Dental Provider Resources
Welcome to the AmeriHealth Caritas DC dental provider network. We are committed to offering a dental benefit program that provides access to high quality oral health care. We are proud that you will provide dental services to our enrollees directly through your agreement with us.
Want to become a participating dental provider?
Professional providers must email the following information to dentalapplications@amerihealthcaritasdc.com.
- Your recently updated and attested CAQH ID number
- Your W-9 (PDF) for your office or group and Ownership Disclosure Form (PDF)
- Your individual Medicaid ID number and a group Medicaid ID number for your office or group
- Your typewritten Practitioner Information (PI) Form (PDF), as handwritten applications are no longer accepted
- Your signed Dental Provider Agreement (PDF) (contract) if not already contracted or if not part of an existing contracted group
For more information about our dental program or to access our dental portal, please refer to the resources below:
- Dental implant benefit policy (PDF)
- Dental periodicity schedule (PDF)
- Dental portal
- Dental provider supplement (PDF)
- Dental quick reference guide (PDF)
- Handicapping labio-lingual deviation (HLD) score sheet (PDF)
- HPV prevention in children (PDF)
- HPV vaccine recommendations (PDF)
- Oral Care Connect® Pay-for-Performance Dental Program
- Periodontal services referral to Howard University College of Dentistry (PDF)
- Primary dental provider overview (PDF)
- Provider information form (PDF)
- Restorative dentists evaluation form (PDF)
- Same-day dental sealant workflow (PDF)
- Silver diamine fluoride coverage (PDF)
- Supporting enrollees with special needs (PDF)
- Universal caries risk assessment form (PDF)