Initial Credentialing and Applying to Join the Network

All dentists are required to submit a completed and signed Participating Provider Agreement and Provider Application, along with copies of the requested supporting documentation, in order for a dentist's application to be considered in received status by the network. To request a packet of information be mailed to you, click here and complete the form.

Click here to submit the Participating Provider Agreement electronically. Click here to go to the Provider Application. Print the Provider Application, complete it, and make sure to attach copies of the requested documents. Fax all documents to (816) 257-4439 or mail to:

Prospective CONNECTION Dental Network applications are reviewed and verified by our Credentialing Department. Copies of the following documents are required to be submitted to the network as part of the initial credentialing process:

• State License
• Federal or State DEA Certificate
• Specialty Board Certificate
• Current professional liability insurance face sheet

We understand how busy our Participating Dentists' offices can be. Therefore, we have made the re-credentialing process as quick and easy as possible. When the time comes for a Participating Dentist to be re-credentialed, our Credentialing Department will send the dentist a re-credentialing packet consisting of a letter and dental profile.

Copies of the following information are required to complete the re-credentialing process:

• Current State License
• Current Federal or State DEA Certificate
• Specialty Board Certificate if old Certificate has expired or the dentist has become Board Certified since the last credentialing instance
• Current professional liability insurance face sheet

Dentists are initially reviewed and then re-reviewed every three years, unless more frequent monitoring is required by state law or regulation. On a monthly basis, our Peer Review Committee reviews and approves new dentists and the ongoing participation of current Participating Dentists.

Our Credentialing Specialists are available to answer questions or provide assistance with our credentialing process. If you have any questions, please do not hesitate to call our Credentialing Department
at (800) 505-8880, Option 3.