MANUAL: 2021 Medicare Provider Manual (PDF) (includes Allwell, Trillium, and Health Net plans)
For markets that offer members out-of-network dental benefits, providers rendering services must comply with all state and federal law licensing requirements:
Ambetter Health Insurance Marketplace Plans
- The provider must be licensed for that state
Allwell and Ascension Complete Medicare Advantage Plans
- The provider must be registered with CMS
- The provider cannot appear on the Medicare Opt-out or Preclusion list
When submitting claims to Envolve Dental you should include the following information with each claim submitted*:
- 2012 ADA Claim Form
- Completed W-9 with payee information
- Any supporting documentation for the services submitted
NOTE: To avoid claims being rejected, providers must submit paper claims.
*Claims submitted by out-of-network providers in markets where members do not have an out-of-network benefit will be rejected or denied.
Envolve Dental Provider Manuals
- 2021 Medicare Provider Manual (PDF) (includes Allwell, Trillium, and Health Net plans)
- 2021 Ascension Complete Provider Manual (PDF)
- 2021 Ambetter Health Insurance Marketplace (PDF)
Questions? Please call Provider Services at the phone number indicated in the applicable provider manual.