Dental

How to Get Credentialed with Liberty Dental Plan in Utah

Network: Open
30-60 Days

Quick Overview

Timeline

30 - 60 days

CAQH

Not Required

Re-credentialing

Every 3 year(s)

Delegated

No

Utah-Specific Requirements

Liberty Dental Plan: Medicaid managed dental and commercial dental networks. Liberty Dental Plan does not currently administer Medicaid dental benefits in this state. Commercial dental plan participation may be available. Apply via Liberty Dental provider portal (libertydentalplan.com/providers). Uses CAQH ProView. Processing typically 30-45 days. State licensing: Utah Dentist and Dental Hygienist Licensing Board issues DDS/DMD licenses. Dental hygienists (RDH) may credential separately. State note: Accepts WREB clinical exam. Requires Utah-specific online jurisprudence exam. Prescriptive practice agreement required for hygienists administering local anesthesia. Operates Medicaid dental managed care in CA, FL, IL, NJ, NV, and TX. Also offers commercial and marketplace dental plans. Providers must be enrolled in state Medicaid first for Medicaid lines of business. Known for rapid credentialing turnaround.

Step-by-Step Enrollment Process

1

Gather Required Documents

Collect all necessary credentials including your medical license, DEA certificate, malpractice insurance, NPI number, and any state-specific requirements for Utah.

2

Prepare Your Application

Complete Liberty Dental Plan's provider enrollment application with all required information and supporting documentation.

3

Submit Your Application

Submit your completed enrollment package to Liberty Dental Plan.

4

Track & Follow Up

Credentialing typically takes 30-60 days. Monitor your application status and respond promptly to requests for additional information.

Required Documents Checklist

CV/Resume

Work history and education

DEA License

Conditional

Required if performing sedation or prescribing controlled substances

Malpractice Insurance

Current malpractice insurance certificate

Medical License

Active dental license required

NPI Certificate

Active NPI number required

Enrollment Forms

Liberty Dental Provider Application

Provider application to join the Liberty Dental Plan network for Medicaid and commercial programs.

Required
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