Calling the number of the patient’s Medicare Advantage Plan ID card (this is not a Medicare card) for benefit information is the only way to determine the plan and network for each patient. Patients may have options to choose multiple plans with their Insurance Company including a Medicare Advantage plan. Each of these plans will have their own network assigned.
The rate is based on your currently contracted fee schedule and will be the same for all plans including the Medicare Advantage patients’ plans.
Medicare Advantage plans are available to folks that are age 65 and older, or disabled. It is offered by private companies that contract with Medicare to provide health care services. Medicare Advantage may have more out of pocket to the patient however the dentist will collect up the fee schedule amount as with any other plan.
The patient’s Insurance card will reflect the plan or you can call the number on the patient’s Medicare Advantage plan ID card.
The Centers for Medicare & Medicaid Services (CMS) mandates that all contracted entities that perform administrative or health care services functions relating to Medicare Advantage contracts complete certain compliance requirements, including training, upon initial contract and annually independently thereafter. To complete the required training forms online through the Participating Provider Portal (you will need to log in to your account.) Once logged in, you may see a red, yellow or green box. Update the information as necessary. Enter the name of person completing form. Check the box next to ‘by signing this form, I certify that the information provider is correct, and then click Verify again. You will then receive a message that says Please allow 10-15 business days. All health care practitioners are required to complete the training modules.
No, at this time Connection Dental is only open to applicants with a current, active, state dental license.
In exchange for accepting the Connection Dental fee schedule, insurance plans utilizing the network will list participating providers in their directories. This will generate new business for providers.
GEHA uses the Connection Dental Network to provide a PPO option to its own members, and for its two federal dental plans: Connection Dental Federal, a FEDVIP plan; and Connection Dental Plus, a supplemental dental plan that is a stand-alone dental product. Both plans are available to all federal employees whether or not they have GEHA medical insurance; however, there are other insurance plans that use the Connection Dental Network. Click here to request our current Client List or call (800) 505-8880, option 2.
Connection Dental Participating Dentists should always submit their regular charges to the insurance plans.
The difference between the insurance benefit amount and the fee schedule amount will be the patient's responsibility. The office should not collect more than the allowed amount listed on the fee schedule for the code billed.
If the service rendered is not listed on the fee schedule, the provider's regular billed charge will be considered as the fee schedule amount. Make sure you have a current copy of the fee schedule to verify that the code has not been recently added.
The provider write-off is the difference between the fee schedule amount and your regular billed charge for that service. If your regular billed charge is less or the service is not listed on the fee schedule, there is no write-off.
Submit the claim to both insurances. Once processed, the lesser of the two fee schedule amounts will apply.
You may bill the member for non-covered services, up to the fee schedule amount. In some states, payors are subject to state regulation and cannot take a discount on non-covered services. GEHA operates under Federal regulation and state regulation would not apply. Since GEHA's plans are not subject to state regulation you may only bill the member up to the fee schedule amount for non-covered services.
Yes. You may charge your PPO patients at the time of service, as long as it is not over the fee schedule amount for those services listed. Federal plans prohibit collecting payment from the patient at the time of service.
Federal plans require providers to submit claims for their patients.
No. Each dentist must complete an Application and sign a Participating Provider Agreement to join the network. If you are a large practice, please contact one of our Network Representatives at (800) 505-8880, option 2, for information about group contracting.
No. This is not a capitated network.
Providers who have created a GEHA Web Account at geha.com can review the status of clean claims by logging into their account. Information about claims that are not listed on the GEHA website may be obtained by calling GEHA’s Customer Service Department at (800) 821-6136.
Yes. Through partnerships with a number of businesses working in the dental community, Connection Dental Network offers our Participating Dentists a number of discounts. Click here for more information about the Connection Dental Rewards Program.
All claims should be submitted to the address on the back of the members’ identification cards. Please keep in mind that approximately 90 companies use the Connection Dental Network to offer a PPO option to their members, and all questions about benefits and claims should be directed to the company that is listed on the back of the insurer's ID card.
