One of the major issues dental practices face is denial of claims. Other than just being frustrating, it causes a major dip in the revenue cycle management of a practice. It can have an adverse effect in the long run, if not taken care of properly. It is observed that most of the dental practice often spend huge amount of dollars to investigate the underlying reasons for claim denials. However, the best thing one could do is avoiding claim denial mistakes in the first place. Dental billing is definitely complicated, however, paying a bit of attention could definitely prevent huge blunders.
Here’s What You Need to Do:
Set Ground Rules and Follow Them Rigorously
There are times when claim denials occur as a result of not checking the reimbursement requests prior to submission. This means a lot of claims are submitted with errors. Therefore, it is important that you set some ground rules and advise your team to follow them strictly. Verifying claim status before submission is really important to bring down the number of claim denials.
Analyzing Why Denial Happened
As the saying goes, “prevention is better than cure”. So, if you let your denial claims be like that, you are wasting your hard earned money. It is very important to follow up and find the reason for the rejection in the first place. This gets you reimbursed faster and help you understand the reasons for denials. Having this knowledge with you will help you and your staff to avoid further denials in the future.
Keep Yourself Updated With the Ever Changing Coding Regulations
If you do not keep yourself in sync with the constantly changing codes and regulations of dental insurance, it might lead to denial of claims. So, the best you can do is to ensure that your practice is always at par with the regulations. It will automatically streamline all your codes and requirements as per the changes implemented. This streamlines your front office workflow and also brings down the number of claim denials.
Keep a Track of Changes
If you have a practice management software (PMS) that takes care of the inaccuracies, it is important that you and your staff must be in sync and well-versed with the changes that come across. Another good thing you can do is research on the latest newsletters to see what is happening around. The more you will keep yourself updated, the lesser will be the chances of a claim getting denied.
Verifying the claim before submitting it to the insurance avoids both errors and denials. There is a consistency required to process claims efficiently, which further helps in maximizing revenue for a dental practice.
People often confuse credentialing and enrollment as one and the same thing. However, credentialing is quite different from enrollment with key factors that set them truly apart from each other. The major variation lies in submission and claim processing.
Let’s understand the two of them:
Credentialing is well-known as background verification amongst dentists. It is done by one of the insurance companies that practices do business with. These companies look for verification of experience, training, certification of dental credentialing services. This happens when a provider (dentist) registers with the insurance company’s system along with presenting their NPI.
The process of credentialing varies depending on the payer, however, it is important for the payer to get reimbursement for the services issued to them. This process can either be completed via paperwork or online. Once the application is submitted, the insurance company will confirm with the provider to complete the credentialing process.
Credentialing is directly managed between dental credentialing outsourcing provider and the insurance companies.
Before dentists start seeing patients and offer services, they should be first enrolled with insurance plans in order to be considered “in network”. It is not required to be enrolled with healthcare plans to get into dentistry. To be listed as “in network provider”, provider must get enrolled with insurance company’s plan. To become enrolled, the provider need to get credentialed which means certain criteria must be fulfilled for the insurance company to approve the provider.
The payer must be credentialed along with the provider before the enrollment process is started by the insurance provider. Enrollment is the process of requesting participation in an insurance network as a provider. The process involves requesting participation, completing the credentialing process, submitting documents and signing the contract.
If you need a credentialing specialist to help in enrollment, we can help you go through the complexities. Our specialist will follow up throughout the process on the applications submitted via completion of process, when the effective date is provided and when the provider is in-network. With this step, the enrollment is completed, signifying that claims can now be released for payment.
Once all the correct information and documentation is received, our enrollment specialist will help you resolve all the credentialing and enrollment hoops for you. Trust the experts at Capline Dental Services to help you navigate the complicated process of provider enrollment and credentialing. We help providers achieve better revenues. Try our Provider Credentialing service and avoid all of the headache.
