Provider Frequently Asked Questions

How do I report Compliance, Privacy, Ethics, Or Fraud, Waste & Abuse concerns?

Report Compliance, Privacy, Ethics, or Fraud, Waste and Abuse Concerns by:

What is credentialing?

Credentialing is a systematic approach to the collection and verification of a provider's professional qualifications. The qualifications that are reviewed and verified include, but are not limited to, relevant training, licensure, certification and/or registration to practice in a health care field, and academic background. Additionally, FCL Dental conducts an assessment of whether the provider meets certain criteria relating to professional competence and conduct. The FCL Dental credentialing process evaluates the qualifications of providers prior to inclusion in the FCL Dental network. However, credentialing and network contracting are separate processes

Will I be notified if erroneous information is discovered during the credentialing process?

Yes, the FCL Dental Credentialing department will notify you if erroneous information is discovered during the verification process from any primary source. It is your responsibility to work directly with the reporting entity(ies) to correct the erroneous information.

How can I check on the status of my (re)-credentialing application?

FCL Dental has a Credentialing department that is happy to assist you if you have any questions about your credentialing or recredentialing process. You can call the Credentialing department for dental providers at 1-877-493-6282

What happens next? Can I begin seeing FCL Dental members once I submit my application for participation?

Once FCL Dental receives your completed application for participation, your information will be evaluated against our business requirements, and your credentials will be validated as described in the "What is credentialing?" question above. Once this process is complete, you will receive written notification that your credentialing is complete and give you information about your participation status. The credentialing and contracting processes are separate.

If you have questions about your participation, please call FCL Dental at 1-877-493-6282.

Who can I talk to about my dental insurance claims?

Call 1-877-493-6282 and a FCL Dental customer specialist will be happy to help you. Our office hours are 8 a.m. to 5 p.m. Monday through Friday.

How can I find a dentist?

You can find a dentist online with our Find a Dentist or call 1-800-493-6282.

How do I change an address on the Internet?

You can change your address two way by registering and loggin in to your MyPortal Itransact website or please call 1-877-493-6282 to update your address with a customer service specialist.

How many cleanings do FCLDental plans cover?

It depends on the plan you are on or plan your employer has chosen.

When do I need an estimate?

Estimates are not required in most cases, but are strongly recommended when services will exceed $300. You should work with your dentist to obtain this information. If you are unsure whether an estimate is required in your case, contact us at 1-877-493-6282.

What are waiting periods?

The time a member must wait from the effective date of coverage for certain procedures to be covered. Waiting periods depend on the size of the group and whether the group had prior dental coverage.

What is an alternate service?

The least expense service when two or more services would correct the same dental condition.

What is an annual maximum?

The amount that may be payable for each covered person for expenses incurred. No further benefits are payable after the maximum benefit is reached.

What is coinsurance?

The percentage of covered charges FCL Dental will pay after the deductible is satisfied and until the annual maximum is met.

What is a deductible?

The portion of the covered expenses that a member pays every year before FCL Dental pays benefits.

How do I become a partnering provider with FCL Dental

E-mail [email protected] to request an application and agreement. Once we receive the signed application and agreement, your information will be processed by our credentialing department. Please allow 60-90 days to complete your credentials.

How do I nominate a dentist

CLICK HERE to nominate a dentist.

How do I update provider information changes?

Have a new dentist joining your practice, changing your location, TIN or other pertinent information? Please complete the forms below and submit via e-mail or postal.

• Provider Information Change Form
• W-9 Form

You can find all of the necessary forms here: Provider Forms

How do I submit claims to FCL?

Please submit claims electronically with:

• PayerID:CX090

Physical Address FCL Dental Attn: Claims 101 Parklane Boulevard, Suite 301 Sugar Land, TX 77479

Submit via secure FAX claims:  Number:  281-313-7154 with Attn: Claims

For Private Plan Members
There are NO claims for the SmileCard plan. This plan is simply a discount membership at partnering dental provider locations. Members are responsible for payment of services at the time treatment is rendered unless providers choose to make other financial arrangements.

What if a patient needs to see a specialist?

Please have the member contact FCL Customer Service at 1-877-493-6282. We will be able to inform the member which specialist in their area has agreed to offer a discount. No authorization is required for members to visit an in-network specialist.

For the PrePaid plans, are services that are not listed on the plan fee schedule covered?

Dental services not listed on the fee schedule are available to the member at a 25% discount off of our dental network’s normal charges.

How are members assigned to a dental office?

Members may choose any participating dentist at any time by calling FCL Customer Service. Members are required to be assigned to an office in order to receive treatment from a participating PrePaid dentist.

How can I verify a member's eligibility?

Visit our online Provider Web Portal to verify eligibility.