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Upgrade Request

Time to request a raise.

Dental Cooperative Members can request to upgrade to the associated Cooperative fee schedules with our partner carriers. Each carrier’s fee schedules are different, including carrier specific restrictions and terms. To achieve the upgrade associated with Cooperative Members, the form below must be submitted to the Dental Cooperative exclusively through the online form.

Step 1) Review the associated fee schedule posted in Member Services. If the fees are acceptable, continue to Step 2.

Step 2) Verify you are directly contracted with the Carrier prior to requesting an upgrade. If you are not directly contracted, please click here to complete the Provider Application Request. If you are directly contracted, continue to Step 3.

Step 3) Use the form below to submit an Upgrade request with the Dental Cooperative insurance partners. Upgrade requests will be processed only if the following criteria are met:

  • Provider is a current paying Member of the Dental Cooperative.
  • Provider is directly contracted with the Carrier. Instructions to verify a direct contract are provided in the form below after you choose your requested Carriers.
  • For first-time insurance requests through the Cooperative, an Initial Provider Data form must be submitted prior to the Upgrade Request. Click here to complete the Initial Provider Data form.
  • All information requested must be included and current. Missing or expired data will delay the submission process.
  • Most Carriers restrict upgrades within a specific time frame. Upgrades requests within the restricted time period will not be submitted. Review Member Services to check any restricted time frames for each Carrier.
  • An Upgrade Request is a request to be added to the Cooperative associated fee schedule. The Cooperative will do everything we can to help to achieve your upgrade, 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.

INSURANCE FEE MAXIMIZATION

Upgrade Request Form

An Upgrade Request must be submitted individually for each provider.

Membership Info:

Requests can only be submitted for current Dental Cooperative Member Providers.

Requests can only be submitted for current Dental Cooperative members. Please contact your local Area Director to add your Provider to the Dental Cooperative before submitting a request.



New Providers are required to submit an Initial Provider Data form. Please click here to complete the Initial Provider Data form prior to your request.



Practice Info:

*required









Carriers Requested:

An Upgrade Request must be submitted individually for each provider. You may select more than one Carrier request per Provider.
Select a Practice State in the Practice Info section to view the corresponding Carriers.

CareingtonCignaConnectionDenteMaxGuardianPrincipalSun LifeZelis
CareingtonCignaConnectionDenteMaxGuardianPrincipalSun LifeZelis
CareingtonCignaConnectionDenteMaxGuardianPrincipalSun LifeZelis
CareingtonCignaConnectionDenteMaxGuardianPrincipalSun LifeZelis
CareingtonCignaConnectionDenteMax
CareingtonCignaGuardianSun LifeZelis



Participation Info:

Providers are required to verify the following information with Carriers prior to submitting an Upgrade Request. The phone numbers below are provided for your convenience. Please specifically ask the following from each Carrier:

  • Contracted Effective Date
  • Most Recent Effective Date
  • Specific plans Provider is directly contracted with.


Careington Provider Relations Team 1-800-441-0380 (option 8)





Cigna Provider Relations Team 1-800-244-6224





Connection Provider Relations Team 1-800-821-6136





DenteMax Provider Relations Team 1-800-752-1547





Guardian Provider Relations Team 1-800-890-4774





Principal Provider Relations Team 1-800-832-4450





Sun Life Provider Relations Team 1-800-434-2638





Zelis Provider Relations Team 1-888-577-1656





Provider Info:

An Upgrade Request form must be submitted individually for each provider.












Click to Download W9


Click to Download W9



Provider License Data:

Please provide the most current license information for the Provider listed above.







Tax Identification Number(TIN):

Please provide the TIN data for this Provider.








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.
• Provider, if not a current Member and/or not included in the original Associate Agreement with the Practice, must sign and submit an Add Member Provider form prior to IFM requests.
• Participating Practice must have signed and submitted an Associate Agreement 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. An Upgrade Request is a request to be added to the Cooperative associated fee schedule. The Cooperative will do everything we can to help to achieve your upgrade, but Carriers reserve the right to restrict and deny requests based on their own criteria.
• Most Carriers restrict upgrades within a specific time frame. Upgrades requests within the restricted time period will not be submitted.





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, sometimes it takes a minute to go through. 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 US!

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