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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements
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Dental Provider Resources

PW_E191300
Tools for Dental Providers 
Empire Dental Prime and Empire Dental Complete Self-Service Tool
Log in to access Dental Prime and Dental Complete eligibility, plan information, dollar amounts used and claim status; submit and view claims online; and sign up for or update Electronic Fund Transfer (EFT) and Electronic Remittance Advice (ERA). EFT and ERA registration available in NY. 
National Provider Identifier (NPI) Registration
Affiliates and Other Payors
Provider Services & Help
 
Communication/Notifications  
CDT Updates Effective 1/1/2015
CDT Updates Effective 1/1/2014
CDT Updates Effective 1/1/2013
Dental Newsletter – Fall 2013
 
Forms 
Dental Care Network Direct Referral and Special Exception Form
Dental Care Network Patient Encounter Form
Dental Care Network Orthodontic Referral Form
Dental Care Network Periodontal Referral Form
Dental Claim Form
Dental W-9 Form
Dental ERA Form
Dental EFT Form
HLD Index Score Sheet
 
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