Add a Cooperative PPO partner to your insurance mix. Complete the form below to become directly contracted with a Carrier partner. Follow the steps below:
Step 1) Beginning July 1, 2021, the Dental Cooperative will be exclusively using CAQH as the platform for collecting and verifying Provider credentials as part of the Insurance Fee Maximization process. CAQH is FREE for Providers to create and manage their credentials, reduces repetitive paperwork, and keeps all the information in one place to share with Carriers. Click here to create a CAQH account. For those already using CAQH, please verify the Provider is current and attested before you submit an action below to ensure faster submission.
Step 2) Review the associated fee schedule posted in Member Services. If the fees are acceptable, continue to Step 3.
Step 3) Verify you are NOT already directly contracted with the Carrier. Phone numbers for verifying are provided in the form process.
Step 4) Use the form below to submit a Provider Application Request with the Dental Cooperative insurance partners. Application requests will be processed only if the following criteria are met:
Provider is a current paying Member of the Dental Cooperative.
Provider is not directly contracted with the Carrier. Instructions to verify a direct contract are provided in the form below after you choose your requested Carriers.
Beginning July 1, 2021, all Providers will be required to have an updated CAQH account and provide their CAQH Provider ID.
All information requested must be included and current. Missing or expired data will delay the submission process.
Applications are submitted on behalf of Cooperative members, but Carriers reserve the right to restrict and deny requests based on their own criteria.
If you are having trouble with the form or need help, please contact your local Area Director for assistance.
Having issues submitting the online form? Please contact your local Area Director: