CAREINGTON DENTAL PROVIDER CREDENTIALING GUIDELINES
Careington International Corporation has been building dental networks since 1979, and today it serves more than 30 million members across its brands, products, and services. With over 90,000 general dentist and specialist locations in the network and more than 3,000 resellers actively marketing Careington plans to individuals, families, and employer groups, joining Careington’s dental network gives your practice access to one of the most distributed patient referral engines in the country.
Why Careington Dental Network Credentialing Is Worth Pursuing for Your Practice
Here are the key facts that make Careington a strategically valuable enrollment for dental practices of all sizes:
| Key Fact | Data / Insight | What It Means for Your Practice |
|---|---|---|
| Total Members | More than 30 million members across Careington brands, products, and services | One of the largest dental discount and PPO network administrators in the nation |
| Provider Locations | More than 90,000 general dentist and specialist locations in the Careington network | Joining means access to a nationally recognized brand that drives patient referrals |
| Reseller Partners | Over 3,000 resellers selling Careington plans at local and national level | 3,000+ distribution channels actively marketing your practice to potential patients |
| Plan Types | PPO (Care PPO, Care Platinum PPO) + Discount/POS plans (500 Series, POS Series) + 5 reimbursement level options | Choose which plans to participate in — more plans = more member access |
| Credentialing Standard | NCQA guidelines — malpractice history, licensure, malpractice coverage, education, government sanction monitoring | Industry-recognized quality standard; meets requirements for insured partner integrations |
| Credentialing Timeline | 60–90 days for the full credentials and contract process | Direct, straightforward timeline — no geographic panel review gate |
| Recredentialing Cycle | Every 3 years — NCQA-compliant | Predictable 3-year cycle with clear submission pathway via mail, fax, or email |
| Cost to Join | No cost — joining the Careington network is free | Zero enrollment fee; no annual participation fee; revenue generated entirely from member visits |
| Founded | 1979 — headquartered in Frisco, Texas | Over 45 years of dental network experience — a stable, long-established payer partner |
UNIQUE ADVANTAGE
Careington’s single-source credentialing process covers multiple networks simultaneously. One application and one credential gives you access to all five plan options across Careington’s PPO and discount networks. As Careington notes: the more plans you participate in, the more members you have access to, and there is no requirement to join all plans.
Understanding Careington's Plan Structure: PPO, Discount, and POS
Careington is neither purely an insurance company nor purely a discount plan, it is both. Understanding this hybrid structure is critical for setting up your billing correctly and ensuring your front desk staff handles patient transactions appropriately:
| Plan / Series | Structure & Reimbursement | Key Provider Consideration |
|---|---|---|
| Care PPO (CI-4 and variants) | PPO — fee-for-service at negotiated schedule rates. Members pay coinsurance/deductibles. Procedure codes not on schedule discounted at 20% off normal fee. | General dentists use assigned fee schedule; specialists apply a flat discount percentage |
| Care Platinum PPO (CP-18 and variants) | Enhanced PPO tier — slightly lower fees than Care PPO but improved member benefits. Non-listed procedure codes discounted at 15% off normal fee. | Higher-tier plan; may attract more employer group members seeking premium coverage |
| 500 Series (Discount / POS) | Discount plan — NOT insurance. Members pay directly at Careington-assigned discount rates (20–60% off). No claims to file. No deductibles. No annual maximums. | Fastest plan to activate for members — same-day use; high volume of individual and family enrollees |
| POS Series (Point of Service) | Discount plan — NOT insurance. Larger provider network than 500 Series but slightly lower discount rates (20–50% off). Members pay directly. | More members eligible because POS network is larger; good for practices wanting broader reach |
| Specialist Discount Plans | Specialists (endodontists, oral surgeons, periodontists, prosthodontists, pediatric dentists, orthodontists) do not use a fee schedule — instead apply a flat 20% discount off their standard rates. | Simple specialist participation — no schedule negotiation required; flat 20% reduction |
| Flexible Fee / Multi-Plan Options | Three different reimbursement levels across PPO and POS plans = five plan options total. Providers may participate in as many plans as they choose. | More plan participation = more eligible members; no requirement to join all plans |
Careington's NCQA-Compliant Credentialing Standards
Careington credentialing is governed by NCQA guidelines, the same quality standard used by the largest health plans in the country. This means your credentials are verified thoroughly and through primary sources.
