Get Humana Dental Recredentialing Application - Webcvo - Humana Webcvo

This guide provides a comprehensive overview of how to accurately complete the Humana Dental Recredentialing Application via an online platform. By following these steps, users can ensure that their application is filled out correctly and submitted without unnecessary delays.

Follow the steps to complete the Humana Dental Recredentialing Application online.

1. Press the ‘Get Form’ button to acquire the application, allowing you to open it for completion.
2. Begin by entering your personal information. Fill in your last name, first name, middle initial, as well as your federal tax ID, Social Security Number, and National Provider Identifier (NPI). Ensure that the name matches exactly as it appears on your W-9 form, including your dental degree (D.D.S. or D.M.D.) and date of birth.
3. Provide your Medicaid number if applicable, and accurately list your office street address, suite number, city, state, and ZIP code. If your mailing address differs from your office address, be sure to include that information as well.
4. Input your office phone number, fax number, and a current office email address for correspondence. Include your state license number and, if applicable, your Drug Enforcement Agency (DEA) registration number. If you do not have a DEA number, please provide an explanation.
5. For Texas applicants, provide your Controlled Dangerous Substance (CDS) registration number, or include an explanation if not applicable. Next, list your professional liability insurance carrier information, including the carrier name, effective date, expiration date, and policy number. Also, indicate your occurrence/claims limit and aggregate limit.
6. Indicate the minimum age of patients you accept, any languages you speak (other than English), and your specialty. Confirm whether you are board certified and include the name of your certifying board if applicable.
7. Answer the disciplinary action questions truthfully and completely, and attach any required documentation that clarifies your responses. These questions include inquiries about your dental license, DEA registration, board certification, clinical privileges, and any investigations or actions taken against you.
8. Complete the health status questions, regarding your ability to perform the essential functions of your position and any unlawful use of drugs.
9. If applicable, provide the name of any hospitals where you hold clinical privileges. Answer further questions related to your clinical privileges or medical staff membership status, ensuring accuracy.
10. Finally, review the Humana Dental Plans Consent and Release Form carefully. Sign and date the application to attest to your understanding that any misrepresentations or omissions may result in the denial of your application.
11. Once you have completed the application, you can save your changes, download a copy, print the document for your records, or share it as needed.

Complete your Humana Dental Recredentialing Application online today to ensure a smooth recredentialing process.