Credentialing Information

Providers wishing to participate in The Dental Network's (TDN) provider network are required to submit credentialing information.

TDN accepts the Maryland Uniform Dental Credentialing Form and the Coalition for Affordable Quality Healthcare (CAQH) Universal Credentialing Datasource application.

To avoid confusion and unexpected out-of-pocket expenses for members, all providers in the same practice must participate in the same plans/schedules.

Maryland Uniform Dental Credentialing Form

The Maryland Uniform Dental Credentialing Form is a state mandated form that is accepted by all health plans in Maryland. Please review the following instructions when completing this mandated form:

Please complete all sections, including any sections or pages that are not applicable to your practice. If a section is not applicable to your practice, please indicate N/A on that specific page or section when submitting, otherwse the application may not be processed.
A Dental Billing Authorization Form also must be completed and submitted along with the Maryland Uniform Dental Credentialing Form, to be considered for participation in the network(s).

The Maryland Uniform Dental Credentialing Form must be:

updated every time there are changes to information to ensure accurate claims processing and directory information
filled out every three years for re-credentialing

CAQH Universal Credentialing Datasource Application

The CAQH credentialing system compiles and organizes comprehensive data from more than 600,000 providers in 23 health plans nationwide at no cost to providers.

As a result, providers avoid redundant submission of credentialing information to participating health plans and health care organizations. Only one completed application per provider is needed.

CAQH Universal Credentialing Datasource:

is compliant with the Maryland Uniform Credentialing Form regulations
streamlines the data collection and submission process into a Web enabled system
allows you to update your information, so you do not have to fill out a new form every three years

If you are interested in using CAQH's Universal Credentialing Datasource, complete the top portion of the CAQH Dental Provider Data Sheet and fax it to 410-720-5080. You will receive a CAQH ID number that allows access to the online application.

If you have already completed the application through another CAQH member insurance company:

Be sure that you have verified your data within the last ninety (90) days
Authorize CareFirst and CareFirst BlueChoice to access your information via the CAQH Credentialing Web site
Complete the top portion of the enclosed CAQH Dental Provider Data Sheet and indicate that you have completed the CAQH application
Fax the CAQH Dental Provider Data Sheet, and a completed Dental Billing Authorization Form indicating the networks you are interested in joining to 410-720-5080.

Then, we can access your data to begin the credentialing process.

Your Rights

To ensure that TDN obtained correct information to support credentialing applications and made fair credentialing decisions, providers have the right, upon request, to:

Review this information
Correct inaccurate information
Obtain the status of the credentialing process
Requests can be made by calling 443-921-0676 or by emailing DentalContracting@CareFirst.com

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