As a dentist, your practice is dedicated to providing the best care for your patients.
And at Humana, we want to help you grow your practice as an in-network provider.
Humana is one of the largest healthcare insurers in the country, with a long history of providing dental coverage and delivering an outstanding experience for dentists in our network.
When you join our network, you gain access to more than 8 million members.
With Medicare Advantage, employer group and individually insured members, Humana can help you access new potential patients in every community across the country.
Humana is well known for our approach to whole person care. We offer plans designed to promote oral health care and prioritize prevention.
As a Humana in-network provider, your patients have access to affordable, preventive, basic and major care.
We see Dentistry as essential healthcare and providers as key partners.
For in network providers we dedicate a single point of contact to answer questions about plans and solve administrative issues, along with a robust provider portal with self-service capabilities.
As a Fortune 50 company, that has been offering dental plans since 1977, Humana is committed to offering providers the service they need to provide life-changing care to Humana members.
If you're interested in growing your practice as a Humana in-network provider, you can reach out to our representatives to learn more and join our network.
Become a participating dental provider with Humana
Learn about the advantages of joining the Humana PPO Dental Network.
Are you ready for your appointments with Humana and Medicare members? By watching this video, you can gain a better understanding of their coverage and benefits.
Humana provides dental insurance benefits to more than 5.7 million seniors nationwide, so many of your patients may have coverage with Humana's Medicare Advantage plans, otherwise known as MA, Special Needs Plans or Medicare Supplement insurance Plans.
Let's first look at your patient’s insurance ID card. The front of the ID card may say HMO, but that only refers to the medical plan. Humana Medicare Advantage dental benefits use a PPO network. Members have in-network benefits or out-of-network benefits, depending on their plan.
Please turn to the back of the card. At the bottom, you'll see dental information and you can visit
When reviewing benefit details, there is one important distinction to be aware of. While most of your senior Humana patients may use the Humana Medicare Dental PPO Nationwide Network, seniors who enrolled in Florida use the Nationwide Florida Gold Plus Dental network.
Now, let's take a moment to discuss Humana Medicare Special Needs Plan members. These patients will present a Medicare Advantage ID card, similar to the one we just saw. Special Needs Plan members are also on Medicaid, so they may be showing you that ID card as well.
Rest assured that the dental benefits are provided through their Humana MA plan. You do not need to accept Medicaid in order to provide care to these patients. Reimbursement is based upon your Humana PPO fee schedule.
What are some features of 2025 plans?
Most Humana Medicare members have some free dental coverage in 2025. And many have coverage for major services like periodontal scaling, crowns, dentures, bridges and dental implants. Benefits vary by plan. See
Dentists can easily confirm benefits on
Be sure to select the Humana Dental payer to get results on dental member benefits.
Here's a recap.
- First, Humana MA plans always use a PPO Network.
- Second, you can find the dental benefit on the back of the Medicare Advantage ID card and visit
humana.com/sb for coverage details.
Questions? Visit our provider site at
Important benefits and claims information can be found at
Thank you for taking the time to learn more about Humana Medicare members.
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Being ready for appointments with Humana Medicare Advantage members
Learn about the Humana Medicare Advantage Dental Office Handbook, which includes details about the dental benefits, the network and member ID card.
At Humana, we're excited to support you and your patients. And we want to make working together easy for you. These tips can help keep everyone on the same page.
In this brief video, we will cover a few of our processes.
Let's start with confirming patient benefits.
Dental offices can quickly verify patient benefits online through
Step two is submitting pre-treatment estimate requests or claims.
Claims and pre-estimates can be submitted electronically or by paper. Submitting claims electronically also allows for claim attachments, making it easier to ensure you've included everything needed for your claim.
Pre-determinations are not required, but if you expect a procedure to cost more than $300, we recommend submitting a treatment plan for review. To learn more, visit
The addresses for paper claims are located at
Electronic claims can be submitted through payor applications such as DentalXChange, Change Healthcare and others.
