Dental Provider Video Library

Your practice is dedicated to providing the best care for your patients. Do enough people know that? Partnering with Humana, one of the nation’s largest dental benefit companies, extends the reach of your office.

When you join our network, you gain access to nearly 7 million members – more than 3.5 million Commercial members, 3.5 million Medicare Advantage members

When you join our Humana PPO network, you are brought into networks for the following dental plans: Humana Group Commercial plans include generous cleaning frequencies.

We offer plans with unlimited or extended annual maximums. And many members pick up our implant rider.

Through Humana’s individual dental we provide a portfolio of plans to fit the individual’s needs and budget. There are plans that cover preventive and basic services, Bright Plus has in office teeth whitening benefit. Other plans cover preventive, basic and major services.

The Federal Advantage network support plans offer fixed copays for services.

Humana’s Medicare Advantage – The dental benefits available in those plans vary, but benefits have increased considerably in recent years. Many cover major services such as periodontal scaling, crowns, dentures, etc.

You also join Humana's Access discount networks. Ready to join? Contact the Humana Dental Network recruiting team at: humana.com/provider/dentist-resources

Humana provides dental insurance benefits to over 4 million seniors nationwide, so many of your patients may have insurance with Humana’s Medicare Advantage Plans, Medicare Advantage Special Needs Plans, or Medicare Supplement Plans.

These dental benefits use a PPO network. In the case of seniors who enrolled in their plan outside of Florida, they use the Humana Medicare Dental PPO network nationwide. If the senior enrolled in Florida, their dental network is the Careington Medicare Network in Florida.

Let’s take a look at your patient’s insurance ID card. The ID card is for their entire Medicare Advantage plan, so it includes information about their Medical, Dental, and Vision benefits. The front of their ID card may say HMO, but that only refers to the medical plan.

You’ll find dental information on the back of the ID card. The bottom of the card indicates the specific benefit. Visit Humana.com/sb, where you can find a detailed description of that benefit.

Let’s take a moment to discuss Medicare Advantage Dual Eligible Special Needs Members. Those individuals will present a Medicare Advantage ID card, similar to the one we just saw. To be on a Special Needs Plan, those members are also on Medicaid, so they may be showing you that ID card as well.

Rest assured that dental benefits for that individual are provided through their Medicare Advantage Plan and Network. You do not need to be in the Medicaid network to provide those Humana members Medicare Advantage dental services.

So here’s a recap: Humana’s Medicare Advantage plans always use a PPO network. Find the dental benefit on the back of the Medicare Advantage ID card. And look to Humana.com/sb for the plan’s details.

If you have questions, we’re just a click or a phone call away. Visit our provider portal at Humana.com/provider. Or call Humana’s dental provider customer service at 800-833-2223.

Your practice is dedicated to providing the best care for your patients.
Humana wants to provide support to you and your patients.

During this brief video, we want to provide tips to work with Humana

This is what we will cover today: Confirming a patient’s dental benefits, submitting claims or requests for pre-treatment estimates and the Evidence of Remittance (or EOR).

Step 1: Confirming member benefits
Dental offices can verify member benefits online through Availity.com
Or call Provider Customer service at 1-800-833-2223.

Step 2: Submitting Pre-Treatment Estimate requests or Claims
It is as easy as going to Humana.com.

Find the other "Humana Sites" and go to “For Providers”

Look for "Dentist Resources" then click "Dental Resources"

Look for "View our Welcome Packet," under the "News and Notification" area

Step 3: The Evidence of Remittance showing the completed claim adjudication
Depending on how you receive claim payments from Humana, you will receive an Evidence of Remittance (EOR) or Electronic Remittance Advice (ERA)

Find the “Making it Easier” powerpoint which provides more detail on dental claims.

So that’s all for today. Make sure to Visit our Dental Provider site, or if you have questions call Provider Customer service at 1-800-833-2223

This short video is about credentialing and your contract with Humana’s dental network.

We want to help you keep your credentialing information up to date, so you can focus on servicing your patients while your claims are processed as in-network.

To comply with state and federal regulations, your completed credentialing application must be approved by Humana prior to the start of your initial contract.

You will also need to recredential at least every 36 months. You will be asked to provide any required updates and attest to the accuracy of your professional information.

During this brief video, we want to provide tips for confirming and sharing your credentialing information with Humana. We know you are likely contracted with many dental networks, each requiring credentialing.

But you can simplify this process with CAQH ProView!

CAQH ProView enables you to submit one standard credentialing application to a single source for all healthcare organizations you choose to partner with.

Using CAQH ProView makes credentialing easier. If you enter all the required profile information in ProView and keep it updated, your credentialing will auto-renew.

Humana’s relationship with CAQH will accelerate your onboarding experience, reducing the time before you can begin scheduling patients.

To get started, U.S.-licensed dentists must first sign into ADA.org/GoDigital

After signing in and accepting the terms and conditions, you will be redirected to the CAQH ProView welcome page.

Please enter all required information to ensure your profile is complete. Required info has a red asterisk.

