August 4, 2023

Humana expands DenteMax Network access

Humana, a long-term client partner of DenteMax, will be expanding its use of the DenteMax Network. Currently, Humana only uses Utilization Review Accreditation Commission (URAC)-compliant dentists for their Commercial and Medicare plans. Effective August 22, 2023, Humana will begin using Commercial Network dentists for all lines of business except Medicare. Medicare Advantage (MA) plans will continue to use only URAC-compliant Medicare dentists.

How does DenteMax and your practice fit into this arrangement?

As a DenteMax Network dentist, you may see Humana plan members. Medicare dentists are subject to the recredentialing requirements outlined in the below MA plans. Claims may be processed according to your DenteMax fee schedule, but contact Humana to confirm how they would like to be paid when verifying benefits, as multiple networks are used to service members.

Humana Medicare Advantage plans

Recredentialed DenteMax dentists only - URAC-complaint

Only dentists who have submitted their DenteMax recredentialing form (or a similar state-mandated form) are eligible to be considered as in-network providers for Humana MA plans. This is because they adhere to a URAC standard met only when these forms are on file with DenteMax. So, if a DenteMax Recredentialing Team member contacts you for recredentialing, please complete and submit all the requested forms.

If you want to see Humana MA patients in-network, but did not turn in your forms, please contact the DenteMax Recredentialing Team. They can be reached at (800) 752-1547 option #2 or via email at recredentialing@dentemax.com. Make sure you mention recredentialing for Humana URAC standards.

Note: All MA dental benefits under the nationwide Humana Medicare Dental PPO Network use the nationwide DenteMax Medicare PPO Network, along with other Medicare networks and Humana's own Medicare Network. This combined network is known as the Gold Plus Network.

Member ID cards

Member ID card examples are below. To find a Humana MA member's dental benefit, look on the back of the ID card for "DENxxx." The letters "DEN," plus a three-digit number, indicate the member's specific dental plan. Benefits vary by plan, so be sure to verify the specific coverage of your MA members. Dentists can find coverage details (such as covered codes, frequency limitations and the name of the dental network for each DENxxx plan) by accessing Humana's 2023 Dental Office Handbook.

Important: The Humana MA ID cards may reference HMO on the front. This only pertains to the medical portion of the member's plan.

Questions?

If you need assistance related to verifying a member's benefits or topics related to pre-treatment estimates and claims, call the Humana Dental Provider Customer Service line at (800) 833-2223.

If you have any questions about your participation with DenteMax, visit DenteMax.com or call (800) 752-1547, option #2.