To learn more about what to include with your claim, please refer to the Claim Documentation document located on the Dental Provider Resource page at
For information about the status of your claims and pre-estimates, please visit
Finally, there is the Evidence of Remittance, which shows the completed claim adjudication. Depending on how you receive claim payments from Humana, you will get an Evidence of Remittance (EOR), or Electronic Remittance Advice (ERA).
Find the PowerPoint titled “How to access and interpret information provided on remittances,” which provides more detail on dental claims. It's available at
Thanks for taking the time to learn about Humana.
Make sure to visit our dental provider site or if you have questions, give us a call at (800) 833-2223.
Support for dentists – Helpful tips regarding member benefits and claims
Learn about how to confirm Humana members’ benefits, how to submit claims or requests for pre-treatment estimates, and information about the Evidence of Remittance (EOR).
At Humana, we want to make credentialing and contracting with us simpler, so you can spend more time caring for your patients.
That's why Humana's dental network uses CAQH ProView to help keep things simple.
First, it's important to remember that to comply with state and federal regulations, your completed credentialing application must be approved by Humana prior to the start of your initial contract.
You will also need to recredential at least every 36 months. You will be asked to provide any required updates and attest to the accuracy of your professional information.
With CAQH ProView, credentialing is easier. It enables you to submit one standard credentialing application to a single source for all healthcare organizations you choose to partner with.
By entering the required profile information in ProView and keeping it updated, your credentials will auto-renew.
This means less time spent on onboarding and less time waiting before scheduling patients.
To get started, U.S.-licensed dentists must first sign in ADA.org/GoDigital.
After signing in, you will be redirected to the CAQH ProView welcome page. Please enter all required information to ensure your profile is complete.
Attesting to your information is a critical step in finalizing your ProView profile. With this step, you will confirm that your credentialing application is complete and accurate. It will also help Humana keep your directory information up to date, so prospective patients can find you.
As a reminder, CAQH will send an email every 90 days to request that you confirm and attest to your profile information.
Do you want your data shared? You choose.
While setting up your profile, you will be given the option to indicate “Yes. Release my data to any organization that requests access,” or “No,” to grant access individually.
We recommend selecting “Yes” because it saves you time later when partner organizations need your info.
Please note: If you select “No,” you will be required to check the “Organizations” page periodically to ensure you've granted access to any organizations requesting your ProView data.
Credentialing delays may occur if this step is not completed quickly or correctly.
If you have questions, please call the CAQH Help Desk at (888) 599-1771.
You can also go to Proview.CAQH.org for a list of reference materials available to dental providers. You can find more helpful information about Humana's credentialing process by visiting our “
Thanks for credentialing with Humana.
If you have questions, please call dental provider customer service at 800-833-2223.
Simplify Credentialing with CAQH ProView
Humana wants to simplify the credentialing process for our providers, that's why we use CAQH ProView. Learn more about the process by watching this informative video.
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If you're looking to grow your practice, Humana can help. Our Dental Health Maintenance Organization plans, also known as DHMO plans, can offer you a steady stream of new patients.
During this brief video, we'll highlight how participating in a DHMO network can benefit your practice. Plus, we'll share tips and resources to help support you in providing care.
When you participate in Humana’s DHMO network, we proactively market your services to new patients. Our goal is to provide you with a steady increase in patient flow, allowing you to determine the number of additional patients you want to accept.
Our DHMO plans put you in control. You can administer care in a manner that best suits you and your patients. When you're in Humana's DHMO Network, be sure to check your roster prior to treating new patients to confirm that a patient has been assigned to your practice. This will ensure that you're being compensated appropriately for the care you provide.
Our DHMO plans have no out-of-network benefits and require that patients select a primary care dentist. If an individual not listed on your roster contacts your office to determine if you accept our DHMO plans or request an appointment, please direct them to Humana Customer Care to ensure their assignment is made appropriately. To do this, look at the patient’s member ID, as shown on their ID card, to make sure they are listed on your patient roster.