| NCQA Credentialing Element | What Careington Verifies | Source / How Verified |
|---|---|---|
| State Dental Licensure | Active, valid, and unrestricted license in all states of practice, initial credentialing and every re-credentialing cycle | State dental licensing board (primary source verification) |
| Education & Training | Graduation from an accredited dental school (DDS/DMD); specialty training if applicable | Dental school directly; ADA Directory also referenced |
| Malpractice History | Thorough check of malpractice history — all prior claims, suits, settlements, and pending actions | Malpractice insurance carrier + NPDB query |
| Adequate Malpractice Coverage | Current and active professional liability insurance meeting Careington's minimum coverage requirements | Certificate of Insurance (COI) — confirmed with carrier |
| Government Sanction Monitoring | Regular monitoring against federal and state government sanction and exclusion lists | OIG Exclusion List + SAM.gov — ongoing between credentialing cycles |
| Background & Disciplinary History | Review of disciplinary actions, license sanctions, criminal history, and other quality checks | State dental board + NPDB + background check sources |
| Professional Standards | Education, background, license standing, and other quality requirements — 7-step approval process | Comprehensive review under Careington's in-house Credentialing team |
NCQA STANDARD
Careington states explicitly that contracted providers are credentialed and re-credentialed according to NCQA guidelines. This includes a thorough check of malpractice history, verification of licensure, verification of adequate malpractice coverage, verification of education, regular monitoring against government sanction lists, and other quality checks at initial credentialing and re-credentialing. NCQA compliance also means your Careington credential meets the quality standard required by insured partners who access Careington’s PPO network.
How Careington Dental Provider Enrollment Actually Works
Here is the complete enrollment workflow from first contact through network activation and re-credentialing:
| # | Stage | Timeline | Key Action / What Happens |
|---|---|---|---|
| 1 | Initial Contact — Request Application | Day 1 | Call Provider Recruiting at (800) 441-0380 option 6 (Mon–Thu 7am–6pm CT, Fri 7am–12pm CT), or complete the online join-network form at careington.com/dentists-and-dsos/join-our-network. A recruiter will contact you to discuss fee schedules and plan options for your area. |
| 2 | Receive Application Packet + Fee Schedule Preview | Days 2–5 | Recruiter sends application packet and assigned fee schedules for your area. Review fee schedules carefully. Decide which plans you want to participate in — you are not required to join all plans. |
| 3 | Gather All Required Documents | Days 3–10 | Collect state dental license, NPI, TIN, malpractice COI, dental school diploma, specialty certificate (if applicable), CV/work history, and malpractice history disclosure. Run OIG/SAM exclusion check. |
| 4 | Complete Application Form | Days 5–12 | Complete every field on the Careington Dentist Application. Note: all dentists in the practice should apply — Careington recommends all dentists participate to avoid patient confusion and claims issues. |
| 5 | Submit Application Package | Day 12–14 | Submit by mail, fax, or email: Mail: P.O. Box 2568, Frisco, TX 75034-9929 | Fax: (469) 252-5919 | Email: credentialing@careington.com. Include all required supplemental documents. |
| 6 | Careington In-House Credentialing Review | Days 14–45 | Careington's in-house Credentialing team reviews and verifies all credentials per NCQA guidelines. Contacts state boards, dental schools, malpractice carriers, NPDB, and OIG/SAM. Any discrepancy triggers a request for additional information. |
| 7 | Contract Execution | Days 40–70 | Once credentialing is approved, Careington sends the Provider Agreement for signature. Each dentist must sign their own agreement directly with Careington. |
| 8 | Network Activation + Directory Listing | Days 60–90 total | Provider activated in Careington's network. Practice listed in dentist searches on careington.com, client partner websites, and printed dentist directories. Access to Provider Portal at provider.careington.com. |
| 9 | Provider Portal Registration | Upon activation | Register at provider.careington.com for fee schedules, specialty rates, plan education, change-of-information forms, and eligibility verification tools. |
| 10 | Recredentialing (Ongoing) | Every 3 years | Careington recredentials all in-network dentists every 3 years per NCQA guidelines. Submit completed re-credentialing application by mail, fax, or email to Credentialing Department. Live representative available Mon–Fri 7am–5pm CT. |
Fee Schedules and Reimbursement and What Dentists Actually Earn
How you are compensated as a Careington provider depends on your provider type (general dentist vs specialist) and the specific plans you participate in. Understanding this before you sign is essential:
| Provider Type | Fee / Reimbursement Structure | What This Means in Practice |
|---|---|---|
