Dental Provider Toolkit
Tools & Resources
Orthodontics Job Aid: Submissions and Documentation Requirements
Service Authorization Letters Job Aid
Claim EOB Reason Code Crosswalk
Dental Provider Portal Guide – updates coming soon
Decision Support for MassHealth Dental Coverage: Crowns and Core Buildup
Forms
Add Form – when adding an additional provider, who is already credentialed with MassHealth, to an existing practice.
Change Form – to change name, address, TIN, EFT, to terminate, etc.
Credentialing Application – for each participating dentist.
Reconsideration Request Form – to submit within 30 days of the clinical or administrative claim.
Void Request Form – to void claims