Credentialing, being a time-consuming process requires lot of effort and focus to be implemented in the right ways. If not done effectively, it can cost your practice a lot of time and money. Though the process of credentialing a provider is not that tiresome, however, chances of error are always there, thereby leading to slow down reimbursement. The entire revenue cycle management (RCM) of your practice is based on proper dental credentialing. When errors happen, revenue is either lost or delayed and your practice can run into coverage issues.
Here’s what you need to avoid in your dental credentialing process:
Relying on Limited Staff
Credentialing dentists is often an extremely laborious process that requires both patience and attention to detail. Along with a long list of certifications and license to verify, there are other individual dental provider that must be verified so that they become eligible to provide service to patients. The entire employment history, including education, training, licenses as well as any certification issued by the board is important to credential.
Since a large number of dentists are involved, the process of credentialing for every single individual can involve a lot of paperwork manually. Practices normally make this mistake of not allocating adequate staff to complete the credentialing process. The result turns out to be overworked and stressed staff. This eventually affects the entire patient care.
Dealing with a lot of paperwork can cause stress and frustration. When your staff makes mistakes on applications and these applications are not accepted by the insurance, the entire process is delayed along with reimbursement and loss of revenue for the practice. The most common mistakes that occur are related to licensing, background checks, which can seriously deteriorate the practice’s revenue and reputation. This is the reason it is important to outsource a reliable credentialing service provider for your practice. We, at Capline can save time, money and headache by getting you credentialed accurately. Our experts eliminate the need for administrative staff hiring by reducing stress and chance of human error.
Sending Incomplete Applications
Provider enrollment application requires a lot of information. Failing to fill out the application with accuracy causes delay in the revenue cycle and coverage denial. Capline completes the credentialing application for you and ensures that every application is complete. By minimizing administrative effort and eliminating the scope for human error, we save your practice time, money and resources.
Not Staying Updated With The Information Needed
Dental service providers must update their licenses regularly. To ensure that dental credentialing is done effectively, providers must stay up to date with board certification and licenses. When practices fail to stay on top of dental credentialing, it leads to dentists performing services that are technically not certified. This leads to malpractice suits.
Outsource dental credentialing services to Capline to minimize errors and keeps costs down.
Provider credentialing and enrollment is a primary necessity for running a successful dental practice. Credentialing enables the provider to get empanelled on the network of various commercial and government insurance companies. That aids immensely the provider to maintain a steady patient flow through referrals and hence, more revenue is generated for the dental office, the core necessity of any business .
Credentialing is relatively straightforward as a process. Here, information about a dentist/provider’s qualifications like education, certifications, work history, licensure, and so on are shared with a payer for review and verification. After clearing this thorough and rigorous vetting process, the provider gets confirmed by the payer and starts getting reimbursements for the services rendered by him or her.
Looks like a simple process, right?
In reality, executing a reliable and consistent credentialing process is not always that simple. Over the years, Capline Services has worked with a large number of dental offices and independent practices for their credentialing and enrollment needs. That enabled us to have amassed a great pool of knowledge on the subject. Using that knowledge, in this article we have tried to highlight certain Do’s and Don’ts of credentialing that people working in the industry should adhere to.
First we go with Do’s
To avoid this, all provider applications should go through an intense audit process to certify accuracy before being submitted to the committee. Getting it right the first time leads to faster credentialing. After the provider has completed the application for the credentialing process, then time should be taken to verify the information they’ve provided. This can be done by taking the provider’s self-reporting information and juxtaposing it against primary or originating sources.
Here’s a look at some of the key elements that should be verified along with the correct primary source that could be used to verify that information.
Provider Education – Sources: American Medical Association or Medical School
Federal Sources: System for Award Management and Office of Inspector General
Ensure office is adequately staffed: Credentialing being a labor intensive process calls for no compromise on staffing. People are needed to manage the process, maintain data, fact check the reporting etc. Any misses on having the appropriate allocation of staff can lead to increased mistakes which slows the whole process down. Credentialing as a process needs a lot of detail checking and requires specialization at some points from the staff. To do any cost cutting on staff might jeopardize the whole process.
