> ## Documentation Index > Fetch the complete documentation index at: https://dso.getlemma.com/llms.txt > Use this file to discover all available pages before exploring further. # Step 8: Enroll with your first payer > Take your state's Delta Dental member company end to end: participation agreement, the Premier vs PPO tier decision, dentist credentialing, and EDI, ERA, and EFT enrollment before you see a patient. **Payer enrollment** is shorthand for the payer-specific work that makes a dental claim payable: contracting, credentialing or delegated credentialing, provider and location affiliation, product participation, and EDI/ERA/EFT setup. A payer may separate or combine those steps. Record what that payer authorizes, for which entity, dentist, location, product, identifier, and effective date. ## What Bluebird did Bluebird started with its state's **Delta Dental member company**, which had the largest dental market share in Bluebird's service area. Sam submitted the group application in week 6. The contract was executed in week 17, Dr. Okafor was linked and effective in week 20, EFT and ERA went live in week 22, and the first claim paid in week 24. This is an illustrative timeline, not a payer commitment. Start as soon as the selected payer accepts the application and all required entity, ownership, location, and provider facts are available. ## Pick your first payer Start with local employer and patient data. **Delta Dental is the largest dental carrier in the country**, but its local share and network terms vary by member company and market.1 Compare these factors before choosing the first payer: | Criterion | Why | | ----------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ | | **Employer mix in your area** | Enroll where your patients are insured. A market anchored by a federal workforce or a military base may make MetLife or United Concordia the real number two. See the [dental payer landscape](/concepts/payments/dental-payer-landscape). | | **Panel status** | Some networks are closed or selective in saturated areas. Find out before you invest four months. | | **Fee schedule adequacy** | Dental fee schedules are carrier-negotiated, not benchmarked to Medicare. Ask for the fee schedule for your top 20 CDT codes and model the write-off; participating practices commonly write off 30–45% of gross production.2 | | **Network leasing terms** | A leasing clause may make the contracted fee schedule available to payers you did not contract with directly. Review it before signing. | If your mix will include Medicaid, start the state's required process in parallel. States use fee-for-service, dental carve-outs, MCOs with dental vendors, and mixed models, so determine whether separate plan, administrator, credentialing, contracting, or affiliation steps apply.3 See [Enroll in state Medicaid](/guides/enrollment/enroll-in-medicaid). For Medicare, begin with the statutory dental exclusion and then test the actual service: covered Part B pathways and DMEPOS supplier billing have different enrollment requirements.4 See [Enroll in Medicare](/guides/enrollment/enroll-in-medicare). ## Delta Dental: 39 companies and two networks Confirm two parts of the Delta relationship before applying. **Do not assume one national Delta contract.** Delta Dental is a federation of **39 independent member companies**. Start with [Delta Dental's join page](https://www.deltadental.com/dentist/join-our-network/), identify the member company responsible for the service area, and confirm the applicable participation agreement, networks, fee schedules, provider-add process, and platform.1 A second-state location may require a separate member-company relationship or additional location and provider actions; verify rather than cloning the first-state file. **"In network with Delta" is really two questions: which network, and at which fee schedule.** Every member company offers two nationally reciprocal networks: | Network | What it is | Fee level | | ------------------------ | ------------------------------------------------ | -------------------------------------------------- | | **Delta Dental Premier** | The legacy network, broadest participation | Higher maximum allowable fees | | **Delta Dental PPO** | The discounted network, in exchange for steerage | Lower negotiated fees, accepted as payment in full | A dentist can participate in Premier only, in both, or in neither. A PPO plan member seeing a Premier-only dentist typically processes at the Premier allowance, which sits between the PPO and out-of-network treatment in this example.5 Model the fee difference against the expected patient mix before signing. Joining both may increase patient access while