To verify your demographic information in our online directory, go to Find A Dentist and review our directory listing.
To submit changes to the network, complete and submit the Provider Address Change Form located under Resource Center or click here
Yes, (URAC) Utilization Review Accreditation Commission, requires Connection Dental to adhere to the state laws. We must also follow state laws for the Clients that lease the network.
Yes, we operate in all 50 states as well as Guam and Puerto Rico, and the Virgin Islands.
These plans are federal and the federal law supersedes state law for those plans.
The Provider Manual here
The appeal rights are listed in the GEHA CD Network Appeals and Disputes Policy within the Provider Manual. Click here
Yes here
Unfortunately, the onboarding process isn't quite that quick. Our URAC accreditation standards require us to credential all of our providers before you can be considered an in network provider.
URAC was originally incorporated under the name Utilization Review Accreditation Commission. That name was shortened to the acronym URAC in 1996 when we began accrediting other types of organizations such as health plans, pharmacies, and provider organizations.
To ensure the quality of the dentists that comprise the network. Credentialing is a critical function that allows health care organizations to identify qualified dentists for participation in their networks.
No.
A complete application with a signed and dated attestation. A dentist's license must be in good standing, they must present proof of active professional liability insurance. Must have verifiable education and cannot be debarred from Federal or State Programs.
Credentialing is a systemic approach to the collection and verification of a provider's professional qualifications which include, but are not limited to relevant training, work history and licensure.
The credentialing process can take as little as 7 days up to 120 if a verification is delayed from a primary source. The network effective date is not the same as your expected credentialing timeframe.
Primary source is a firsthand account verification.
An incomplete application. Ensure when completing the application, all fields are completed in their entirety. A complete five year work history tends to be the highest missing element. Ensure when completing the work history requirement that an explanation is provided for all work history gaps greater than six months.
Upon approval by the Peer Review Committee, you will receive a notification within 10 days stating what day your application was approved and the specialty (education) that was verified. The notification is sent electronically when an email address has been provided otherwise we will send notification by regular mail.
To process your credentialing application in a timely manner, the application must meet the Connection Dental Credentialing requirements as well as the state required application requirement, if applicable.
Yes. We work with VPoint, a Credentialing Verification Organization (CVO). You may receive requests for credentialing information, via fax, email or phone from VPoint on behalf of Connection Dental Network.
First, authorize GEHA to access your application via CAQH ProView. Second, provide your CAQH ID to your Connection Dental Network representative.
No. Each dentist must complete an Application and sign a Participating Provider Agreement to join the network. If you are a large practice, please contact one of our Network Representatives at (800) 505-8880, option 2, for information about group contracting.
Yes. Through partnerships with a number of businesses working in the dental community, Connection Dental Network offers our Participating Dentists a number of discounts. Click here for more information about the Connection Dental Rewards Program.
Connection Dental Network only includes PPO plans—there are not any DHMO, Capitated, or Discount plans included in our network.
Contact our provider relations department via phone at 800-505-8880 Option 2 for details about what information we require you to submit for a review of your current contracted fee schedule.
Connection Dental has dedicated staff working to serve each state. Contact our Network Development department via phone at 800-505-8880 Option 2 to reach a Network Representative, or click here to visit our online portal to find your dedicated representative’s contact information.
Joining Connection Dental Network has many advantages. You’ll gain access to more than 25 million covered lives nationwide, as well as have access to our exclusive rewards program that is designed to help make your office run more smoothly. Along with our first-class customer service and prestigious URAC accreditation, Connection Dental can help increase the value of your practice.
There is no cost associated with joining Connection Dental. We offer a “quid pro quo” contract, meaning, when you enroll in our network, you agree to the fee schedule amount as the maximum allowed amount for services performed for our members. In return, we’ll market your office to our members to help increase the patient flow in the office.