insurance.dental

Payer Enrollment Intake

Upload a W-9 or CAQH PDF to pre-fill the form, then review every field before submitting.

Import from CAQH ProView

Save 20 minutes — pull your name, NPI, license, DEA, school, malpractice, and address straight from your CAQH ProView record.

Don't have API access yet? Upload your CAQH ProView printout PDF and we'll extract your data.
Drop W-9 or CAQH PDF here
or click to browse — we'll pre-fill matching fields
Completeness0/33 fields complete · 0%

1. Provider Identity

2. Professional IDs

3. Education

4. Practice Entity

5. Service Location

6. Billing Address

7. Malpractice Insurance

* Required: Full Name and Individual NPI