Chapter 2 – Contracting, Program Enrollment and Re-enrollment

Program Enrollment / Re-enrollment Process

  • Online Enrollment Tool
    Providers are required to submit enrollment/re-enrollment applications via the web using the Online Enrollment Tool at
    In order to enroll or re-enroll online, you must first have all of your material assembled for the enrollment process. You will need:

o Your Federal and State Tax ID
o Your NPI (National Provider Identifier Standard) 

And a copy of your:

• Liability insurance
• Specialty certificate
• Diploma
• Office owners will need a W-9 and EFT (Electronic Funds Transfer) information

Note: Once you begin with the enrollment wizard, you cannot save the application and return to the enrollment application at a later time.

  • Go to the website; 
  • Go to the “Provider” box and scroll down to “Provider Enrollment;”
  • Click ”Next” to start the enrollment wizard. It will walk you through the information needed.

Remember: Once you begin the enrollment process, you cannot save the information and return to it at a later date.

NOTE: Re-enrollments must complete the credentialing process prior to your expiration date. Please submit your re-enrollment information 6 – 8 weeks prior to your expiration date to ensure uninterrupted enrollment in the program. Also, re-enrollment applications cannot be back-dated.

Dental Taxonomy Assignment Chart

The CT Dental Health Partnership offers personalized assistance with the Enrollment and Contracting processes. By contacting CTDHP at tel: 860-507-2307, we will work with you and your office staff to get your office enrolled or re-enrolled with the CMAP network. Once enrolled in the program, you will need to submit new contracts in the event that you change Tax IDs, add individuals to a group practice, add new office locations open to HUSKY Health or Covered CT members or add new provider specialties to a practice.

The Department of Social Services recognizes and enrolls providers in the following dental specialties: 

Specialty Taxonomy Chart

Paper Enrollment Process

Dental providers are required to enroll via the secure web portal you can access at: If you are unable to submit your application via the web portal you may submit a paper application to Gainwell with a letter that requests an exception to the requirement with details of the reason for the request.

A PDF of the enrollment form can be downloaded by following the steps below:

For the most up to date enrollment requirements, please consult the website.