Becoming a Delta Dental of Arkansas Network Dentist

1. Delta Dental of Arkansas Credentialing Application
   • Complete all fields on the online app. Do NOT leave anything blank!
   • Anything left blank will be returned to you for completion
   • You may note "N/A", if appropriate
2. State Dental License
3. American Board Certificate if applicable for specialists
4. Drug Enforcement Administration (DEA), if applicable
5. Arkansas PMP (Prescription Drug Monitoring) registration verification (My Profile Page), if applicable
6. Current Malpractice Insurance Declaration Page for your professional liability coverage
   The declaration page must show your:
   • Name
   • Policy number
   • Coverage amounts
   • Dates of coverage

Important Information About the First Time Credentialing Process

• When Delta Dental of Arkansas (DDAR) receives your Initial Credentialing application the approval process can take up to 30 days.
• Providers should keep the following in mind if they decide to see DDAR members prior to credentialing approval:
  
  • DDAR does not back-date the approval (effective) date of the credentialing application. Effective dates are determined based on application approval date (the date the DDAR Dental Director reviews and signs the application).
  • If Commercial claims are submitted prior to the approval date, claims will be processed as out of network and payments will be issued to the member.
  • If claims are submitted prior to the approval date for Delta Dental Smiles or Medicare Advantage, the claim will be denied.

Re-credentialing with Delta Dental of Arkansas

1. Delta Dental of Arkansas Credentialing Application
   • Complete all fields on the online app. Do NOT leave anything blank!
   • Anything left blank will be returned to you for completion
   • You may note "N/A", if appropriate
2. State Dental License or license renewal receipt
3. American Board Certificate if applicable for specialists
4. Drug Enforcement Administration (DEA), if applicable
5. Arkansas PMP (Prescription Drug Monitoring) registration verification (My Profile Page), if applicable
6. Current Malpractice Insurance Declaration Page for your professional liability coverage
   The declaration page must show your:
   • Name
   • Policy number
   • Coverage amounts
   • Dates of coverage

Annual Arkansas Medicare Advantage Attestation

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