Summary Disclosure Form And Dentist Agreement OhioDentist Participation Agreement • November 18th, 2020 • Ohio
Fee Maximums: A schedule containing 50 commonly billed procedure codes and Fee Maximums is included with the Participation Agreement.
DENTIST PARTICIPATION AGREEMENTDentist Participation Agreement • January 3rd, 2019
In consideration for Delta Dental of Minnesota’s (a non-profit Minnesota health service plan corporation, hereinafter referred to as DDMN) agreement to include me as a provider for the Medicare Program (as such term is defined in the Delta Dental Participating Dental Provider Policies and Procedures) administered by DDMN for members of Medicare Programs, I represent and agree that:
Dentist Participation Agreement State Dental PlanDentist Participation Agreement • August 12th, 2008
DENTIST PARTICIPATION AGREEMENTDentist Participation Agreement • October 31st, 2018
DENTIST PARTICIPATION AGREEMENT FOR MEDICA* LABELED PRODUCTSDentist Participation Agreement • December 7th, 2015 • Minnesota
THIS AGREEMENT, effective ("Effective Date"), is made between Delta Dental of Minnesota, a Minnesota nonprofit health service plan corporation ("DDMN") and ("Dentist"). The purpose is to set forth the terms and conditions under which Dentist shall render Dental Services to individuals covered by Benefit Contract whose payment specifications are described in the attached Appendix B. For Dental Services provided on or after the Effective Date, this Agreement supersedes and replaces any existing agreements between Dentist and Medica ("Medica") relating to Dental Services provided to individuals covered for Dental Services under any Medica Benefit Contract after the effective date.
