Get the free Provider application - DentaQuest Provider Network Enrollment Portal
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12121 North Corporate Parkway, Mellon, WI 53092 (262) 241-7140 or (800) 417-7140 Fax (262) 241-7401 **INCOMPLETE APPLICATIONS WILL DELAY THE CREDENTIALING PROCESS** 1. 2. 3. 4. Please print or type
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How to fill out provider application - dentaquest
How to fill out provider application - DentaQuest:
01
Visit the DentaQuest website or contact their customer service to obtain the provider application form.
02
Carefully read and review all instructions and requirements mentioned in the application form.
03
Gather all the necessary documents and information required for the application, such as your professional credentials, contact details, office location, and any relevant certifications.
04
Fill out the application form accurately and completely. Be sure to provide all the requested information and double-check for any errors or omissions.
05
Attach any supporting documents or additional information requested in the application. This may include proof of malpractice insurance, copies of professional licenses, or any other relevant documentation.
06
Review the completed application form and supporting documents to ensure everything is accurate and well-organized.
07
Submit the filled-out application form and supporting documents to DentaQuest as instructed. This can usually be done through mail, email, or an online submission portal.
08
Keep a copy of the submitted application and any supporting documents for your records.
09
Wait for a response from DentaQuest regarding the status of your application. This may take some time, so be patient.
10
If your application is approved, follow any additional steps or requirements provided by DentaQuest to become a contracted provider.
Who needs provider application - DentaQuest?
01
Dental professionals, such as dentists, dental hygienists, and orthodontists, who wish to become contracted providers with DentaQuest.
02
Healthcare facilities and practices that offer dental services and want to expand their network by partnering with DentaQuest.
03
Individuals or organizations interested in becoming providers for Medicaid or CHIP dental programs administered by DentaQuest.
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What is provider application - dentaquest?
Provider application - dentaquest is a form that dental professionals must submit to be a participating provider in the DentaQuest network.
Who is required to file provider application - dentaquest?
Dental professionals who wish to become part of the DentaQuest network are required to file the provider application.
How to fill out provider application - dentaquest?
The provider application - DentaQuest can be filled out online or by mail, following the instructions provided on the form.
What is the purpose of provider application - dentaquest?
The purpose of the provider application - DentaQuest is to establish a contractual agreement between the dental professional and DentaQuest, allowing the professional to provide services to patients within the network.
What information must be reported on provider application - dentaquest?
The provider application - DentaQuest typically requires information such as contact details, qualifications, services offered, and billing information.
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