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Principal: Contracted

What would you like us to do for your Provider?

Select what Requested Action you would like us to take for your Provider with Principal.  Once submitted, we will verify you in our Member database and send you an email with instructions for the next step. 

    INSURANCE FEE MAXIMIZATION

    Principal: Contracted


    REQUESTED ACTION:


    PRACTICE INFORMATION:






    PROVIDER REQUESTING ACTION:








    LOCATIONS OF REQUESTED ACTION:



    *If more than 5 locations, do not fill out the Address info below:







    TERMS AND CONDITIONS OF PARTICIPATION
    To qualify for Insurance Fee Maximization through the Dental Cooperative, Providers must meet the following criteria:
    • Provider must be a current, paying member of the Dental Cooperative in good standing.
    • A completed, signed, and submitted Associate Agreement to the Dental Cooperative is required for all participating Providers.
    • Any Provider who has terminated their Dental Cooperative membership will have access to fee schedule resources terminated.
    • The Dental Cooperative will inform Principal of membership termination and Principal will take appropriate action as their individual policies dictate, which may include but not limited to a downgrade of fee schedule, return to previous fee schedule prior to membership or upgrade, or change to a base fee schedule indicated by the carrier.
    • Additional program details and terms are available on your Associate Agreement.





    Once submitted, the Information Request will be sent to our Director of Insurance Fee Maximization for verification. Once received and processed, you will receive an email with instructions for the next step.

    Having issues submitting the online form? Please contact your local Area Director: