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 www.ctdssmap.com.
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 www.ctdssmap.com 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:
Paper Enrollment Process
Dental providers are required to enroll via the secure web portal you can access at: https://ctdhp.org/dentalproviders/provider-login/. 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:
- Go to the website www.ctdssmap.com;
- Click on “Information” and a drop-down box will give the option “Publications”
- Choose this option, and then scroll down the page to the “Forms” section;
- Continue to scroll down the list to “Provider Enrollment/Maintenance Forms” and click on “Provider Enrollment Application.”
- The enrollment package will download as an Adobe Acrobat (.pdf) file
For the most up to date enrollment requirements, please consult the ctdssmap.com website.