{"data":{"id":"us-ky/krs-304.17c-132","jurisdiction":"us-ky","citation":"KRS 304.17C-132","heading":"Definitions for section -- Third party access to provider network","body":"contract -- Prohibition against dental carrier contract cancellation.\n(1) As used in this section:\n(a) \"Contracting entity\" means a dental carrier, a third -party administrator, or any\nother person that enters into direct contracts with providers for the delivery of\ndental services in the ordinary course of business;\n(b) \"Provider network contract\" means a contract between a contracting entity and\na provider that:\n1. Specifies the rights and responsibilities of the contracting entity; and\n2. Provides for the delivery and payment of dental services to a covered\nperson; and\n(c) \"Third party\":\n1. Means an individual or entity that enters into a contract with a\ncontracting entity or with another person to gain access to the dental\nservices or contractual discounts of a provider network contract; and\n2. Does not include an employer or other group for whom the dental carrier\nor contracting entity provides administrative services.\n(2) A contracting entity may grant a third party access to a provider network contract or\na provider's dental services or contractual discounts provided pursuant to a provider\nnetwork contract if:\n(a) At the time the provider network contract is entered into or renewed, or when\nthere are material modifications to the provider network contract relevant to\ngranting a third party access to a provider network contract, the dental carrier\nallows any provider which is part of the dental carrier's provider network to\nchoose to:\n1. Not participate in third-party access to the provider network contract; or\n2. Enter into a provider network contract directly with the health insurer\nthat acquired the provider network;\n(b) The provider network contract includes the following third -party access\nprovisions:\n1. That the contracting entity may enter into an agreement with third\nparties allowing the third parties to obtain the contracting entity's rights\nand responsibilities as if the third party were the contracting entity; and\n2. When the contracting entity is a dental carrier:\na. That the provider network contract grants third -party access to the\nprovider network;\nb. The provider chose to participate in third -party access at th e time\nthe provider network contract was entered into or renewed; and\nc. The provider has the right to choose not to participate in third -\nparty access;\n(c) The third party accessing the provider network contract agrees to comply with\nall of the contract's terms;\n(d) The contracting entity:\n1. Identifies all third parties in existence in a list on its Internet Web site,\nwhich shall be updated at least once every sixty (60) days;\n2. Except for electronic transactions required by the Health Insurance\nPortability and Accountability Act of 1996, Pub. L. No. 104 -191,\nrequires the third party to identify the source of the discount on all\nremittance advices or explanations of payment under which a discount is\ntaken; and\n3. Makes available a copy of the provider netw ork contract relied on in the\nadjudication of a claim to a participating provider within thirty (30) days\nof a request from the provider; and\n(e) The third party's right to a provider's discounted rate ceases as of the\ntermination date of the provider netw ork contract with the exception of\ncovered dental services that are in progress.\n(3) A dental carrier:\n(a) Shall not cancel or otherwise end a contractual relationship with a provider as\na result of the provider opting out of third -party access in accordan ce with\nsubsection (2)(a) of this section; and\n(b) When initially contracting with a provider, shall accept a qualified provider\neven if the provider opts out of a third-party access provision.\n(4) A provider shall not be bound by, or required to provide d ental services under, a\nprovider network contract that has been granted to a third party in violation of this\nsection.\n(5) This section shall not apply:\n(a) If access to a provider network contract is granted to:\n1. A dental carrier or any other entity ope rating in accordance with the\nsame brand licensee program as the contracting entity; or\n2. An entity that is an affiliate of the contracting entity. A contracting entity\nshall make a list of its affiliates available to providers on its Internet\nWeb site; or\n(b) To a provider network contract for dental services provided to beneficiaries of\nstate-sponsored public medical assistance programs, including Medicaid and\nthe Kentucky Children's Health Insurance Program.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=52589","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:49Z","sha256":"27cc6989f383e693216ab225eddcf6a7e3c6849516fbdab4b7e33bdb2d0c403c","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17c-130","next":"us-ky/krs-304.17c-134"},"notice":"GroundRules: Original legal text. Not legal advice."}