accepting the deeper PPO discount; Premier-only may preserve higher fees but receive less PPO steerage. Bluebird signed both to build its new schedule and calendared a review once it had production and retention data. ## The three parts ### Part 1: Group contracting Identify the legal provider that will enter the **participation agreement** and the signer authorized by state law, the entity documents, and the payer's form. The agreement and incorporated materials identify the applicable networks, products, and fees. Through the member company's join process. You will need the PC's legal name, EIN, Type 2 NPI, taxonomy, service address, and the W-9. The carrier decides whether it wants more general dentists in your area. A closed or selective panel is a real answer. If you get it, ask what would change it. Request the fee schedule for your top 20 CDT codes before signing. Read the timely filing limit, the amendment clause, the takeback window, and the **network leasing clause**: whether your contracted fees can be leased to other payers, TPAs, and umbrella networks, and what notice or opt-out rights you have. Roughly 30 states have leasing statutes; the ADA's Contract Analysis Service, free through state dental societies, reviews proposed agreements including leasing terms.6 See [Network leasing](/concepts/payments/network-leasing). Premier, PPO, or both, in writing, with the fee schedules for each in hand. Use the written effective date in enrollment, scheduling, billing, and revenue planning. ### Part 2: Credentialing and linking the dentist Contracting establishes the group's participation. Credentialing verifies the dentist and links that person to the group contract. Complete both when the payer requires both processes. Most dental carriers pull from your [CAQH profile](/start/zero-to-paid/get-npis-and-caqh), which is why Step 6 came first and why your attestation must be current. The carrier performs primary source verification of license, education, malpractice, and exclusion status, then presents the file to a credentialing committee. Published and observed review times vary by carrier, file completeness, market, and committee process; Ameritas, for example, publishes a 15–20-business-day estimate for its process.7 Record each payer's current estimate and recredentialing cadence, but do not treat an industry range as a service-level commitment. **Every new dentist triggers a payer-by-payer authorization review.** Determine whether each payer requires credentialing, delegated credentialing, rostering, affiliation, a contract amendment, or another action for the applicable entity, location, and products. Build the tracking grid now. See [Credential each new dentist you hire](/guides/enrollment/credential-new-dentists). ### Part 3: EDI, ERA, and EFT Three separate functions that may appear in separate forms or a consolidated enrollment tool. Their authorizations and routing can still differ. | Enrollment | What it authorizes | Failure mode if skipped | | ---------- | ----------------------------------------------------------------- | ------------------------------------------------------------------------------ | | **EDI** | Your clearinghouse to submit 837D claims on the PC's behalf | Claims rejected at the front door | | **ERA** | The payer to deliver 835 remittance advice to a specific receiver | Payments arrive with no electronic explanation; manual posting from paper EOBs | | **EFT** | The payer to deposit funds to a specific bank account | Paper checks, or worse, virtual credit cards | Until EFT is active, a payer may use checks, virtual cards, or another method permitted by its terms. **ERA and EFT route independently even when one portal collects both requests.** When a clearinghouse or bank changes, determine which payer and trading-partner records must be amended and test both remittance and funds routing. **What you'll commonly need:** the billing provider's W-9 and identifiers, the account evidence required by the payer, and the clearinghouse's submitter or receiver information. Use the account authorized for the enrolled billing provider and permitted by state law, payer terms, and the bank arrangement. Where a payer participates in CAQH's EFT/ERA enrollment tool, you can often do this once rather than per payer. See [Set up EDI, ERA, and EFT with each payer](/guides/enrollment/set-up-edi-era-eft). ## Effective dates, the thing to get right At minimum, test these dates and any location, product, or enrollment date the payer separately assigns: * **Contract effective date**, when the participation agreement starts. * **Provider effective date**, when *this dentist* is credentialed and linked to it. Obtain the payer's written rule for which date controls a claim. A group contract effective in March does not, by itself, establish that a dentist's April services are in network when the payer linked that dentist in June. **Retrospective effective dates** are payer- and program-specific. Request the rule and any determination in writing before relying on later submission for an earlier date of service. **Do not assume a pending application authorizes in-network billing.