| General Dentist — PPO Plans | Follows an assigned fee schedule based on geographic area. Maximum fee per procedure code. Non-listed codes discounted at 20% off normal fee. | Fee schedule assigned at credentialing — review it carefully; rates vary by zip code and plan tier |
| General Dentist — Discount Plans | Follows Careington's published member-transparent discount fee schedules. 500 Series: 20–60% off. POS Series: 20–50% off. Members pay directly — no insurance claims. | No claims processing for discount plan patients; members pay at time of service at the Careington rate |
| Specialist — All Plans | Specialists do NOT use a fee schedule. Instead, apply a flat 20% discount off their standard/normal fees for all Careington plans. | Simpler participation — no negotiated fee table; every service is 20% off your standard rate |
| Care Platinum PPO — Non-Listed Codes | Procedure codes not on the Platinum schedule are discounted at 15% off the general dentist's normal fee | Higher Platinum tier provides slightly better protection on non-scheduled codes for providers |
| Orthodontics | 20% savings on orthodontics including braces and retainers for children and adults across all Careington plans | Consistent orthodontic discount applied to the total case fee |
| Lab and OSHA Fees | Lab and OSHA fees are NOT the responsibility of the member — not subject to additional charges beyond the plan rate | Do not separately bill members for lab or OSHA fees on Careington plan services |
FEE SCHEDULE TIP
General dentists: your assigned fee schedule is geographic, rates vary by zip code and plan tier. Before signing your contract, ask your Careington recruiter for the fee schedules assigned to your specific area and compare them to your current production rates. This is the most important financial analysis to do before joining. Careington provides these schedules during the application process
How Careington Identifies and Recruits in Your Area
- One of Careington’s most distinctive network management features is its annual GeoAccess reporting system. Understanding this helps you anticipate whether Careington will actively recruit in your area and how it affects your practice’s competitive positioning:
- Careington runs GeoAccess reports annually to assess current network accessibility and availability across all geographic markets
- Reports identify deficiencies, areas where the network does not have enough providers to adequately serve the member population
- A recruitment strategy is built specifically targeting deficient regions, meaning providers in underserved areas may receive proactive outreach from Careington recruiters
- This means that if your practice is in a geographic area that Careington identifies as underserved, you may find faster acceptance and potentially more favorable fee schedule negotiations
- Conversely, in markets with high provider density, Careington may be more selective about accepting new applications, confirming panel availability before applying saves time
INSIGHT
Careington’s GeoAccess-driven recruitment strategy means the network is actively managed for geographic balance. If you’re in an area with fewer participating Careington providers, your application is likely to receive faster attention and processing. If you’re in a saturated market, asking your recruiter about current network needs in your zip code before submitting is a smart first step.
Common Errors That Delay or Complicate Careington Dental Credentialing
These errors appear in applications and post-credentialing practice management every week. Most are specific to Careington’s hybrid PPO/discount plan structure and the direct-pay model for discount plans:
| Error | Consequence | Impact | Professional Solution |
|---|---|---|---|
| Not all dentists in practice apply individually | Non-applying dentists cannot see Careington members; patient confusion and claims issues | Ongoing per-dentist issue | All dentists in the practice enrolled simultaneously |
| Billing members for lab or OSHA fees | Contract violation; member complaint; potential termination | Immediate compliance issue | Fee structure explained to billing team on day one |
| Charging members the wrong Careington rate | Member complaint; contract violation | Per-visit issue | Fee schedule loaded into practice management system on activation |
| Expired malpractice COI submitted | Credentialing hold | 2–4 weeks | 60-day advance expiration tracking system |
| OIG/SAM exclusion check skipped | Automatic denial | Full disqualification | OIG/SAM check run on every provider before application |
| Demographic changes made verbally instead of in writing | Change not processed; directory errors; misdirected claims | Ongoing billing errors | All demographic changes submitted in writing to Provider Relations |
| Participating in plans that conflict with in-house discount plan | Patient confusion between plans | Retention risk | Careington plans add new patients — not convert existing ones; clearly separate patient populations |
| 3-year re-credentialing deadline missed | Network participation lapsed | Re-application required | Automated 90-day advance recredentialing calendar |
| PPO claim questions directed to Careington instead of TPA | Delay in claims resolution | Per-claim delay | TPA contact number on member ID card used for all PPO claim questions |
