Guardian Providers

Associate Acknowledgement Form
Credentialing Checklist
MDG Advantages
MDG Dentist Profile
MDG Office Profile
W9 Form
Specialty Referral Form
Guardian PPO ADA Claim Form

Premier Access Providers

General
Associate Application
Practice & Facility Information
Form W-​9: Request for TIN and Certification
Provider_​Dispute_​Resolution
Claim Form
Emdeon ePayment Enrollment and Authorization Form

Provider Manual /​Dentist Handbook /​Reference Guide
Commercial PPO Dentist Handbook

Member Grievance Forms
Grievance Form — English
Grievance Form — Spanish

Access Dental Providers

General
Associate Application
Practice & Facility Information
Form W-​9: Request for TIN and Certification
Provider Dispute Resolution Mechanism
Specialist Referral Form
Claim/​Encounter Form
Transfer Request Form
Emdeon ePayment Enrollment and Authorization Form

Member Grievance Forms
Grievance Form — English
Grievance Form — Spanish
Grievance Form — Chinese
Grievance Form — Vietnamese
Grievance Form — Russian