Unlock the PPO

06/03/2026

Cigna has also added a new shared network agreement with Principal effective 8/1/26. If you have a direct contract with Cigna, pay close attention because there were two announcements made on the same day. One was with Guardian and the second one with Principal so be sure you are catching them all! Below is a 4 min video about the Cigna/Principal one for some added guidance on how it may apply to your office's situation Check out this video from Sandi Hudson

06/02/2026

Cigna announced a new shared network agreement with Guardian effective 8/1/26 . . . does this impact your office?

05/19/2026

Mid-Year Check In Info from our friends at Odyssey Management Dental Speaking & Consulting

Evaluate your insurance workflows with me on June 10th for the Vyne Dental Mid Year Insurance Check-In. Let's check in on your revenue cycle to make sure you're on track to have a stellar year. I'll give you a sneak peek at next year's code changes and legislative trends to watch. Yes, they affect you!

Use the link in the comment section to secure your seat today!

05/18/2026

Thanks to the South Dakota folks for having me for the State Dental Convention! It was a pleasure to chat with an amazing group willing to give up some of their Friday to talk insurance strategy. And the highlight for me was getting to meet Dr. Lane Ochi who I've followed on DentalTown for years! For those of you not on DentalTown, check it out!

05/13/2026

PLANNING A DENTAL STARTUP?

Some insurance tips as you get prepared to launch!

Documents/items you may need to gather in advance of a practice purchase or Startup if you are planning on participating with any dental insurance plans:

- TIN for business

- SS4 (IRS document assigning the TIN/EIN to your new business) **Delta will require this document. If you cannot find it, the IRS typically takes a while to generate a copy so reaching out early to generate it is recommended

- Prepared W9 form

***Important note- if you are in the process of changing the name of a legal entity with the IRS, this can take many months to process. Delta requires contracting with the legal entity name as recognized by the IRS, even if your state has already recognized a DBA so if a change request is in process, your options are to contract with that network using the original name and updating later when it’s updated by the IRS, or wait until you have received acknowledgement by the IRS of the name change.

- Signed lease if a Startup leased space or new physical space- you must ensure that the address that you use is an address the post office will recognize. If it’s a new space entirely, we strongly recommend checking with your local post office to confirm the address you have will be the final delivery address. Conflicts with this are not uncommon and can be very disruptive, not just to credentialing/contracting but also to your marketing budget if you have to make changes after having used an incorrect address on marketing material.

- Malpractice/liability policy in your name without a current associateship practice showing as a covered party- must be effective when any application is submitted, even if the practice has not yet opened. This policy must be for the state you are opening a new practice in but does not have to show the new practice physical address on it.

- Current dental license- If it may expire within 90 days, plan on renewing it, possibly a bit early since some nets will not take a copy if it’s close to expiration. You can typically capture a screenshot of the renewed status even before you get the renewed copy and carriers will accept that as proof of active status.

- DEA with the address in the same state you are opening your new practice in. If it may expire within 90 days, plan on renewing it, possibly a bit early since some nets will not accept a cert that is close to expiration. If you do not have a DEA and/or do not plan on obtaining one, most carriers will accept a waiver letter or one of their own waiver forms indicating that you will not be prescribing controlled drugs. If you are practicing in another state, even though this is a federal document, you must obtain one showing the state you will be practicing in.

- CDS (Controlled Drug) certificate, if applicable in your state

- Sedation Certificate, if applicable in your state

- Specialty Certificate, if applicable

- Board Certificate, if applicable

- CPR/BLS Certificate- current (not typically required but if you have it, a current copy should be submitted)

- Copy of your Undergrad/Dental School diploma if your studies were outside of the U.S.

- Final practice phone number obtained- All applications must have a practice phone number. If you are wanting to contract prior to having a final number, you can get a Google voice number or a cell number for a cell that you plan on converting into your emergency phone. You should not attempt to update the number midstream in the application process. Some networks may kick the application back to the beginning so update the information after you are confirmed effective with the network(s).

- NPI2 # For the facility if you are planning on participation with some HMO’s, Medicaid, or a few Blue Cross plans. It’s quick and easy to obtain on the NPI site if you do need one.

With either a practice purchase or a Startup, you'll have 1000 different things happening at the same time with countless decisions to make so the more you can plan on the things above which you can control and begin gathering as you obtain them, the less stressful the actual application process can be for you.

