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How can I get a Maryland Uniform Dental Credentialing Form?
Click here to print a copy of the Maryland Uniform Dental Credentialing Form or request an application by calling Dental Provider and Credentialing and Contracting at 443-921-0676.
Can I submit the Maryland Uniform Dental Credentialing Form by itself?
No. You must submit a Dental Billing Authorization Form with the completed Maryland Uniform Dental Credentialing Form.
What information is required to be submitted with each Maryland Uniform Dental Credentialing Form?
The following items must be submitted with each Maryland Uniform Dental Credentialing Form:
- Copy of DEA registration certificate, if applicable;
- Copy of Controlled Dangerous Substance registration issued by the State or District in which you practice, if applicable;
- Copy of current professional license(s);
- Copy of specialty board certification, if you are board certified;
- If you are not board certified, proof of eligibility, such as copy of admission for examination or proof of successful completion of residency program.
- Copy of professional liability coverage certification and must include the limits of coverage, the expiration date, and the name of the provider covered under the policy. Shared limits coverage is not acceptable
Where do I send the completed Maryland Uniform Dental Credentialing Form and Dental Billing Authorization Form?
Please mail all the required information to:
CareFirst BlueCross BlueShield
Attn: Dental Provider Credentialing and Contracting
Mail Stop CT06-24
10455 Mill Run Circle
Owings Mills, MD 21117
I practice in several different locations, do I need to participate with CareFirst at each location?
Yes. CareFirst requires that providers who practice with multiple provider groups or have more than one office location participate in all practice locations.
For example, if you are in the CareFirst Participating and/or Preferred Provider Networks in one practice location, you must be in the same networks at all locations.
I already submitted a CAQH Universal Credentialing Datasource application, do I need to complete a Maryland Uniform Dental Credentialing Form also?
No, the Maryland Uniform Dental Credentialing Form requirements are incorporated in the CAQH Universal Credentialing Datasource application.
If you have already completed the application through another CAQH member insurance company, please contact CareFirst's Provider Dental Credentialing and Contracting Department at 443-921-0676. CareFirst will add your name to the roster and access your information on CAQH's Web site.
How should I notify CareFirst if I move my practice, change my office telephone number or change my Tax ID Number?
Please submit the new address, telephone number and/or Tax ID Number (with a W9) on your office letterhead and send to:
CareFirst BlueCross BlueShield
Dental Provider Credentialing and Contracting
Mailstop CT06-24
10455 Mill Run Circle
Owings Mills, Md. 21117
Or Fax it to: 410-720-5080
Whom do I call if I have additional questions regarding dental credentialing and participation?
Please direct calls to CareFirst Dental Provider Credentialing and Contracting at 443-921-0676.
Whom should I call if I have questions regarding claims, benefits, authorizations or referrals?
Click here for phone numbers and claim addresses.
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