Attesting to your information is a critical step to finalizing your ProView profile. With this step, you will confirm that your credentialing application is complete and accurate.

CAQH will send a reminder email (add audio “ding” indicating new email) every 90 days to request that you confirm and attest to your profile information.

Attesting to your ProView profile every 90 days reduces the time required of you during recredentialing. It should lighten your administrative burden so that you can concentrate on what’s important – your patients. It will also help Humana keep your directory information up-to-date, so prospective patients can find you.

You determine how you want your data shared:

While setting up your profile, you will be given the option to indicate “Yes. Release my data to any organization that requests access,” or “No,” to grant access individually.

We recommend selecting “Yes” because it can save you time later while ensuring that Humana or any other organization requesting access to your information can get it quickly.

Please note: If you select “No,” you will be required to check the “Organizations” page periodically to ensure you’ve granted access to any organizations requesting your ProView data. Credentialing delays may occur if this step is not completed correctly or in a timely manner.

If you have questions regarding the setup of your CAQH ProView profile, please call the CAQH Help Desk at 1-888-599-1771 or use the live-chat icon at the top of each webpage.

You can also navigate to Proview.caqh.org for a full list of reference materials available to dental providers.

You can find more helpful information about Humana’s credentialing process by visiting our “Join our network” webpage or by emailing our credentialing team.

And that’s all for today about credentialing with Humana. If you have questions, please call Dental Provider Customer service at 800-833-2223. We’ll be glad to answer your questions.

Are you looking to reduce financial uncertainty and establish a more predictable cash flow? Would you like to decrease your administrative overhead while also reducing the time your practice waits for reimbursement?

One of the greatest advantages Humana’s dental health maintenance organization plans can offer your practice is the ability to access a stable, more predictable income through streamlined processes and guaranteed payments.

During this brief video, we will highlight how participating in a DHMO network can benefit your practice. We will also provide tips and resources to help support you in providing care to Humana DHMO members.

Our DHMO plans are structured to simplify processes for you. Most routine services do not require a claim submission, and our plans do not include deductibles or benefit limits to track, thereby alleviating the burden on your staff.

Humana has developed plans to help virtually any practice augment its bottom line.

As a Humana-participating DHMO provider, you will be reimbursed in three ways: via monthly capitation payments, supplemental payments and member copayments.

Your monthly capitation will provide a reliable financial foundation. These payments are provided at a set, predetermined rate for each plan, and they are provided monthly for each member assigned to your practice. Capitation payments are issued automatically. They do not require a claim submission, and they are paid regardless of whether a patient receives care within the payment period.

Certain covered procedures qualify for a supplemental payment. This is reimbursement above and beyond your capitation payments and any member copayment you receive.

Supplemental payments are provided when the member’s copayment is less than the minimum payment guaranteed to you. Please note that claim submission is required to receive supplemental payments.

Your patients and your staff can easily determine exact benefit and copayment amounts by referring to our schedule of benefits. Your staff will be able to explain to patients, simply and clearly, what their treatment program is and what it will cost.

In order to use their plan benefits, our members are required to be seen by a DHMO-participating general dentist. There are no out-of-network benefits, so our members will be looking for your practice in our DHMO directory.

Participation in our DHMO network makes you a vital resource for patients already enrolled with us. We aggressively market your services to maintain a healthy flow of new patients.

Our DHMO members are required to select a primary care dentist. Members who contact your practice to determine if you accept DHMO patients should be advised to contact Humana Customer Care. This will ensure their assignment to your practice is made appropriately.

Our goal is to provide you with a desirable increase in patient flow, not to inundate your practice. You determine the number of additional patients you can accept, based on your desired workload.

Our DHMO plans are structured to empower you to administer care in a manner and frequency you see fit. Having assigned patients will help you with patient retention, while also enabling you to better manage their dental care.

Check your roster prior to treating new patients to confirm that they have been assigned to your practice. This will ensure you’re being compensated appropriately for the care you provide.

Just confirm that the patient’s member ID, as shown on their ID card, is listed on your current patient roster.

Printed rosters and capitation checks will be generated and mailed to your practice during the final 10 business days of each month.

In lieu of postal delivery, Humana can transmit your capitation payments via electronic funds transfer, or EFT.

This method offers faster payment times, with EFT payments hitting provider bank accounts within three business days of issue.

It provides improved security, too. No longer is there a chance of checks being lost, misdirected or even stolen.

And, EFT reduces the volume of paper mail your practice receives, thus reducing your administrative load and your environmental footprint.

Finally, it costs you nothing to switch to EFT payments. To get started, email your dental services representative for instructions.

Here’s another benefit to working with Humana: You can retrieve your rosters electronically through the Availity Essentials multi-payer portal.

Simply sign in and navigate to the Humana Dental Payer Space.

From there you will find the DHMO Rosters application.

Note that member assignment changes are reflected in your roster according to the date they are received.

And that’s all for today about participating in Humana’s DHMO network. If you have questions, please call our Dental Provider Customer service at 800-833-2223. We’ll be glad to answer your questions.