Simply sign in to
Our DHMO plans are structured to ease the burden on your staff. Most routine services do not require reclaim submission and our plans do not include deductibles or benefit limits to track.
As a participating Humana DHMO provider, you're reimbursed in 3 ways:
- Monthly capitation payments
- Supplemental payments
- The patient responsibility
Your monthly capitation payment provides a reliable financial foundation. These payments are provided at a set rate, predetermined for each plan. They're provided per patient, per month, for each patient assigned to your practice. Capitation payments are issued automatically, do not require a claim submission and are administered regardless of whether a patient receives care within the payment period.
Certain covered procedures may qualify for a supplemental payment. This is extra reimbursement above and beyond your capitation payments and any patient responsibility you receive.
These payments are provided in circumstances where the patient responsibility or copayment is less than the minimum payment guaranteed to you. Claim submission is required to receive reimbursement for supplemental payments from Humana.
Your patients and staff can easily determine the exact benefit and copayment amount by referring to the schedule of benefits.
Not contracted with Humana? Contact us to join our vast network.
- Email:
DentalRecruitment@humana.com - Call: 800-255-5930
- Online:
Provider.humana.com/dentist-resources/join-dental-network
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Become a DHMO participating provider with Humana
Learn about how participating in our DHMO network can benefit your practice by leveraging simplified processes and accessing plans structured to help your practice augment its bottom line.
Hello and welcome to the Federal Employee Dental and Vision Insurance Program (FEDVIP).
We're here to help you learn more about our dental plans for our federal civilian workforce, federal annuitants and Tricare retirees. Today we'll review the 2 Humana Fed VIP dental plan options, telling you a little about plan benefits and how the coordination of benefits works.
The PPO and Federal Advantage plans are both available in the green colored states you see on the screen. Your commercial PPO contract automatically includes the federal PPO High option and pays up to your PPO fees. However, the EPO plan is a state specific contract.
There are 2 Humana dental plans to choose from:
- The EPO Standard Advantage plan that features set copays for specific services.
- The Humana PPO High plan with standard deductibles and coinsurance.
Both dental options offer no waiting periods, coverage for child and adult orthodontics and coverage for implants. Referrals are not required on either plan.
The EPO plan is a lower cost option and is a good choice for patients on a budget. Patients can receive services from an in-network Standard Advantage provider.
Out-of-network services are not available, except in case of an emergency. This plan also offers an unlimited annual and lifetime maximum, including 3 annual routine cleanings.
The PPO option provides benefits for patients who see both in- and out-of-network providers. The deductible does not apply to preventive or orthodontic services. This plan offers 3 routine cleanings and 4 periodontal cleanings covered per year, plus no annual maximum.
For patients with Federal plans, they may have dental coverage included in their medical plan. The office of personnel management requires the medical carrier to pay first. Once the medical carrier's claim is processed, attach a copy of the medical explanation of benefits to the dental claim form and send to Humana for processing. The patient is only responsible for their copayment or coinsurance.
Now, let's review the support and resources available to you as a Humana Provider. Register at
Humana can serve you in many ways. Call our dental provider customer service line at 800-833-2223 for further assistance.
Participating providers can also email our dental service team at
Not contracted with Humana? Contact us to join our vast network.
We appreciate your time to learn more about Humana's Federal Dental plans.
Please visit our Humana
Thank you for serving our federal members.
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Learn About FEDVIP: Our Federal Employee Plan Network
Learn more about participating in the FEDVIP (Federal Employee Dental and Vision Insurance Plan) network that Humana offers to the Federal civilian workforce, Federal annuitants and TRICARE retirees. Understand the benefits of each plan, how coordination of benefits works, how to join the FEDVIP network and learn more about provider resources available to you.