Dental credentialing
Credentialing is the process Anthem uses to evaluate and select licensed dentists to care for our members.
Credentialing overview
Why do we credential?
We evaluate credentials according to criteria set forth in our policy to ensure the competency and conduct of the dental providers serving members in our network.
Who do we credential?
We credential licensed dental professionals with whom the company intends to contract and market to our members.
We credential the following dental specialties:
- General dentists
- Endodontists
- Oral surgeons
- Orthodontists
- Pediatric dentists
- Periodontists
CAQH credentialing process
Use CAQH (Council for Affordable Quality Healthcare) to streamline and accelerate credentialing:
- Register with CAQH (if you are not already registered). You may register by visiting proview.caqh.org. This is a secure and private website.
- Authorize Anthem so we can access your credentialing information. If you are already registered with CAQH, you will need to give us permission to review your information.
- If you need assistance with CAQH, please log-in to review the New Provider Quick Reference Guide or call the CAQH Provider help line at 888-599-1771.
- Review and update your application. Please ensure all sections of the application are complete and accurate and all required supporting documentation has been uploaded to your profile.
Credentialing application requirements
A complete application includes:
- CAQH status of Initial Application Complete or Re-attestation; or completion of the standard or state-required application that is signed and dated.
- Explanations to disclosure questions on the credentialing application (if applicable).
- Current dental license to practice in each state where services are provided.
- Current DEA certificate or DEA waiver for each state where services are provided.
- Education/training to support requested specialty(ies).
- American Board Certificate (if applicable).
- Specialty Certificate (if applicable).
- Five years’ work history in month/year format.
- Current professional liability insurance showing dentist’s name, policy number, limits of at least $1million/$3million, and effective and expiration dates.
Recredentialing
Anthem recredentials participating dentists every three years. If your CAQH application is current and complete at that time, no additional effort on your part may be required. If CAQH is expired or missing information, or if a non-CAQH application is required, we will contact you to update the information.
Nonresponse to recredentialing request
If you do not update CAQH or supply the required information for recredentialing by the due date, your application will be considered incomplete and may result in administrative termination from the network.
Provider rights
Providers have the right to: