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Dental
Products & Plan Features
Programs
User Guide
Reference Guides & Policy Manuals (Registered Providers Only)
- CIGNA Dental Oral Health Integration ProgramSM* (PDF)
- Dental Specialty Referral Guidelines: single-page summaries* (PDF)
- DHMO Dental Office Reference Guide* (PDF)
- DHMO General Dentist Policy Manual* (PDF)
- DHMO Endodontist Reference Guide* (PDF)
- DHMO Oral Surgery Reference Guide* (PDF)
- DHMO Orthodontist Reference Guide* (PDF)
- DHMO Pediatric Reference Guide* (PDF)
- DHMO Periodontist Reference Guide* (PDF)
- DPPO Dental Office Reference Guide* (PDF)
Policies
X-Ray Policies - NEW!
- DHMO X-Ray Policy* (PDF)
- DPPO X-Ray Policy* (PDF)
Forms (Registered Providers Only)
- Sample PQA Form 2008
- Additional Location Form
- NEMB (AZ only)
- ABN (AZ only)
- Pediatric Dental Chart
- Adult Dental Chart
- Periodontal Evaluation Chart
- Medical Update Label
- Comprehensive Treatment Plan
- Dissatisfaction Form (CA only)
- Notice of Provider Dispute (CA only)
- Add a Dentist
- Address Change Form
- Caries Risk Assessment (PDF)
- Dental Claim Form* (PDF)
- Dental Office Supply Requisition Form* (PDF)
- DHMO Uniform Referral Form Maryland dentists only* (PDF)
- Submitting Orthodontia Claims
Sample PPO Orthodontia Claim Form* (PDF)
Being a CIGNA Dental Provider
Communications Update
** Previously known as CIGNA Choice
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