Frequently Asked Questions

General
How does DenteMax work?

DenteMax strives to make its PPO partnership easy and hassle-free. You will continue to operate your practice as usual. Verify the eligibility of your patients and submit claims through their insurance company, administrator or group.

You should submit claims using your customary fees and the insurance company or administrator will adjust them according to the DenteMax fee schedule.

Is DenteMax an insurance company?

DenteMax is not an insurance company. DenteMax is a network of participating dentists who have agreed to a fee schedule. The network is leased to insurance companies, third-party administrators and self-funded groups to enhance or build their dental benefits programs.

How will patients know my office participates?

Your practice information will be included in the printed and online directories of DenteMax and its payer partners. Over 9 million members currently have access to these directories.

How do I verify eligibility?

DenteMax does not have access to eligibility information. In order to verify eligibility, please contact the plan administrator by using the number listed on the back of the patient’s insurance identification card.

Where do I submit claims?

Claims are sent to the patient’s insurance company or benefits plan administrator. DenteMax is not the patient’s insurance company.

Where do payments come from?

All payments are made to you by the patient’s insurance company or benefits plan administrator. DenteMax is not involved in any financial transactions between our doctors, patients or plan administrators.

What do I do if I have a claims issue?

If you have specific questions regarding claims processing or claims issues, you should contact the insurance company or plan administrator for the patient’s plan.

Can I bill the patient?

Patients are responsible for any coinsurance or deductibles. You cannot bill the patient for the difference between the DenteMax fee and your customary fee except as allowed by state law.

What if I want to terminate participation?

Very few dentists choose to leave the DenteMax network.  However, if you do choose to terminate all requests must be submitted in writing.

This request must include the following information:

  • Office Name
  • Associate Name(s)
  • Effective date of termination (must be the last day of a month) depending on your state laws
  • Tax ID number
  • Reason for termination
  • Signature

Please fax this request to (888) 586-0296. You will receive confirmation of your termination with all included termination dates and are based on your contract and are applicable to state laws.

Are there any charges to participate?

Participation is free. There are no annual dues and there are no requirements to perform free services for patients.

How do I update my information?

Any updates, including adding a location, dentist, or changes to your practice can be performed here.

If you have any further questions, please contact us at (800) 752-1547.

Why does DenteMax send me amendments to my Provider Service Agreement?

DenteMax continually monitors the legislation in each state to ensure we are in compliance. If your state legislation changes, you will receive an amendment to your Provider Service Agreement. We are required to amend our contract with you in order to comply with these regulations.

If you receive an amendment to your Provider Service Agreement, review it carefully and file a copy with your DenteMax contract. Amendments can also be viewed online by logging on to our secure website. As always, should you have questions about an amendment, don’t hesitate to contact us. 

In addition, DenteMax monitors compliance with the federal laws and regulations governing Medicare Advantage Plans. Dentists in the Medicare Advantage network will receive amendments to their Provider Service Agreement that reflect changes mandated by such laws and regulations.

How does DenteMax communicate with the office?

Regular communications with dental offices occurs via quarterly DenteMax Digest newsletters, phone, fax, e-mail, and on our secure web portal where you can access up-to-date network information.

Need more assistance?

DenteMax is committed to providing you with excellent service. Simply contact us at (800) 752-1547 during regular business hours, Monday-Thursday 8:15am-7pm Friday 9:00am-4:45pm EST to be connected to a live Network Support Representative ready to assist you. If your request is after hours or you are away from a phone, feel free to email us at customerservices@dentemax.com.

Credentialing
What does DenteMax do with my information?

Information collected during the credentialing process is used only for the review of dentists wishing to join the DenteMax network. Dentists meeting the criteria established for participation, and who have completed all other portions of the contracting process, will be approved for participation.

How often does DenteMax re-credential?

Every participating DenteMax network dentist must be re-credentialed every three years, or sooner, if required by law.

How will I know the results of my re-credentialing?

You will only receive notification if any issues arise during re-credentialing. If you are found to be ineligible for continued participation due to changes in your licensure, standing with state or federal programs, or any other criteria stated in our credentialing policy, you will be notified via certified mail of DenteMax’s intent to terminate your agreement and supplied with appeal rights.

