Contracting and Participating Dental Agreements
Regence contracts with multiple dental professionals, forming dental networks to meet our members' needs. In return we offer predictable reimbursement amounts and schedules, direct payment, and a pool of potential patients.

Dental Networks and Products

Participating
The Participating Dental Network serves our members enrolled in our participating fee-for service dental plans in Oregon and southwest Washington. Participating dentists are reimbursed according to our maximum allowable fee schedule. Payments and a remittance statement (which explains payment for services provided to our members) are sent directly to participating dental offices each week.

Dentacare
We offer our Dentacare products through Willamette Dental Group (WDG), a Dental Health Maintenance Organization (DHMO). Members located within 50 miles of a contracted Willamette Dental Group office may be offered this product for their dental care needs. Offices are located in Oregon, Washington, and Idaho.

Participating Dental Agreements
Regence has standardized contracting practices and will now use a single Dental Group Agreement for multiple providers using a Federal tax ID number (TIN). This agreement will cover all providers doing business under that tax ID number (TIN). Providers using their Social Security Number (SSN) will receive an Individual Dental Provider Agreement.

If you would like to request a packet via the mail, contact a Dental Services Representative & Consultant.

The packet will contain an Application, two (2) copies of the appropriate Agreement and some additional information regarding Regence. Return the completed Application and both signed copies of the Agreement using the provided envelop to the following address:

Dental Business
Regence BCBSO
PO Box 1271 MS E7F
Portland, OR 97207-1271

Upon receipt of the completed Application and signed Agreements, we will validate licensure, certification(s), malpractice insurance and other documentation where necessary. We will countersign both copies of the signed Agreement. One copy will be returned to you for your records, the other copy will remain part of our records. Please note that these Agreements are legal documents, and should not be altered in any way from the original document.

Application Checklist

The following is a checklist of documents that must be legible and included with your Application:

• A photocopy of the current state dental license (with license number, issue date and expiration date) for each provider.
• A photocopy of any specialty certification(s)/or general anesthesia or conscious sedation permits, if applicable for each provider.
• A photocopy of the current malpractice insurance certificate (with policy number, levels of individual aggregate coverage and dates of coverage) for each provider.
• A photocopy of the current Drug Enforcement Administration certificate(s), if applicable for each provider.
• A W-9 indicating how the tax ID is registered with the IRS.