Let’s Get Started!
Get started by filling out the provider credentialing application online today.
ATTENTION PROVIDERS IN SELECT STATES
Illinois, Louisiana, Mississippi, Nevada, and Oregon providers, click on your state name to download your state-specific credentialing packet.
- Nevada (application, packet)
- Oregon (credentialing application, recredentialing application, packet)
Disclosure of Ownership
If you are currently credentialed and need to update your Disclosure of Ownership form only, click below. Please complete the Disclosure of Ownership Form in order to maintain state requirements for credentialing.
As part of the Envolve credentialing/recredentialing process all providers must have a current disclosure of ownership and control interest form on file. Forms must be signed within three years from the date the provider is being credentialed/recredentialed.
Providers in Indiana, South Carolina, and Wisconsin are not required to complete a disclosure form.
The purpose of the credentialing process is to help make certain that Envolve Dental maintains a high-quality healthcare delivery system by validating the professional competency and conduct of our providers. This includes verifying licensure, board certification, education, and identification of adverse actions, including malpractice or negligence claims, through the applicable state and federal agencies and the National Practitioner Data Base. Participating providers must meet the criteria established by Envolve Dental, as well as government regulations and standards of accrediting bodies.
Envolve Dental has the exclusive right to decide which dentists it accepts as participating providers in the network. Envolve Dental does not discriminate based on age, race, ethnicity, gender, national origin, or religion when making credentialing determinations.
Note: In order to maintain a current provider profile, providers are required to notify Envolve Dental of any relevant changes to their credentialing information in a timely manner.
To comply with NCQA standards, Envolve Dental re-credentials providers at least every 36 months from the date of the initial credentialing decision. The purpose of this process is to identify any changes in the practitioner’s licensure, sanctions, certification, competence, or health status that may affect the ability to perform services the provider is under contract to provide. This process includes all providers, primary care providers, specialists and ancillary providers/facilities previously credentialed to practice within the Envolve Dental network.
A provider’s agreement may be terminated at any time if Envolve Dental’s Credentialing Committee determines that the provider no longer meets the credentialing requirements.
For more information on the credentialing or re-credentialing process, please refer to the Envolve Dental provider manual.
Providers looking to join the Envolve Dental network should email DentalNetwork@EnvolveHealth.com.
Current in-network providers can email DentalCredentialing@envolvehealth.com.