Provider Resources

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 (or later) 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

Questions? Please call Provider Services at the phone number indicated in the applicable provider manual.