CAQH PROVIDER ID

CareingtonConnectionDenteMaxGuardianPrincipalSun LifeZelisLevelHumanaSolstice

CareingtonConnectionDenteMaxGuardianPrincipalSun LifeZelisLevelHumanaSolstice

CareingtonConnectionDenteMaxGuardianSun LifeZelisLevelHumanaSolstice

CareingtonConnectionDenteMaxGuardianPrincipalSun LifeZelisLevelHumanaSolstice

CareingtonConnectionDenteMaxPrincipalLevelHumanaSolstice

CareingtonConnectionGuardianDenteMaxPrincipalSun LifeZelisLevelHumanaSolstice

CareingtonConnectionSolstice

CareingtonSolstice

CAREINGTON
Careington Provider Relations Team 1-800-441-0380 (option 8)
CAREINGTON: CONTRACTED EFFECTIVE DATE mm/dd/yyyy

CAREINGTON: PARTICIPATING PLANS

Careington Platinum PPOCareington Platinum POSCarePPOCarePOS500 Series

CAREINGTON: CURRENT FEE SCHEDULE NAME/CODE (may be found at bottom of printed fee schedule)

CONNECTION DENTAL(GEHA)
Connection Provider Relations Team 1-800-821-6136
CONNECTION: CONTRACTED EFFECTIVE DATE mm/dd/yyyy

CONNECTION: CURRENT FEE SCHEDULE NAME/CODE (may be found at bottom of printed fee schedule)

DENTEMAX
DenteMax Provider Relations Team 1-800-752-1547
DENTEMAX: CONTRACTED EFFECTIVE DATE mm/dd/yyyy

DENTEMAX: CURRENT FEE SCHEDULE NAME/CODE (may be found at bottom of printed fee schedule)

GUARDIAN
Guardian Provider Relations Team 1-800-890-4774
GUARDIAN: CONTRACTED EFFECTIVE DATE mm/dd/yyyy

GUARDIAN: CURRENT FEE SCHEDULE NAME/CODE (may be found at bottom of printed fee schedule)

PRINCIPAL
Principal Provider Relations Team 1-800-638-1959
PRINCIPAL: CONTRACTED EFFECTIVE DATE mm/dd/yyyy

PRINCIPAL: CURRENT FEE SCHEDULE NAME/CODE (may be found at bottom of printed fee schedule)

SUN LIFE(DHA)
Sun Life Provider Relations Team 1-800-434-2638
SUN LIFE: CONTRACTED EFFECTIVE DATE mm/dd/yyyy

SUN LIFE: MOST RECENT EFFECTIVE DATE mm/dd/yyyy

SUN LIFE: CURRENT FEE SCHEDULE NAME/CODE (may be found at bottom of printed fee schedule)

ZELIS
Zelis Provider Relations Team 1-800-878-7896
ZELIS: CONTRACTED EFFECTIVE DATE mm/dd/yyyy

ZELIS: CURRENT FEE SCHEDULE NAME/CODE (may be found at bottom of printed fee schedule)

Level
Level Provider Relations Team 1-855-400-5705
LEVEL: CONTRACTED EFFECTIVE DATE mm/dd/yyyy

LEVEL: CURRENT FEE SCHEDULE NAME/CODE (may be found at bottom of printed fee schedule)

HUMANA
Humana Customer Service 1-800-833-2223
HUMANA: CONTRACTED EFFECTIVE DATE mm/dd/yyyy

HUMANA: CURRENT FEE SCHEDULE NAME/CODE (may be found at bottom of printed fee schedule)

SOLSTICE
Solstice Customer Service 1-877-760-2247
SOLSTICE: CONTRACTED EFFECTIVE DATE mm/dd/yyyy

Include any necessary notes, comments, or instructions:

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.
• Participating Practice must have signed and submitted an Associate Agreement prior to IFM requests.
• Provider, must be included in the original Associate Agreement with the Practice. If not included, Provider must sign and submit an Add Member Provider form prior to IFM requests.
• Provider who has terminated their Dental Cooperative membership will have access to fee schedule resources terminated.
• The Dental Cooperative will inform Carriers of membership termination and Carriers 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.
• Provider must sign and return Insurance Fee Maximization Provider Agreement prior to any IFM requests.
• The Dental Cooperative acts within the SEC parameters of a Messenger Model. Carriers reserve the right to restrict and deny requests based on their own criteria.

I agree to the Terms and Condition of Participation in this Agreement.

Name of Authorized Agent (required)

Date Agreement Signed mm/dd/yyyy (required)

Once submitted, we will verify your membership and information. Once verified, you will receive an email with instructions for the next step. Just hold tight until you receive the email.

Please confirm the form submits. You will get a "Success!" message at the bottom of this form if it submits correctly. IMPORTANT: IF YOU DO NOT RECEIVE A CONFIRMATION EMAIL THAT WE RECEIVED YOUR DATA WITHIN 5 BUSINESS DAYS, PLEASE CONTACT YOUR AREA DIRECTOR.