Best wishes for any of you who may be embarking on an upcoming journey of practice ownership!!!

05/12/2026

If you will be at the South Dakota Dental Association Convention, please visit Sandi as she's speaking during the Friday morning session on PPO Insurance Control, Negotiations and Strategy!

05/05/2026

Wish our Start Up Consultant, Delicia, a happy 10 year work anniversary with us today! We are blessed to have an incredible, long term staff that has helped us created continuity through great team work. Thanks, Delicia, for your willingness to take on new adventures, we appreciate you. Here's to the next decade ahead!

03/03/2026

There have been so many new agreements added between insurance companies and third parties that it's become difficult to know what fee schedule applies when. Hopefully this helps sift through some of the confusion:

DOES A DIRECT CONTRACT ALWAYS TAKE PRIORITY OVER A SHARED NETWORK AGREEMENT?
No. With most companies, it does but there are a few exceptions. In general, when you sign a direct contract between you and the insurance company, those fees will override any shared network agreements but not always. Two more notable exceptions are United Concordia and Ameritas which may downgrade to a lower paying option even when you have a direct contract in place. You can typically opt out of lower agreements to push the fees back to the direct contract rates.

IF I HAVE A CONTRACT AND RECEIVE A NOTICE THAT THEY ARE ENTERING INTO A NEW SHARED NETWORK AGREEMENT WITH ANOTHER COMPANY, HOW DO I KNOW IF I'M BEING INCLUDED?If
You will automatically be added into any new shared network agreement by default. You can typically opt out of new agreements but the burden is on you to opt out. And after you send an opt out, be sure to follow up. We see a surprisingly high number of opt outs that need follow up confirmation to get them in place.

I'VE NOTICED THAT I'M GETTING SOME PATIENTS WITH AN INSURANCE COMPANY UNDER ONE FEE SCHEDULE AND OTHER PATIENTS WITH THAT SAME COMPANY ANOTHER ANOTHER FEE SCHEDULE. HOW IS THAT POSSIBLE?
While not common (and be sure that the insurance company didn't just make a mistake first), it can happen. An example of this would be an office that has a United Healthcare direct contract but has opted out of Medicare. If they have another shared network contract that also picks up UHC Medicare, that shared network agreement may be picking up just the UHC Medicare portion while the commercial plans remain with the direct contract.

WHY AM I NOT BEING PICKED UP WITH A SHARED NETWORK AGREEMENT BUT SOMEONE ELSE I KNOW IS?
There can be lots of reasons. Shared network agreements change over time. For example, in September, 2022 Aetna decided to no longer pick up under Zelis with new additions however if an office was already getting Aetna via Zelis prior to that, they were allowed to remain with Zelis. An office down the road may be getting Aetna in-network via that relationship but if you are trying to add it now, you would not get added through this path. In some cases, a brand new pickup may occur but if you drop a direct contract, that pickup may take longer through a shared network or there may be a block in certain cases. There are some relationships that are active in some states but not all so someone in a different state may have access to a relationship you do not or vice versa. It may also be a case where someone was picked up when providers were needed in the area and that is no longer the case. This is why we recommend caution in knowing that advice given about someone's situation may not apply unilaterally and knowing exceptions is important.

WHAT IF I'M NOT SURE IF I'M IN-NETWORK THROUGH A DIRECT CONTRACT OR A SHARED NETWORK AGREEMENT, HOW DO I FIND OUT?
You can always call the insurance company and ask if you are showing up in-network and, if so, what fee schedule they are showing you attached to in their system. The other way is to check an EOB, the relationship should be noted and you can cross check the fees to the fee schedule listed. It's good office protocol now to spot check EOBs every few months regardless since it's hard to catch when companies may be downgrading without cross checking.

01/16/2026

Mark your calendar for September, our friends at Odyssey Management Dental Speaking & Consulting are the best!
https://www.facebook.com/share/p/1J3Zxhz8HM/

I'm happy to announce that registration has opened for Practice Management Power Day! It's designed for those of you who always want more CE, more interaction, just more of everything. I understand - that's how I am with CE as well. Check it out and grab your spot before Early Bird ends or it fills up!

🔗 https://www.odysseymgmt.com/pmpd

01/13/2026

Join Sandi's latest podcast with our friends at ACT for PPO tips to kick of your year right!

ACTdental Podcast - The Best Practice Show with Kirk Behrendt