Why am I required to complete a state-specific credentialing application form?

Whenever possible, we only require submission of the streamlined DenteMax credentialing application. However, several states have mandated the use of a state-specific credentialing application form. While the state forms are typically longer than the DenteMax Credentialing Application, we require their completion to ensure compliance with state laws.

Participation
When do new dentists become effective in the DenteMax network?

New dentists become effective in the DenteMax network once the following requirements are met:

  • The dentist completes signs and submits to DenteMax all applicable and required forms
  • The dentist has completed our credentialing review
  • The dentist has been entered into our database

Once the above requirements are met and approved, the dentist will become effective in the network on either the 15th or last day of the month. The office will receive a welcome call and confirmation letter to confirm participation with DenteMax and the effective date.

What happens if I add a new associate too, or lose an associate from, a participating practice location?

It is important that you notify DenteMax as soon as possible when a new associate joins your practice or an existing associate leaves. These notifications help ensure you are paid properly by our contracted administrators and that the information in our directories is accurate for members.

To make an update to your information including changes in name, address, TIN, specialty, or any others, simply click here.

Alternative Benefits
Alternative Benefits - How to handle them?

If an administrator’s benefit guidelines determine that an alternative benefit should be applied, reimbursement will be calculated on the DenteMax fee for the alternative procedure. The subscriber liability will be based on the DenteMax fee for the procedure performed. You can collect up to the full DenteMax fee for that procedure.

For example, a dentist installs a crown for a patient who has an 80 percent benefit for restorative services. The administrator determines, based on review of the documentation submitted with the claim, that a three-surface amalgam would have been an appropriate treatment and makes the payment accordingly. The following shows the breakdown of liability:

Alternative Benefit Chart

Can I plan treatment?

Yes. You and your patient determine the treatment that is most appropriate for your patient’s needs.

Do I need to predetermine?

DenteMax recommends that you predetermine services. The patient will know whether the procedure you are recommending is covered under his or her plan and what his or her financial responsibility will be. If it is not a covered benefit, you may perform the procedure with the patient’s consent and collect from the patient up to the DenteMax fee for the procedure performed (subject to state laws).

What about patient authorization?

DenteMax recommends that you have the patient sign the chart or a standard agreement to assume responsibility for the services performed for your protection.

Secure Dentist Portal
What is the secure dentist portal?

DenteMax has created a secure website to provide our network dentists with access to information about DenteMax and our contracted administrators.

How do I log on?

User name = your Tax ID number on file with DenteMax
Password = last 6 digits of your Tax ID on file with DenteMax

Once you log on, you will be able to create a new password. DenteMax strongly encourages you to change your user name and password after your initial login.

We encourage you to visit our web site on a regular basis to receive DenteMax updates and information, industry news and exciting offers to benefit your practice.

What can I do as an in-network dentist?

  • Access information regarding exclusive discounts on goods and services for your practice.
  • See what new groups have joined DenteMax.
  • Download your office’s fee schedule.
  • Look up insurance companies, administrator and group information.
  • Download applications, information update forms and instructions.

Additional Programs
Individual Membership Program

As a dentist in the DenteMax network, you may also receive patients who participate in individual membership programs. While many employers are reducing or eliminating dental benefits, employees still want access to a network of high-quality dentists like you.  DenteMax has partnered with several companies to refer these cash-pay patients to your office. These patients present a card indicating they are a member of one of these types of programs and are eligible to receive services from a DenteMax participating dentist at the DenteMax fee schedule.

Payment should be collected from the patient at the time services are performed. No claim forms need to be submitted.

Medicare Advantage Program

You may also be eligible to receive patients covered by Medicare Advantage programs. Also known as Medicare Part C., Medicare Advantage (MA) plans offer enhanced benefits that are not normally covered under traditional Medicare. These plans typically include preventive dental services.

The DenteMax Medicare Advantage network is open to all MA eligible providers. This is a win-win for patients and dentists. Patients have greater access to quality dentists and dentists are reimbursed at the DenteMax fee. Participating is a great way to build your patient base and increase revenue for your practice. As the population ages, there will be an influx in the Medicare patient population. Most MA members are required to go to an in-network dentist, which puts you in a position to increase your patient base.