Thus, segregate the credentialing process into different jobs and hire specialized people to perform those jobs. Also, there should be proper training channels for employees/staff to hone their skills to perform the job better.
Now, let’s talk about the Don’ts
Communication is Essential – Working on establishing a rapport with the representative of the insurance company dealing with your case may make things easy. Procuring that individual’s contact information and communicate regularly to make sure that all questions are answered and follow up has been done on applications that are in processing.
Don’t delay in starting: Many practices get started too late, which can be a matter of success and failure for the practice. At a minimum you would want to give yourself at least 90 days. Realize that you are working on someone else’s timeline – the payer. The responsiveness of the payer to your application will be determined by their workload and their motivation to add new providers to their network. As payers have merged and supersized, a practice's ability to expedite an application has shrunk.
Capline Dental Services in now offering Dental Credentialing in Florida as well. for more information please visit: Florida Dental Credentialing
Credentialing in dental practice has never been a piece of cake. Maintaining credentialing requirements is a complex process upon which a dental practice’s overall revenue and reputation balances. The path towards a successful and timely credentialing can be lost if the admin staff of your practice is not qualified enough to conduct paperwork with accuracy. To make sure that the credentialing process of a dental practice gets recognized, offices have started taking assistance from dental credentialing experts who submit, analyze and maintain provider credential with your payers.
Problems With the Present Credentialing Process
Credentialing in a dental practice fails because neither the staff nor the system is strictly focused on working towards it. The staff is handled several things at once including the paperwork and verification related to credentialing. On the other hand, practices do not have sufficient or required tools. They still rely on an offline process which is quite inefficient and naturally leads to errors.
The top reasons why your dental practice must outsource the credentialing verification process are:
Less Scope of Errors
As discussed above, automating the credentialing process leads to reduced errors. Automation is not subjected to human errors. Integrating such tools helps in automatically spotting the errors. Similarly, if you outsource the credentialing verification process, you will be able to gather, report and monitor credentials in an unbiased way.
Allow Your Staff to Focus on Other Important Tasks
Since the credentialing process is time taking and challenging, you should definitely outsource it. If you keep your staff occupied with credentialing, they will definitely not be able to provide better care. Outsourcing will keep your staff free and they will be able to dedicate their time on other important activities. If you try to take the entire process of credentialing on your own, it will consume too much of your time, ultimately leading to a negative impact on patient care.
Streamlined Credentialing Process
To make the process of credentialing less frustrating for you, we ensure that your application transitions smoothly in the contracting phase. We work through your payer list to ensure that we have effective dates and provider ID for applicable payers. Further, this information is passed to our billing department and helps to process the applications.
There are some practices that do credentialing internally. However, in-house credentialing can only be quick and effective if practices have full access to resources, i.e. an experienced dedicated staff. Having outsourced credentialing verification services saves a lot of time, money and reap many benefits for your practice like timely collections, increased revenue and happier patients.
Capline Dental Services in now offering Dental Credentialing in Florida as well. for more information please visit: Florida Dental Credentialing
Capline Dental Services understand the painful process of credentialing and health insurance enrollment that comes along while running a practice. While the insurance enrollment process is extremely important, it also brings stress and can take a long time to finish. Provider credentialing is an important step in your practice that ensures your practice gets paid on time. At Capline, we can help you by saving your time, money and headache, thereby allowing you to focus on patient care.
The process of credentialing involves insurance networks, healthcare organizations and other hospitals to evaluate documentation regarding a provider’s training, education, license, work history and so on. It is extremely important for any dental practice to participate with insurance carriers. Physicians along with other professionals must offer a list of verification's to insurance carriers including Medicare and Medicaid. This must be done to ensure eligibility for reimbursable expenses.
