Your care makes all the difference

If you are a dentist interested in participating in the HumanaDental® network, please complete our dentist network application form:

Complete dentist network application form

Applicants in the following states should use these links instead:

Minnesota: Premier, opens new window

Nevada: Diversified, opens new window

Michigan: DenteMax, opens new window

To refer another dentist for participation 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:

• Providers who would like to review the Credentialing and Recredentialing policies here, opens in new window
• If there are credentialing/recredentialing questions, please contact Medversant Humana Customer Contact by calling 1-855-654-3371 or emailing support@medversant.com

Credentialing process

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

Humana requires the use of ProviderSource, a service that provides 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 become credentialed for the first time, you will need a current and complete 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), DEA and professional license number.
• All questions answered, including any necessary explanation.
• Attestation, signature and date.
• Digital (scanned) copies of your:
  • Curriculum vitae or work history in a month/year format
  • Professional license
  • Drug Enforcement Agency number or an explanation if there is no DEA number
  • Controlled Dangerous Substances (CDS) certificate
  • Copy of malpractice insurance face sheet
  • Summary of pending or settled malpractice cases

Getting started

If you have 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 www.providersource.com, 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.

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