** Claims for pre-effective services may process out of network or remain unpaid, and payer or program rules constrain what the patient can be billed. If you must open early, first review the permitted options in [Handle credentialing delays and gaps](/guides/enrollment/handle-credentialing-delays). ## Common reasons applications stall Applications may be approved, denied, returned, or left pending. Common causes of delay include: * **CAQH attestation lapsed** mid-review * **Name mismatch** between the W-9, the EIN letter, NPPES, and the application * **Taxonomy mismatch** between what you enrolled and what the contract covers * **Work history gap** in CAQH with no explanation * **Missing malpractice certificate**, or coverage limits below the carrier's minimum * **No response to a payer request** sent to an unattended email or mailing address Follow the payer's stated cadence and log submission receipts, deficiencies, contacts, and written determinations. The record supports escalation and any request for retrospective treatment; it does not guarantee approval. ## Your artifact from this step * One executed participation agreement with a recorded effective date and a deliberate network-tier decision * One dentist credentialed and linked, with their own effective date * The leasing clause read, with opt-outs exercised where wanted * EDI enrollment complete and confirmed by your clearinghouse * ERA enrollment routing 835s to the right receiver * EFT enrollment depositing to the account authorized for the enrolled billing provider * A payer tracking grid, started ## Checklist * [ ] Payer chosen on market share and fee adequacy, not convenience * [ ] Fee schedule for your top 20 CDT codes reviewed before signing * [ ] Premier vs PPO tier decision made deliberately and recorded * [ ] Leasing clause read; notice and opt-out rights understood * [ ] Timely filing limit recorded in the tracking grid * [ ] Group contract executed; effective date recorded * [ ] Dentist credentialed and linked; provider effective date recorded * [ ] Retro-effective date requested in writing * [ ] EDI enrollment confirmed * [ ] ERA enrollment confirmed, pointing at your current clearinghouse * [ ] EFT enrollment confirmed, pointing at the PC account * [ ] Medicaid two-layer enrollment also started, if Medicaid is in your mix ## Next PMS, dental clearinghouse, and who operates them. ## Sources 1. Delta Dental Plans Association, [member companies](https://www.deltadental.com/us/en/about-us/delta-dental-member-companies.html); [join our network](https://www.deltadental.com/dentist/join-our-network/) (routes by state); state credentialing examples: [Tennessee](https://deltadentaltn.com/dentists/credentialing-and-recredentialing-for-dentists), [Michigan](https://www.deltadentalmi.com/dentists/credentialing). 2. Consultant-reported write-off benchmarks: Veritas Dental Resources, [the true cost of dental insurance participation](https://veritasdentalresources.com/post/the-true-cost-of-dental-insurance-participation-a-write-off-reality-check); Dental Billing Assist, [dental billing KPIs](https://dentalbillingassist.com/blog/posts/dental-billing-kpis-benchmarks). 3. DentaQuest, [Medicaid/CHIP solutions](https://www.dentaquest.com/en/what-we-offer/medicaid-chip-solutions); Louisiana DOH, [dental services](https://ldh.la.gov/medicaid/dental-services). 4. Social Security Act § 1862(a)(12), 42 U.S.C. § 1395y(a)(12); CMS, [Medicare dental coverage](https://www.cms.gov/medicare/coverage/dental). 5. Delta Dental, [How our networks work](https://www1.deltadentalins.com/administrators/word-of-mouth/2022/how-our-networks-work.html); Delta Dental of Washington, [PPO vs Premier](https://www.deltadentalwa.com/dental-benefits-guide/Delta-Dental-PPO-vs-Premier-Whats-the-Difference). 6. ADA, [PPO leasing networks white paper (PDF)](https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/practice/dental-insurance/ppo_leasing_networks.pdf); ADA, [Contract Analysis Service](https://www.ada.org/ada-for-dental-societies/contract-analysis-service). 7. Ameritas, [provider FAQ](https://www.ameritas.com/dental-providers/faq-provider/); Cigna, [credentialing](https://www.cigna.com/health-care-providers/credentialing) (30–60 days for a complete file).