Managing Your Careington Network Membership After Approval
Once you are in the Careington network, your obligations are straightforward, but they require attention to keep your membership active and claims flowing correctly:
Provider Portal — provider.careington.com
View current fee schedules and specialty rates by plan
Access plan education materials and training resources
Complete and submit change-of-information forms for any demographic updates
Check credentialing status and effective dates
Access eligibility verification tools for discount plan members
Eligibility Verification
- Discount plan members: use Careington’s 24/7 IVR service at (800) 290-0523, speak with a member services representative, or use the provider portal at provider.careington.com
- PPO plan members: use the contact number on the back of the member’s membership card, the TPA processes PPO claims and benefits inquiries
- Always check the member’s card: some plans are private-label and will not show the Careington name, the card contact number routes to the correct administrator
Demographic Changes
- All demographic changes (address, phone, new associates, TIN changes) must be submitted in writing
- Contact Provider Relations Department in writing: (800) 441-0380 option 8 or via mail to Careington International Corporation, Attn: Provider Relations, P.O. Box 2568, Frisco, TX 75034
- Verbal change requests are not accepted or processed — written confirmation is required for all updates
PPO Claims Questions
- Do NOT contact Careington for PPO claim payment questions, Careington contracts with insured partners who access the PPO network through their own TPAs
- Use the claims phone number on the member’s membership card, the TPA can analyze the claim payment in detail
- Careington Provider Relations handles network participation questions; the TPA handles benefit and claims questions
Recredentialing and What Happens Every Three Years
- Careington re-credentials all in-network dentists every 3 years per NCQA guidelines. The process mirrors initial credentialing:
- Careington will notify you when re-credentialing is due, watch for mail or phone contact from the Credentialing Department
- Submit a completed re-credentialing application by mail, fax, or email, same submission channels as initial credentialing
- Mail: P.O. Box 2568, Frisco, TX 75034-9929 | Fax: (469) 252-5919 | Email: credentialing@careington.com
- Re-credentialing covers the same NCQA-standard verification elements as initial credentialing, have current documents ready
- A live Credentialing representative is available Monday–Friday 7am–5pm CT at (800) 441-0380 option 7 for questions
- Failure to complete re-credentialing results in removal from the network, active participation requires successful completion of each 3-year cycle
RECREDENTIALING NOTE
Careington’s re-credentialing is NCQA-compliant, the same thoroughness as initial credentialing applies. Ensure your state dental license, malpractice insurance, and professional history documents are current and ready before your re-credentialing window opens. Government sanction monitoring against OIG/SAM continues between cycles, any exclusion will trigger a review regardless of where you are in the re-credentialing calendar
DIY vs. Professional Credentialing and What Specific to Careington Makes It Worth Managing Professionally
Careington’s credentialing process is one of the more provider-accessible in the industry, but specific aspects of its hybrid PPO/discount structure create post-approval compliance issues that DIY enrollment routinely misses:
| Factor | DIY Credentialing | Professional Credentialing Service |
|---|---|---|
| Multi-Provider Enrollment | Some dentists in the practice missed — Careington recommends ALL dentists apply | All dentists in the practice enrolled in a single coordinated effort |
| Plan Selection Strategy | Providers often select fewer plans without understanding revenue impact | Fee schedules reviewed and plan selection optimized for maximum patient access and reimbursement |
| Fee Schedule Setup | Fee schedules not loaded into PM system — staff charge wrong Careington rates | Fee schedule loaded into billing system immediately upon activation |
| Billing Compliance (Lab/OSHA) | Billing team not briefed — lab/OSHA fees incorrectly charged to members | Billing team briefed on Careington fee structure before first member visit |
| Demographic Change Management | Changes communicated verbally — not processed; directory errors persist | All demographic changes submitted in writing; Provider Relations notified promptly |
| Recredentialing Cycle | 3-year cycle missed despite straightforward process — participation lapses | Automated 90-day advance alert with managed submission |
| PPO vs Discount Plan Understanding | Staff confused about which patients use fee schedule vs which pay directly | Front desk team briefed: PPO patients use TPA claims process; discount patients pay directly at Careington rate |
| Provider Portal Activation | ://careington.com registration delayed — fee schedules and eligibility tools not accessible | Provider portal registered on day of network activation |