How to Join Dominion National as a Kaiser Permanente Dental Plan Provider

There are two forms that must be completed by your office and returned to us in order to participate in the Kaiser Permanente Dental Plans. These are our credentialing form and our standard "Dental Provider Agreement." We also need a copy of your dental license, malpractice insurance coversheet, DEA certificate and any post-graduate information and board certification (for specialists). The forms are available by contacting our Provider Relations Department at 888.681.5100. A Dominion representative will explain the details, coordinate the delivery of our provider manual and specialty care guidelines and answer any questions you have regarding this program.

POS/PPO Members should be charged according to the plan’s “POS” Plan fee schedules. Claim reimbursement will follow your same Dominion contracted PPO fee schedule and claims will be processed in the same manner as our typical PPO business.