Get the free Dental Provider Credentialing Application - Premera Blue Cross

P.O. Box 327 Seattle, WA 98111-0327 DENTAL PROVIDER CREDENTIALING APPLICATION This application is not a contract. The information provided in this application is used to determine whether a practitioner

How to fill out dental provider credentialing application

How to fill out dental provider credentialing application?

1. Complete personal information section: Provide your full name, contact details, and professional background.
2. Submit supporting documents: Attach copies of your dental degree, licensure, and any additional certifications or training.
3. Provide detailed practice history: Include information about your previous dental positions, including the dates and addresses of the practices.
4. List professional affiliations: Mention any dental organizations or associations you are a member of.
5. Document malpractice history: Disclose any malpractice claims or disciplinary actions taken against you.
6. Include references: Provide contact information for colleagues or supervisors who can vouch for your professional abilities.
7. Submit the application: Review all the information provided and ensure accuracy before submitting the application to the appropriate dental organization.

Who needs dental provider credentialing application?

1. Dentists: Dentists who wish to be recognized as providers by insurance companies or networks will need to complete the dental provider credentialing application.
2. Dental specialists: Orthodontists, periodontists, endodontists, and other dental specialists may also need to undergo credentialing to participate in certain insurance programs or join dental networks.
3. Dental clinics and practices: Dental clinics and practices that want their dentists to be credentialed and recognized by insurance companies or networks will need to submit the credentialing application on behalf of their providers.

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What is dental provider credentialing application?

Dental provider credentialing application is a form or process used to apply for credentials as a dental provider. It is typically submitted to a credentialing organization or insurance company in order to become an approved provider.

Who is required to file dental provider credentialing application?

Dental providers, such as dentists, dental hygienists, and dental assistants, are typically required to file a dental provider credentialing application. This may also apply to dental clinics or practices.

How to fill out dental provider credentialing application?

The dental provider credentialing application typically requires information about the provider's education, training, licensure, professional experience, and references. It may also require a submission of supporting documents, such as copies of licenses or degrees. The application can usually be filled out online or in paper form, following the instructions provided by the credentialing organization or insurance company.

What is the purpose of dental provider credentialing application?

The purpose of dental provider credentialing application is to assess the qualifications and reliability of dental providers before allowing them to participate in a network or offer services to patients covered by specific insurance plans. It helps ensure that dental providers meet the necessary standards of competence and professionalism.

What information must be reported on dental provider credentialing application?

The specific information required on a dental provider credentialing application may vary, but it typically includes details about the provider's education, training, licensure, professional experience, certifications, malpractice history, and references. It may also require disclosure of any disciplinary actions or criminal history.