The dental recredentialing process is a vital process for any dental practice. It helps it to stay compliant with the prevailing rules and regulatory guidelines.
In-network dental credentialing is important for a practice to run profitably. As the practice needs to update all documents and certifications that were done earlier during credentialing. This process helps a dental practice to remain compliant as regulations keep changing over time.
The recredentialing process can include the acquisition of additional licenses and certifications. It also includes renewal of existing licenses and certifications. The process can consume a great deal of time and follow-up.
Maintaining The Status And Recredentialing Can Be Profitable
The credentialing and recredentialing process can consume time and also needs some focus. While not a glamorous task, its importance needs to be noted. For a new or established practice, maintaining the credentialing status of dental practitioners is vital for keeping the practice running smoothly and profitably. It is unethical and wrong for any practitioner to offer services to a patient, and hence, maintaining status or recredentialing can help generate positive cash flows.
The Impact Of Recredentialing Status
Maintaining status or recredentialing of dental practitioners ensures that the dental team has a good standing with the insurance organization.
This is because all insurance organizations insist that dental practitioners stay credentialed regularly. The usual validity period is three years, after which the team needs to start the recredentialing process again.
For recredentialing, the dental team needs to commence the credentialing process yet again to confirm that there are no major changes and that the dental practitioners are still eligible to participate in the insurance organization’s network and offer services to patients.
The most important point of consideration is to ensure careful monitoring of the status and ensure that the practitioner’s status does not lapse. Once this happens, the service to a patient from such a practitioner is not permitted.
This means that the practitioner is now out of the insurance network, and the dental team will have to start the entire process of credentialing from scratch.
Awareness Of The Recredentialing Effective Date
The dental team needs to ensure that the status of the dental practitioner is live and valid. The team needs to be aware of when the dentist was initially credentialed. All dental practices have an effective date with the respective insurance organization. The team needs to calculate a period of three years from the effective period for getting recredentialed.
This timeline could fluctuate in case the dentist was credentialed before or after joining the dental practice. Hence, tracking of validity dates is important right at the start.
The dental team needs to ensure that the effective and validity dates are properly documented and are easily accessible. The team can also mark the calendars for about three months before the validity dates for the respective dentists. This allows the dental team to finish the recredentialing process on time.
Avoid Reminders From The Insurance Organization
The easy way out for the dental team is to depend on the insurance organization to send a reminder to the dental practice with regards to the validity date.
This can be risky for a dental practice, as not all insurance companies might send a three-month notification. It is also possible that the notification can be misplaced or left unread. It could also be sent to a non-functional email ID. When contact details are not updated with the insurance company, the practice might miss out on reminders. In case of a lapse in status, the entire process of credentialing must begin again.
Hence, the team can set reminders to ensure the process of recredentialing begins before the validity date and is completed before the time.
Documentation Is Vital For A Dental Practice
Documentation is vital for any dental practice. The team responsible for the credentialing and recredentialing process must be responsible for maintaining files, documents, and the status of the dental care providers.
This includes the dental practitioner’s effective date, the contact numbers, and the continuing education records up to the last three years would be useful. The liability insurance cover page is also needed. These details are needed for the recredentialing process. Hence, the team needs to keep such details and documents accessible so that the recredentialing process can start well ahead of time.
Lapse In Status
A lapse in credentialing can spell trouble for any dental practice. In the case of a lapse, the practice cannot submit any claims to the insurance organizations for reimbursement. This means a halt in payments that can affect cash flows. For a practice owner, this could indicate salary payouts for a dentist who cannot render any service.
A few insurance organizations can consider a lapse as a red flag. As a result, the recredentialing process could take longer, or they might keep the process on hold for a particular period.
Setting Up The Recredentialing Process
Since tracking the credentialing status is critical, setting up a smooth process is a must. The process must be streamlined and organized so that all details and documents are captured and accessible as and when the need arises. A few steps need to be followed.
Tracking The Effective Dates
All dental practitioners have unique effective dates with insurance organizations. The dates need to be recorded in any applicable software package used by the practice for easy access. Tracking for any dentist must be done for every insurance company they’re credentialed with.
Calendar Alerts
Calendar alerts must be set for at least 3 months before the credentialing due date of the respective dentist. The team can use convenient options such as Google Calendar or Outlook. This helps the dental team to avoid dependence on the insurance company for a reminder. This provides plenty of time for the team to commence the recredentialing process.
Collation Of Documents
The recredentialing process requires documents from a dental practitioner. The team must ensure that the necessary details and documents are in place. This includes Continuing Education (CE) records for the last three years, contact details, etc.
Connection With Insurance Organizations
The dental team must build strong relationships with the insurance companies. These teams can prove useful for the dental team when there are issues with the re-credentialing process.
Follow Up For Completion
On submission of the re-credentialing application, the team needs to rigorously follow up with the insurance organizations to ensure that all things are in order. One cannot wait for the insurance organization to respond. A few allow dental practices to check for the status online, and this can prove useful for the team to keep checking on it regularly.
Like credentialing, the recredentialing process ensures that qualified dental healthcare professionals offer care and solutions to patients, thereby curtailing potential errors and reducing medical errors. The process takes time, so the team needs to initiate it at least three months before the validity date. The efforts are worth it as credentialed dental practitioners boost the reputation and trust of the dental practice.
