includes dental benefits, please complete the form below.

Last Date of Update 12/22/2021

*Nevada Medicaid Member First Name

*Nevada Medicaid Member Last Name

*Nevada Medicaid ID Number

Name of other insurance company

Other insurance address/phone

Name of family member insured thru them

Relationship of family member to Nevada Medicaid member

Effective date of other coverage

Group, Policy, Member Numbers of other coverage

Type of other coverage

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