Provider News
News and Updates
Instruction for Provider Updates:
12/8/2016
If you have questions or would like to update your provider profile, please contact the Provider Relations Department by:
Email: [email protected]
Phone: 1-877-493-6282
You may also download the Provider Change Form and page 1 and 6 of the Provider Application for address and plan changes by clicking on below links:
FCL Dental Provider Change Form:
DINA Dental Provider Change Form:
Provider Application Form: Page 1 and 6 for changes to Plan options and offices changes
Provider changes will be updated in the system in real time by the Data Maintenance Department. This will assist us in maintaining our records to ensure correct provider payments and accurate provider directory listing. Additionally, to be consistent with marketplace rules, online directories will be updated in real time to mean within 30 days.
Provider Changes:
12/8/2016
In accordance to section 100.4-42 CFR 422.111(b)(3) and (h)(2)(ii), 422.112, 423.128(d)(2) of the CMS Chapter 3-Medicare Marketing Guidelines (MMG), online provider directory requirements Medicare Advantage Organizations and Medicare-Medicaid Plans are required to send network providers a quarterly provider verification. Additionally, to be consistent with marketplace rules, online directories will be updated in real time to mean within 30 days. This will assist us in maintaining our records to ensure correct provider payments and accurate provider directory listings. Below is the information that we will required in order to update in our system. Please notify FCL Dental immediately if any of the below changes have occurred:
- Ability to accept new patients’ changes:
- Street Address
- Phone Number
- Fax Number
- Email Address
- Office Hours
- And any other changes that affect availability to members.
- Any billing address changes
Required Compliance and Training Documents for FCL Dental Providers:
12/8/2016
FCL Dental is strongly committed to ethical and legal conduct in the operation of our business, the provision of health care services, and the participation in government health care programs. As part of FCL Dental commitment to legal and ethical conduct and business practices, we have adopted standards to uphold these principles. These standards are the basis for FCL DENTAL Compliance Program. The cornerstone of FCL DENTAL Compliance Program and commitment to regulatory compliance and legal conduct is Compliance & FWA, Cultural competency and HIPAA trainings. FCL DENTAL does not condone unethical, non-compliant, or criminal conduct by employees or contracted entities or individuals with whom we do business. FCL DENTAL requires that the following training or a training equivalent be completed with all staff.
FCL Dental Medicare Advantage network provides benefits to FCL Dental members enrolled in Medicaid/Medicare Advantage programs. The Centers for Medicare & Medicaid Services (CMS) mandates that all FCL Dental-contracted entities, including those contracted with FCL Dental subsidiaries, complete compliance requirements on an annual basis.
Please see the following link to the required CMS Mandatory Medicaid/Medicare Advantage training items:
- Instruction for accessing the CMS Training Content:
Please return the attestation that you have provided the following training or your own equivalent training. For additional information, please contact
[email protected]
Claim Form:
12/8/2016
Dental Provider that that using ICD-10-CM please use ADA claim form version 2012 to effectively capture the new ICD-10-CM codes when sending paper claims and on Electronic Claims (837D) please follow up if you have not done so with your office management software vendor to have the most update to date version to effectively capture the new ICD-10-CM when submitting claims. To download the 2012 ADA Dental Claim Form and completion instructions, please see below link to the American Dental Association:
http://www.ada.org/en/publications/cdt/ada-dental-claim-form