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 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
- Allwell Medicare Advantage
- Ascension Complete Medicare Advantage
- Ambetter Health Insurance Marketplace
Questions? Please call Provider Services at the phone number indicated in the applicable provider manual.
Arkansas, Indiana, Kansas Antwan Perez-Alvarez 727-437-1723 Michael Williams 727-437-1832 |
Florida, Georgia, Ohio, South Carolina Cherie McCarter 727-437-1833 Tyneshia James 727-437-1755 |
Louisiana, Mississippi, Pennsylvania, Texas Melinda Clesca 727-437-1814 Zariana Ortiz 727-437-1808 |
Nevada Enrique Echave 727-437-1742 Alegna Ventura 252-544-9299 |
Arizona, New Mexico Alegna Ventura 252-544-9299 Enrique Echave 727-437-1742 |
Illinois, Michigan, Missouri, Wisconsin Tony Smith 727-437-1781 |