Your care makes all the difference

Thank you for your interest in Humana. You can choose to participate in our Preferred Provider (PPO) network, Managed Dental Care (DHMO) network, Humana Advantage Plan (EPO) network, or all three. If you would like more information on participating in the HumanaDental^® network, please complete an application:

Complete dentist network application form

What’s next?

A Humana contracting representative will review your request and contact you to initiate a participation agreement. You’ll have an opportunity to review the agreement and be asked to sign it and return it to Humana. Credentialing may be required before an agreement becomes effective, and you may be asked for additional information to complete credentialing. Once credentialing is complete, you’ll receive a copy of the contract. It will be signed by a Humana representative, and you will be advised of your effective date with Humana.

If you’re a member and interested in referring your dentist to participate in the HumanaDental network, please use our refer a dentist form.

Credentialing is the process of obtaining and reviewing documentation to determine participation status in a health plan. The documentation may include, but not be limited to, the applicant’s education, training, clinical privileges, experience, licensure, accreditation, certifications, professional liability insurance, malpractice history and professional competence. Generally, the terms credentialing and recredentialing include the review of the information and documentation collected, as well as verification that the information is accurate and complete.

Please note:

• For details regarding the credentialing and recredentialing policy, click here, PDF opens new window
• For answers to questions regarding credentialing status or the process described below, please call 1-855-654-3371, Monday through Friday, 8 a.m. to 7 p.m. Central time to speak with our credentialing partner Medversant Technologies.
• If you have a question about a contract, you can send an email to dentalrecruitment@humana.com

Credentialing process

Medversant Technologies processes dental credentialing and recredentialing applications on behalf of Humana.

Humana encourages the use of CAQH or ProviderSource. These electronic methods provide a fast and easy way to securely submit credentialing information to multiple plans and networks by entering information just once. Application data can be submitted online at any time. The simplified credentialing process reduces paperwork and saves time. It is provided at no cost to your practice.

To become credentialed for the first time, you will need a current and complete CAQH or ProviderSource application and should include the following:

• All information is completed on the form or marked as “not applicable.”
• All prior and current practice locations should be included on the application.
• Identification numbers such as the provider’s Social Security number, National Provider Identifier (NPI), Drug Enforcement Agency (DEA) and professional license number.
• All questions answered, including any necessary explanation.
• Attestation, signature and date should be within 180 days.
• Highest degree of education in MM/YYYY format, and needs to include city and state.
• Digital (scanned) copies of your:
  • Curriculum vitae or work history in a MM/YYYY format for the past 5 years, and any gaps greater than 6 months need to be explained.
  • Malpractice insurance, and it must not expire within 60 days of your application and should include coverage period with aggregate and occurrence dollar amounts.

How Do I Become Credentialed?

Once you have completed the contracting process, please follow the below options for completing recruiting. For providers with a CAQH ID, visit www.providersource.com, opens in new window and do the following:

1. Create a username and password
2. Create a user profile
3. The system will ask if you have a CAQH ID. A “Yes” answer prompts you to enter your CAQH number.
4. You will receive an email confirmation to re-attest in ProviderSource.

If you don’t have a CAQH ID, visit ProviderSource, opens in new window and do the following:

1. Create a username and password.
2. Create your user profile.
3. The system will ask if you have a CAQH ID. A “No” answer prompts you to complete the online application
4. You will receive an email confirmation.

Humana encourages the use of electronic credentialing methods*; however, if you are unable to complete an electronic application, please work with your contracting representative on obtaining a paper application.

*Note: The following states require the use of CAQH:

• Colorado
• Georgia
• Illinois
• Indiana
• Kentucky (in lieu of form KAPER-1, Part A)
• Louisiana
• Massachusetts
• Maryland
• Minnesota
• Mississippi
• Missouri
• New Mexico
• North Carolina
• Nevada
• Ohio
• Oklahoma
• Oregon
• Texas
• Vermont
• Washington
• Washington District of Columbia
• West Virginia

Quarterly Newsletter

The new Provider Quarterly Newsletter is designed to keep providers informed of changes and relative information.

Provider Quarterly Newsletter, PDF opens new window

Electronic funds transfer and electronic remittance advice

Get paid faster and reduce administrative paperwork with electronic funds transfer (EFT) and electronic remittance advice (ERA). To start or update ERA and EFT, please sign in to the secure Dental portal and select the “Dental providers” dropdown at the top left of the page. The ERA/EFT link displays under the “Payments” menu.

DentalXChange

Want to save time and increase efficiency?

Submit claims online via DentalXChange, opens new window

HumanaDental issues digital member ID cards

HumanaDental commercial group members have the convenience of a digital member ID card and may no longer need to present a physical member ID card. They may use Humana tools to print a paper version of their card or email or fax a copy to your office. They also may present a digital ID card using their MyHumana mobile app. We respectfully request that you accept a digital, fax or printed version of these patients’ ID cards.

For more information, refer to these frequently asked questions and answers.

HumanaDental digital member ID cards FAQ,PDF opens new window

Claim attachment guidelines

Before submitting a claim form to Humana, learn more about claim documentation.

Claim documentation, PDF opens new window

Medicare dental plan summary sheets and important information

Are you part of the HumanaDental Medicare network (or Careington Medicare Network in Florida)? If so, be sure to review the summary sheets for our dental plans, as well as an outline of plans sold in each state.

2019 HumanaDental Medicare network summary, PDF opens new window

2018 HumanaDental Medicare network summary, PDF opens new window

Refer to humana.com/sb for additional information.

Mandatory Medicare compliance requirements

The HumanaDental Medicare network provides benefits to Humana members enrolled in Medicare Advantage and prescription drug plan programs. The Centers for Medicare & Medicaid Services mandates that all Humana-contracted entities, including those contracted with Humana subsidiaries, complete compliance requirements on an annual basis.

Mandatory Medicare compliance requirements, PDF opens new window

DHMO and Advantage network plan summaries

Are you part of the dental health maintenance organization (DHMO) or Advantage network? If so, you may wish to review these plan summaries.

DHMO and Advantage network plan summaries, PDF opens new window

Member summary information

The Humana Member Summary is a tool that displays patient-specific, clinically relevant information in a standardized format to assist you in identifying opportunities to improve clinical outcomes and reduce medically related costs.

W9

Some Humana networks may have additional participation criteria physicians and other healthcare providers must meet in order to be granted participation status. If you are eligible to use our online application, please review this important information.

Form W-9 (Rev. October 2018), PDF opens new window

Humana leases our dental network to the following clients in Virginia and North Carolina: TeamCare, New Benefits, and Group & Pension Administrators. If you have questions about these arrangements, please call the Provider Call Center at 1-800-833-2223 between 8 a.m. and 8 p.m. Eastern time, Monday through Friday.