Applying to Join the Dentegra Network
Request information or a Dentegra Dentist Information Package from: firstname.lastname@example.org, or call 866-238-1580.
Your Network Contract Terms
Once you’ve been accepted into our Dentegra network, your contract is in effect until you let us know otherwise. If you have any questions or concerns, please give our network development specialists a call at 866-238-1580.
Our Credentialing/Re-credentialing Process
We are required to confirm your professional qualifications to treat enrollees. We credential each provider as part of the initial application process prior to joining the Dentegra network and re-credential every three years thereafter. Our credentialing and re-credentialing process is based on the standards of national, federal and state accrediting and regulatory agencies. All your information submitted for the credentialing/re-credentialing process is kept confidential.
Credentialing activities involve verifying each treating provider’s submitted information with regulatory agencies, professional associations and educational institutions to ensure the provider is legally qualified to practice. Our credentialing criteria and guidelines are used to verify dental providers meet and maintain the required standards.
To achieve this goal, our credentialing procedures are focused on confirming the following elements:
- Completed Credentialing Form that attests to ability to practice
- Valid and current license to practice (state dental license)
- Hospital privileges, if applicable
- Permits and registrations that are current, including DEA, conscious sedation, oral conscious sedation and general anesthesia, if applicable
- Board Certification of specialty/residency completion/medical school, if applicable
- Current acceptable professional liability insurance coverage limits
- Professional liability claims history, including previous lawsuits, if any
- Application processing — professional questions and attestation
- National Practitioner Data Base (NPDB) information
- Medicare and Medicaid sanctions
- Sanctions against licensure — state license limitations
- Prior work history
National Provider Identifier (NPI)
Obtaining your NPI is simple and once obtained, it stays with you for life. To obtain your NPI, simply go to the National Plan and Provider Enumeration System and follow the instructions to complete the application.
Check out our Why You Should Get an NPI? article to learn more about NPIs, and why we recommend every dental provider have one.
Updating Your Information
Keep your records up-to-date. Let us know in advance of any office updates so enrollees have access to your correct information, and we do not delay processing your claims.
- Update your Provider Directory listing
- Selling your practice? To make your sale as smooth as possible, start with filling out a Sale of Practice Notification form.
Seeing Patients with a Dentegra Policy?
Find out how to seamlessly provide dental care to your Dentegra enrollees. Here are a few tips to help you get started:
- If you haven’t already, register for secure online access to provider’s resources & tools
- Log in and review your Dentegra Dental Provider Handbook for processing policies and detailed guidelines
Check Eligibility & Benefits
- Log in to your secure provider account, or use our automated phone system at 877-280-4204
- Use the standard ADA claim form, or download a Dentegra claim form
- Get your money faster by submitting your Dentegra claims electronically using Payer ID #88888
- Dentegra Individual PPO plans do not coordinate coverage and always pay as primary
Payments from Dentegra
- Make sure your Tax Identification Number (TIN) has been submitted so we can identify how to make claim payments to your office
- We process your claims within five business days. Paper checks will arrive by mail, or you can sign up for direct deposit.
Troubleshooting Your Online Provider Account Access
Don’t have an account? Register. You’ll need your TIN, City, Zip Code, Provider First and Last Name, License Number and State. Look for the mark to guide you through your registration process.
Didn’t receive, or lost your authorization code to complete registration? That’s an easy fix, just give us a call at 877-280-4204.
Forgot your username or password?
Any other issues, call us at 877-280-4204
Still Have Questions?
Contact the following departments below:
Processing Center for Claims:
P.O. Box 1850
Alpharetta, GA 30023-1850
Payer ID: 88888
P.O. Box 1850
Alpharetta, GA 30023-1850
Hours: 7 a.m. to 8 p.m. Eastern Time
Practice Maintenance and Demographic Updates: