Dental Provider Resources

As shown in the network overview below, EMI Health offers several network and plan configurations, including Premier, Advantage, Value, TDA PPO, and TDA DHMO networks. Some member ID cards may display a network name followed by a dash and letter designation (such as Premier-A or Advantage-D). These suffixes identify national wrap networks used for out-of-state access and do not affect Utah provider participation or reimbursement arrangements.

EMI Health dental plans are built to be flexible, cost-effective, and easy for members to use. Preventive services are covered at 100% when members utilize in-network providers, helping encourage preventive care and better long-term oral health outcomes. Employers may also customize plan designs to include enhanced benefits such as implant coverage and other expanded services not commonly available in standard dental plans. Digital member tools and optional on-site dental clinic solutions further support accessibility and convenience.

In addition to comprehensive plan offerings, EMI Health prioritizes member and provider satisfaction. Consistently high satisfaction scores reflect EMI Health’s commitment to responsive customer service, efficient claims administration, and dedicated provider support.

Our goal is to continue to offer exceptional support to our providers. If you have any questions, please contact our provider representatives or customer service team. Their contact information is listed page 2.

EMI Health Address

5101 S Commerce Drive
Murray, UT 84107

Provider Relations

For network participation, contracting, demographic updates, fee schedules, and provider support:
Local: 801-270-2882
Toll-free: 800-662-5850

Provider Assist / Customer Service

For claims, benefits, NPI, EDI, eligibility, and general provider assistance:
Email: providerassist@emihealth.com
Local: 801-262-7975
Toll-free: 800-644-5411

Claims Review

Email: claimsreview@emihealth.com
Mail: EMI Health, PO Box 21482, Eagan, MN 55121

UHIN Help Desk

For missing 835s/ERAs and related electronic transaction assistance:
Phone: 877-693-3071
Email: customerservice@uhin.org

Website

emihealth.com

ADD INFO ABOUT REPRESENTATIVE CONTACTS

Joining the Network

Providers interested in joining the EMI Health dental network should submit a participation request to their assigned Provider Relations representative.

Please include:

• National Provider Identifier (NPI)
• Tax Identification Number (TIN)
• Specialty
• Service location(s)

Once the participation request is received, Provider Relations will provide the necessary contracting paperwork.

Providers participating in EMI Health networks are not automatically enrolled in TDA networks. A separate application is required. To add TDA participation, contact Provider Relations.

Confirming Network Participation

Providers can confirm their network participation status by reviewing their contract or provider portal, or by contacting Customer Service or their Provider Relations representative for assistance.

When treating a member as an out-of-network provider, providers should inform the member of their out-of-network status before treatment. Claims will be processed according to the member’s out-of-network benefits, which vary by plan. Some plans may not include out-of-network benefits.

Fee Schedules

Contracted providers may request a copy of their applicable fee schedule by contacting their Provider Relations representative. When making a request, providers should provide their NPI, TIN, and service location.

Leased Networks

EMI Health does not currently lease its dental networks to third-party payers. TDA does lease its PPO network to third-party payers. Network leasing arrangements are subject to change.

Providers who need to verify participation in a leased network should contact their representative for confirmation.

Credentialing helps ensure providers continue to meet EMI Health’s participation requirements.

Once contracted, providers are required to complete recredentialing every three years.

Providers must submit current documentation, including:

• Application
• Current state license
• Current DEA registration (if applicable)
• Current Certificate of Insurance (COI)
• Current board status
• Disclosure of current adverse actions

Recredentialing documentation is due within 10 days of the dated notice. Providers are responsible for submitting the requested documentation to ensure they continue to meet participation requirements.

Updating Provider Information

Providers are responsible for keeping their demographic information current. Changes should be submitted before they become effective.

Examples include:

• Address updates
• Phone number updates
• Tax Identification Number (TIN) additions or changes
• IRS TIN updates
• Name changes

Accurate provider information helps ensure members are directed to the appropriate service location and reduces billing discrepancies caused by outdated information. The Provider Directory is updated nightly.

When adding a provider who is already participating in the EMI Health network at another office, provide Provider Relations with the provider’s NPI, TIN, specialty, service location, and whether the provider will continue practicing at both locations or will practice only at the new location. Provider Relations will provide the necessary paperwork to update the provider’s participation.

Leaving a Practice

Provider Relations should be notified when a provider leaves a practice. Timely notification allows EMI Health to update its records and Provider Directory so members have access to accurate provider information. 

HOW DO PROVIDERS SUBMIT NOTIFICATION?

Providers wishing to terminate participation should submit written notice in accordance with the terms of their Provider Agreement.

Providers are encouraged to contact their Provider Relations representative before initiating termination.

Member Identification and Eligibility

Each insured will have an identification card indicating participation with EMI Health. Members are expected to present their card at the time of service.

If a member does not present an identification card, contact Provider Assist at 801-262-7975 or 800-644-5411 to verify the necessary member information. Eligibility may also be verified through the Eligibility Verification portal, which provides immediate access and does not require registration or login credentials.

Provider Relations does not handle member eligibility, benefit, or claim inquiries. Member eligibility and benefit information can be accessed through our Eligibility Verification portal. This tool provides immediate access and does not require registration or login credentials.

For claim information, please visit the Provider Portal. For further assistance, contact Customer Service.

Member Financial Responsibility

Members are responsible for applicable copayments, coinsurance, and deductibles according to their plan at the time of service. Participating providers accept the EMI Health maximum allowable amount and the member payment as payment in full and agree to bill EMI Health directly.

Out-of-Network Care

If you see a member as an out-of-network provider, inform the member before treatment. Claims will be processed according to the member's out-of-network benefits, which vary by plan. Some members may not have out-of-network benefits.

Referrals

Members receive maximum benefits with lower out-of-pocket costs when referred to participating providers. The most current provider listing is available on the EMI Health website.

My EMI Health

My EMI Health is an online services system that allows providers to view claims, eligibility, benefit information, and patients' Explanations of Benefits online.

To register, go to emihealth.com, select My EMI Health under Sign In, select Register Account, and follow the online instructions.

For assistance, contact Provider Assist at 801-262-7975 or 800-644-5411.

Providers may also sign up for EMI Health's monthly Dental Provider News through the Resources page under the Providers section of the EMI Health website.

The member ID card contains the information needed to verify eligibility and submit claims.

Highlight the following fields:

• Patient ID (Member ID)
• Member Name

Most EMI Health dental plans do not use a group number. The exception is Summit Plus plans outside of Utah, which use a group number when claims are submitted to Cigna for pricing.

EMI Health encourages providers to submit claims electronically whenever possible. Electronic claim submission improves processing times, reduces errors, and eliminates paper handling. 

Electronic Claims

EMI Health accepts electronic dental claims through major clearinghouses and through the Utah Health Information Network, or UHIN.

When submitting an electronic claim, use:

Payer ID: SX110

Some clearinghouses may assign EMI Health a custom payer ID. If your clearinghouse includes a payer search feature, search for EMI Health or Educators Mutual.

Providers submitting claims directly through UHIN must first obtain a UHIN trading partner number. Test claims are not required.

Electronic dental claims are submitted using the applicable HIPAA-standard transaction format.

Paper Claims

Paper ADA claims are only accepted for corrected claims and claims requiring supporting documentation, such as office notes. Please submit paper claims to the address below. 

EMI Health
PO Box 21482
Eagan, MN 55121

Paper claims must:

• Be submitted on the most current standard ADA Dental Claim Form.
• Be computer-generated or typed.
• Include all information required to process the claim.

Handwritten claims are not accepted.

Corrected Claims

Clearly identify a corrected claim as “Corrected.” Do not use white-out, cross out information, or otherwise alter the original claim form.

Include the information needed to explain the correction and support the revised claim.

Claim Submission Requirements

To help prevent processing delays, providers should:

• Verify the member’s eligibility before providing services.
• Use the most specific current CDT code available.
• Complete all required claim fields.
• Include the provider’s billing and rendering information.
• Include the appropriate National Provider Identifier, or NPI.
• Include relevant tooth numbers, surfaces, quadrants, dates, and treatment details.
• Include supporting documentation when required.
• Submit claims under the correct Tax Identification Number.

When a miscellaneous or unspecified code is necessary, include a description of the service or supply.

Contact EMI Health before submitting claims under a new Tax Identification Number so the required provider records can be updated.

Timely Filing

Claims must be received by EMI Health within 12 months of the date of service. Claims received after that deadline may be denied as untimely.

Once EMI Health receives your claim, it is reviewed to determine eligibility, benefits, and payment based on the member’s plan and your provider participation status.

Claim Processing

After a claim is received, EMI Health will:

• Review the claim for completeness.
• Determine member eligibility and available benefits.
• Apply applicable plan provisions.
• Process the claim for payment or identify any additional information needed.
• Billed charges
• Allowed amount
• Provider discount
• Deductible, coinsurance, and copayment amounts
• Payment amount
• Member responsibility
• Reason codes explaining claim determinations

If additional information is required to process a claim, EMI Health will notify the provider.

Explanation of Payment (EOP)

An Explanation of Payment (EOP) is issued after a claim has been processed and provides details regarding how the claim was adjudicated.

The EOP includes information such as:

When a member has coverage under more than one dental plan, Coordination of Benefits (COB) determines the order in which each plan pays benefits.

When EMI Health is the secondary plan, benefits are coordinated in accordance with applicable COB rules and the member’s plan benefits.

(add — attachment requirements are a top denial driver and a standard section in dental manuals)

Supporting Documentation

When additional documentation is required, providers may submit attachments electronically through the EMI Health website using the Claim and Attachment Submission form.

