To help ensure accurate claims processing and compliance with industry standards, Select Health dental providers should be aware of the following credentialing and billing requirements:
- Every provider in your office must be individually credentialed and contracted with Select Health using their own NPI. Dental practices sometimes assume that one contracted provider can bill on behalf of the entire clinic, but this is not permitted. Each treating dentist must complete the credentialing and contracting process under their unique National Provider Identifier (NPI) before they begin seeing Select Health members.
- All claims must list the actual treating (rendering) dentist, consistent with American Dental Association (ADA) billing rules. The ADA requires that the dentist who performs the procedure be the one identified on the claim, and that provider is responsible for the accuracy of the submission. Claims cannot be billed under another dentist’s name or NPI, even if that dentist is participating with Select Health.
Submitting claims with an inaccurate rendering provider—whether that provider is participating or not—can lead to reimbursement issues and may require correction. Ensuring your practice bills under the correct provider from the start helps avoid delays, reprocessing, and potential compliance concerns.
Learn more about these policies in the Select Health Provider Reference Manual: Dental Plans.
Questions? If you have any questions about credentialing requirements or how to ensure claims are billed correctly, please contact your Provider Relations representative.