Avoiding Common Provider Credentialing Mistakes

Best Practices for Effective Dental Patient Billing Services
December 27, 2023
What Are The Most Common Errors When Submitting Claims?
January 3, 2024

Provider credentialing is time-consuming yet crucial for ensuring patient safety and receiving timely payments. With proper attention and care, provider credentialing errors can be rectified, and credentials accurately verified. Let’s overview the common mistakes and how to avoid them to help providers approach the credentialing process with confidence and success.

Depend on Limited Staff and Management:

Credentialing demands unwavering attention to detail, precision, and patience. Properly credentialing every provider requires significant effort from the team, and allocating additional human resources to complete the process is not always feasible. This often results in a loss of revenue and overworked staff, which can lead to costly mistakes. However, considering a third-party provider like Capline Dental Services can reduce provider credentialing errors.

Incomplete Application Results in Provider Credentialing Errors:

The provider enrollment application process involves a vast amount of data and information. Any non-compliance with the application’s requirements can have significant consequences, potentially jeopardizing the entire process. Incomplete application submissions can lead to claim denials, negatively impacting the provider’s reputation. Therefore, it is crucial to ensure that all necessary details are included to avoid complications.

Treating Patient Before Credentialing Can Cause Provider Credentialing Errors:

Recent court cases have unequivocally held dental clinics liable for the actions of dental care providers who falsify their credentials. It is tempting to avoid the lengthy credentialing process and allow dental providers to begin treating patients beforehand, but such negligence can lead to non-compliance. Dental care providers who fail to verify credentials expose themselves to penalties, lawsuits, compliance issues, and risk mitigation. Therefore, dental hospitals must take the necessary steps to ensure that all dental providers are credentialed and licensed before providing dental care.

Not Updating Information Is a Reason for Provider Credentialing Errors:

Dental providers must keep their licenses and credentials up-to-date as per government regulations. Initial credentialing and re-credentialing ensure there are no provider credentialing errors. Credentialing and re-credentialing compliance ensures positive patient outcomes and avoids costly malpractice lawsuits.

Non-Compliance in Credentialing and Covering the Action:

It is crucial to comply with credentialing and covering the action. Negligence in screenings for prior disciplinary steps, such as sanctions, debarment lists, and exclusions, can lead to severe consequences. Therefore, a thorough background check is necessary to avoid any non-compliance issues.

Waiting to Start the Credentialing Process:

Delays in the credentialing process can impact consistent cash flow. Conducting a thorough background check of the provider is an essential step in the credentialing process, which requires considerable time and effort. This includes verifying their education, licensure, work experience, malpractice history, and other critical details. Delays in completing the credentialing process can result in delayed reimbursements. A seamless credentialing process involving a third-party service provider such as Capline Dental Services can expedite the process without strain.

Not Using the Provider Credentialing Checklist:

Ensuring compliance with state-specific provider credentialing checklists and payer-specific requirements can be helpful. A provider credentialing checklist reduces errors. Therefore, maintain consistency and enhance compliance efforts confidently.

Missing Primary Source Verification:

When credentialing providers, relying on outdated information can lead to costly mistakes for organizations. For accuracy, credentialing teams rely on primary source verification methods, such as contacting medical schools, licensing boards, and other certifying organizations. These verification methods help to confirm important provider information, including contact details, certifications, and licensing status. By gathering information from trusted sources, credentialing teams can avoid costly mistakes and ensure that providers are vetted before being approved to work with a dental office.