Umbrella PPO Network Cheat Sheet

How Leased Networks Work

You sign a contract

You contract with a plan (e.g., Humana) at a specific fee schedule. That agreement is your reference point.

They lease your participation

Buried in your contract: the plan can allow other networks to "access" your agreement. They lease you to Zelis, Careington, DenteMax — without telling you.

Claims reprice at a different rate

A claim you expect to reprice at Humana rates actually reprices through Zelis at a lower fee schedule. The difference comes out of your revenue.

You find out on the EOB (maybe)

The EOB shows a write-off. Most practices process it without questioning it. That's the silent PPO problem — and it scales with your volume.

⚠️

Key audit trigger: If your EOB shows a payer name different from the plan your patient presented, or if the write-off amount is larger than your contracted fee schedule allows, you are being repriced through a leased network. Pull the actual claim path before processing the write-off.

The 6 Major Umbrella Networks

Zelis / Maverest

Formerly: Stratose, 4Most, PPOPlus, HFN, NPPN, Maverest

Plans that reprice through Zelis

Humana Dental Often lower fee

Most Humana dental plans route through Zelis repricing. Verify which specific plan type before accepting write-off.
Principal Financial Often lower fee

Principal routes through Zelis for many employer group plans. Check EOB for Zelis/Maverest processor name.
Cigna Dental Varies by plan

Select Cigna DPPO plans access Zelis network. CIGNA DPPO Open Access typically processes direct.
MetLife PDP Plus Often lower fee

MetLife PDP Plus plan accesses Zelis/Maverest leased network. PDP (non-Plus) typically direct. Check plan type carefully.
Various regional/employer plans Verify

Zelis services 750+ payers. If you see Zelis as the processor on an unexpected EOB, check your contract stack.

Careington International

Formerly known as: Careington Dental Network

Plans that reprice through Careington

United Healthcare Dental (select) Often lower fee

UHC leases select employer group dental plans through Careington. UHC Dental PPO/Flex plans more likely to access Careington.
Humana Dental (select plans) Often lower fee

Some Humana plans access Careington instead of Zelis depending on geography and employer group.
Aetna Dental (select) Varies

Some Aetna DPPO plans access Careington leased network, particularly smaller employer groups.
Various discount/supplemental plans Often lower fee

Careington 500 Series and Care500 are their primary discount plans that many employers bundle. Different from insurance.

DenteMax

Subsidiary of: BCBS Michigan affiliate network

Plans that reprice through DenteMax

Ameritas Life Partners Often lower fee

Ameritas accesses DenteMax for expanded network access. Repricing at DenteMax rates common for out-of-territory claims.
Mutual of Omaha Dental Often lower fee

Mutual of Omaha leases DenteMax for national dental network access. Check EOB processor.
Lincoln Financial Dental Varies

Lincoln Financial accesses DenteMax or Careington depending on employer group and region.
Various regional BCBS dental plans Verify

Some BCBS affiliates use DenteMax for leased network access outside their direct coverage area.

Connection Dental / GEHA

Government Employees Health Association

Plans that reprice through Connection Dental

GEHA Federal Dental Often lower fee

Primary FEHB dental plan. Connection Dental is GEHA's proprietary network — repricing occurs when you're contracted through a leasing agreement.
MODA Health Dental Often lower fee

MODA uses Connection Dental for leased network access. Strong presence in Pacific Northwest federal employee plans.
Various FEHB plan participants Varies

Any Federal Employee Dental coverage may route through Connection Dental. Verify plan type and processor before accepting write-off.

DHA / Dental Health Alliance

Aetna-affiliated leased network

Plans that reprice through DHA

Aetna DPPO (select) Often lower fee

Some Aetna DPPO plans access DHA leased network. Aetna DMO typically routes direct. Verify plan type on front of insurance card.
CVS Health / Aetna MA Dental Varies

Post-CVS-Aetna merger, Medicare Advantage dental benefits route through various networks. Verify each plan's routing.
Cigna Dental (select employer plans) Varies

Some Cigna employer group dental plans access DHA, particularly for groups that switched from Aetna.

Premier Dental Group

Delta Dental Premier access tier

Plans that reprice through Premier

Delta Dental Premier Lower than PPO

Delta Dental Premier pays less than Delta Dental PPO. Accepting Premier patients means accepting the lower fee schedule. Know which tier applies.
Various plans with Delta Delta access Varies

Third parties that access the Delta Dental network may use Premier tier rates rather than PPO rates. Check participation agreement tier.

Quick Reference: Common Plans & Their Network Path

Insurance Plan	Routes Through	Fee Schedule Impact	Action
Humana Dental (most plans)	Zelis / Maverest	Often lower than Humana direct	Audit EOBs
MetLife PDP Plus	Zelis / Maverest	PDP rates lower than PDP Plus direct	Audit EOBs
MetLife PDP (non-Plus)	MetLife Direct	Direct contract rates apply	OK
Principal Financial	Zelis / Maverest	Often lower than direct	Audit EOBs
UHC Dental (select)	Careington	Careington rates may differ from UHC contracted	Verify plan type
Ameritas	DenteMax	DenteMax rates often lower than direct	Audit EOBs
Mutual of Omaha	DenteMax	Check DenteMax vs direct rates	Verify plan type
GEHA Federal Dental	Connection Dental	Connection Dental fee schedule applies	Audit EOBs
Aetna DPPO (select)	DHA / Careington	Varies by employer group	Verify plan type
Cigna Dental DPPO (select)	Zelis / DHA	Varies — check EOB processor	Verify plan type
Delta Dental PPO	Delta Direct	PPO rates apply — highest Delta tier	OK
Delta Dental Premier	Delta Premier	Lower than PPO — separate fee schedule	Audit EOBs
Cigna DPPO Open Access	Cigna Direct	Direct contract rates apply	OK

3 Things to Do With This Information

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Audit your top 10 plans

Pull the last 90 days of EOBs for each plan above marked "Audit EOBs." Compare what repriced vs what your contract says. The gap is your leakage number.

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Read your participation agreements

Find the "network leasing" or "third-party access" clause in each agreement. That clause is what allows repricing to happen. Knowing it's there lets you negotiate to remove it.

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Quantify before you renegotiate

Don't call the plan until you know the dollar amount at stake. Calculate write-offs on Zelis/Careington-routed claims vs what your direct contract would have paid. That number is your negotiation leverage.

See your actual network routing in PayorMap

Enter any payor and plan type — PayorMap shows you exactly which network is repricing the claim and what fee schedule applies.

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