Accepted attachment formats include:

• PDF
• JPG

EFT Enrollment

Providers who wish to enroll in Electronic Funds Transfer (EFT) must first contact their clearinghouse to begin receiving electronic remittance advices (835s/ERAs). Once 835s/ERAs from EMI Health are being received through UHIN, providers may enroll in EFT online.

By authorizing EFT, providers agree to discontinue paper Explanations of Payment (EOPs).

Missing 835s/ERAs

If an expected 835/ERA is not received, providers should first contact their clearinghouse for assistance. Providers may also contact the UHIN Help Desk and should be prepared to provide their NPI, transaction number, processing date, and trading partner number.

UHIN Help Desk: 877-693-3071
Email: customerservice@uhin.org

If additional assistance is needed after contacting the clearinghouse or UHIN, contact our Customer Service team.

Missing EFT Payments

For assistance with a missing EFT payment, contact Customer Service and provide the transaction number and date the payment was processed. Providers may also be asked to provide their routing and account numbers to assist with research and verification.

• Contacting EMI Health before submitting claims under a new Tax ID if a Tax ID has changed.
• Submitting claims within 12 months of the date of service. Claims submitted after 12 months will be reviewed on a case-by-case basis and may be denied.

EMI Health is committed to maintaining a compliant provider network and supporting providers in meeting applicable federal and state regulatory requirements. Participating providers are expected to comply with all applicable laws, contractual obligations, and professional standards while delivering quality care to our members.

Provider Responsibilities

Participating providers are expected to:

• Maintain all required professional licenses, certifications, and credentials.
• Comply with applicable federal and state laws and regulations.
• Adhere to the terms of their EMI Health Provider Agreement.
• Notify EMI Health of changes that may affect participation in the provider network.
  

HIPAA & Privacy

Providers are responsible for safeguarding Protected Health Information (PHI) in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and other applicable privacy and security requirements. This includes protecting the confidentiality of member information, limiting access to PHI to authorized individuals, maintaining appropriate administrative, physical, and technical safeguards, and reporting privacy or security incidents in accordance with applicable law.

 Fraud, Waste & Abuse

EMI Health expects providers to conduct business ethically and in compliance with all applicable laws.

Examples of fraud, waste, or abuse may include:

• Billing for services not rendered.
• Billing for services that are not medically or dentally necessary.
• Misrepresenting services, procedures, or diagnoses.
• Duplicate billing.
• Knowingly submitting inaccurate or misleading claims.

Providers who suspect fraud, waste, or abuse should report their concerns to EMI Health.

Documentation Requirements

Providers are responsible for maintaining complete, accurate, and timely documentation that supports all services billed. Documentation must be maintained in accordance with applicable legal and regulatory requirements and made available upon request as permitted by law.

Audits & Records Requests

Providers are expected to cooperate with EMI Health in responding to record requests, claims reviews, audits, investigations, and other compliance-related inquiries. Timely cooperation helps ensure accurate claims processing and compliance with contractual and regulatory requirements.

If EMI Health denies payment of a claim, in whole or in part, and you believe the claim should be payable under the terms of the member’s plan, you may request a review of the claim decision.

First-Level Appeal

Submit a written request for review to the EMI Health Claims Review Committee within 180 days of the date the claim was paid or denied.

The appeal should include:

• All pertinent information related to the claim.
• An explanation of why you believe the claim should have been paid.
• Any additional documentation that supports the appeal, such as medical necessity documentation, misquote call log numbers, or applicable ADA guidelines.

EMI Health will notify you in writing of the Claims Review Committee’s decision. If the original claim decision is upheld, in whole or in part, the notice will include the specific reason for the decision.

Second-Level Appeal

If you disagree with the Claims Review Committee’s decision, in whole or in part, you may request a second-level review of the disputed claim.

The second-level appeal must be submitted in writing and received by EMI Health within 60 days of the first-level appeal decision. EMI Health will provide written notice of the second-level decision and the basis for that decision.

Submitting an Appeal

Appeals may be submitted by mail or email:

Mail:
EMI Health
PO Box 21482
Eagan, MN 55121

Email:
claimsreview@emihealth.com

Eligible Appeals

An appeal may be submitted when a provider believes a claim should have been properly compensated under the applicable terms of the member’s plan.

Providers should submit all documentation necessary to support the appeal. Supporting documentation may include, but is not limited to:

• Medical necessity documentation
• Misquote call log numbers
• Applicable ADA guidelines
• Other records or information relevant to the disputed claim

Providers must have written authorization from the member to appeal a claim on the member’s behalf. EMI Health may request proof of this authorization.

Initial Claim Decision Timeframes

EMI Health will provide notice of its initial claim decision within 30 days after receiving the initial claim or 45 days after receiving the claim if EMI Health determines that an extension is necessary due to circumstances beyond the control of the plan and provides notice of the extension during the initial 30-day period.

Appeal Status and Additional Information

Providers who would like to check the status of an appeal may contact our Customer Service team.

If additional information or documentation is needed to complete the review of an appeal, the required information will be identified so the provider knows what must be submitted for the appeal to proceed.