Provider credentialing is a continuous process. A one-time verification won’t suffice the needs and expectations of your patients. Therefore, we, at Capline helps the credentialing process flow smoothly. Practices/physicians that are not properly credentialed may not be paid on time.
Listed below are some ways we can make the credentialing process flawless for your practice:
We keep a track and analyze
The initial process is time-consuming and might take 90-180 days for the submission. This happens because a lot of paperwork is involved. Our dental credentialing company will help you throughout the process to ensure that credentialing is carried out successfully. This also removes pressure from your shoulder. You don’t have to worry about whether or not you are missing on anything while taking care of your patients.
Expert Application Completion and Processing
Any kind of errors in the application results in denials and delays. A proper credentialing form requires practice’s address, phone, fax, services provided, license copy, employment history, patient profile and any other past records related to your practice.
Our credentialing service includes completing the application, submitting it to the carrier, and following up until the application has been processed by them. This prevents any kind of mistakes from happening in the future.
We Keep Ourselves Updated With CAQH
The Coalition for Affordable Quality Healthcare (CAQH) is adopted by payers these days. Practices who regularly update their information with CAQH tend to have an efficient credentialing process.
If you are looking forward to outsourcing provider credentialing, Capline Dental Services is here to help. To get you paid on time, we also offer dental billing and insurance verification services. Contact us today to get a better insight into our services and let our experts explain you the process thoroughly.
Provider credentialing is an important process for verifying the expertise, willingness, and interest in providing dental care. Failing to understand and follow the provider credentialing process results in denial of provider payment. Provider credentialing requires you to fill up a form. It is a continuous process that involves a lot of hassle. Therefore, to make your practice efficient, it is important to outsource credential service provider. They will help your practice operate without any hindrances. The provider credentialing process involves submitting documents and forms.
Factors to be taken into account for successful credentialing
Staying aligned with CAQH
Council For Affordable Quality Healthcare (CAQH) has been operating its program for the last few years. This program is aimed at authenticating the accuracy of credentialing information that is submitted by healthcare companies to health plans.
Create an efficient credentialing process
Provider credentialing is not something that just happens accidentally. It requires careful planning beforehand. It could take several weeks to process the credentialing paperwork. The problems that come across in the initial phases can be skipped by getting an early start on the process. Get assistance from a credentialing service provider is one the best ways to get ahead of everything.
Focus on clean and accurate applications
Once the applications are returned, make sure to review and assess each of them for accuracy before sending it to the payer. An application that is devoid of errors and easy to understand definitely gets processed faster.
Providing the present copies of paper documents
Your credentialing specialist needs to put forward the current copies of licenses and other documents. If any of these documents include incorrect data or is expired, the credentialing process will delay. This will hold up the credentialing process as it requires time to receive and submit updated versions of these documents. Reprocessing the new document again may take some time.
Creating an effective credentialing process may take some time but it definitely helps over the long term. So, practices must take a step forward in maintaining a workflow that has all the required documents and forms. Understanding how credentialing works has a positive impact on how smoothly a practice runs. To ensure that credentialing always remains up to date, you must have a process and plan in place.
We hope these tips help you in moving ahead with a streamlined credentialing.
Click here to know more about our Dental Credentialing Company
Credentialing is a process wherein insurance networks acquire and evaluate documentation regarding the training, work history, license, and regulatory compliance record of a dental provider. This process is done and verified before the dental practice provider gets involved in treating patients.
To make the process smooth, efficient and quick, dentists must provide a list of verifications (Medicare and Medicaid) to insurance carriers. This makes them eligible for reimbursable expenses.
Not acquiring proper credentialing results in lost revenues. Insurance carriers do not accept or reimburse bills that have not been properly credentialed. Therefore, it is becoming quite difficult to credentialed because there are many dentists in the market competing for spaces on an insurance company panel. So, the most viable solution is to outsource credentialing services. Outsourcing the entire credentialing process reduces the burden of credentialing.
