Existing DeltaCare Dentists

You will receive forms directly from CreDentals before your anniversary date. You will also receive interim requests for any expired documentation. Please respond!

Form #1 is a "Data Form." You must complete all portions!

Form #2 is an "Attestation." This form asks you ten questions about any adverse experiences in your career. Your answers need to correlate to data we receive from the National Practitioner Databank and the New Jersey State Board of Dentistry. The former provides information on any malpractice settlements against a dentist, and the latter provides sanction records. We also have access to any Medicaid infractions.

Along with these two forms, you need to include a current copy of:

• Your current malpractice declaration page, reflecting your name, the expiration date of the policy, and the occurrence and aggregate coverage. Our minimum requirement is $1,000,000 per occurrence, and $3,000,000 aggregate.

• Your current DEA certificate (check the appropriate box on Form #1 if you don't have one).

• If applicable, your current CDS certificate.

That's it! Two forms, and two or three certificates, depending on your status.

Please be complete on the first try. Here's why:

Three pieces of information expire every four months at CreDentals:

• Attestation

• Hospital Privileges

• Work History

If you have neglected anything which holds up the process, and you remain incomplete for more than 120 days, these three things all need to be submitted again, along with any other outstanding data.

If you are still feeling unsure, need extra forms, or have questions, please do not hesitate to contact our credentialing analyst:

By phone: 1-800-722-3524 x4156
By e-mail: ayoung@deltadentalnj.com

For your convenience, we are providing a link directly to CreDentals' Web site: www.credentals.com

DeltaCare is underwritten and administered by Flagship Dental Plans, a wholly-owned subsidiary of Delta Dental of New Jersey, Inc.