The process of getting a provider credentialed involves a lot of manual paperwork that includes completing the application form, providing clarification from payers, and following up with them to resolve the credentialing request. This service is a true alternative to traditional paperwork which is quite a slow and cumbersome process. It also eliminates the frustration with other steps in the credentialing process like:
Initial Application.
EFT Enrollment.
Timely follow-ups with Networks on Credentialing status.
Status Reports of credentialing to facilities.
Notifications of renewals to providers.
Re-Credentialing.
Fee negotiation.
Capline’s credentialing services fit any dental office, be it large or small. Our staff keeps you up to date on the progress of your credentialing by allowing you to focus more on other important patient-related issues.
Click here to know more about our Dental Credentialing Services
According to a research by Health Affairs, it has been reported that patients fail to receive dental services which they actually ask for. The reasons given by them were cost, inconvenient locations and the hassle in seeking a dentist who accepts their insurance. The major challenge dental offices face these days is related to dental insurance verification.
Before you start looking after your patients, it is necessary to assure how they are going to pay for your services, Right? Dental insurance verification is all about assessing a patient’s active coverage with the insurance company. It also involves verifying the eligibility of their insurance claims.
To ensure approval of the claim, a verification process is done before the patient gets admitted to the hospital. This verification process is beneficial for both the parties, i.e. patients as well as practice.
Importance of Dental Insurance Verification:
At first, dental insurance verification might just sound like another unnecessary expense, however, if you dive deep into its benefits, you will definitely realize how worth it is. To make sure that you have a bright smile maintained at each phase of life, it is recommended to visit your dentist every 5- months. However, the overall cost related to x rays, cleanings, and other treatment might go pretty high. A great insurance plan comes as a rescue here as it covers the entire treatment without costing you too much.
To restore a sound dental health, it is important to choose a dental insurance verification plan that strictly matches your needs. The right dental plan will help you cover all the expensive services like fillings and dental implants.
A comprehensive insurance verification process must include information like:
Dates for which the coverage is effective.
Type of plan
Coverage for tooth implant, tooth grafting, full mouth x rays, missing tooth clause
Maximums and deductibles
Important documentation
With such important information in place, dental experts will be able to get an accurate estimate created for patients. Whether it’s a dental implant, denture or inlay, each of them asks for both time and money. However, if you consult a dental insurance verification company, you will be able to get a range of benefits.
Conclusion:
These days managing the insurance process has become quite swift and simple. Thanks to the assistance given by billing companies. The best part about working with such famed organization is that they acquire the right information and also remain connected with insurance providers. This way the process becomes quick with an improved insurance case acceptance.
Click here to know more about our Dental Insurance Verification Services
More often than not, the credentialing process is stressful and burdensome and takes away from your precious time that you could have spent taking care of your patients. Our specialists can take this worrisome task off your back and get yourself and your providers credentialed quickly and efficiently!
Here’s a step-by-step guide to what our credentialing experts do to get you in-network with providers like PPO, HMO, DMO and Medicaid among others, in the shortest time possible!
1. Create Your Profile - We gather your information via a simple and secure online form. We waste no time in updating your information and get your profile ready quickly.
2. Follow-ups - We follow-up regularly with insurance companies to ensure proper handling of your applications, and work with them throughout the enrollment process so that you get in their network as fast as possible. This allows you to focus better on your practice and spend more time on your patients than over call with insurance companies.
3. Submit Enrollment Applications - Our specialists prepare and submit enrollment applications in a timely manner. We work closely with your office and take away the load of paperwork from your shoulders and manage it efficiently.
4. Reporting - We provide bimonthly status updates and reports on each enrollment application and keep you in the know at all times.
5. Negotiate Fee Schedule - We understand why it is important and assist you in negotiating a better fee schedule with the insurance providers whenever possible.
What’s more? We offer all these services at highly discounted prices that are very competitive and will have a cost advantage over any in-house credentialing arrangement that you may have!
