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Common Challenges in Dental Credentialing and How to Overcome Them

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Dental Credentialing Challenges

Every dental practice strives to provide quality patient care, and part of that care also incorporates relationships with dental insurance providers. Dental credentialing services are crucial in this context. It is the process of getting a dentist from the practice into a contract with an insurance company.

Credentialing Comes with Multiple Challenges

The most obvious and typical challenge is not commencing the process early enough and putting aside enough time. Credentialing takes time, and not being prepared for it in its entirety or not commencing at the earliest can lead to disappointment. A dental practice needs to address and manage typical credentialing hurdles that come their way.

Dependence on One Less Dentist

While waiting for a credentialing application to be approved, a dentist is not entitled to provide in-network insurance-covered services. Any patient treated by a dentist who is not credentialed is considered “out of network.” This can equate to a halt in production. Hence, depending on the size of the practice and the volume of patients, such a situation can be overwhelming.

Credentialing should be a top priority once a new dentist comes on board. The productivity of the practice depends on how fast the dentists are credentialed. As the next step, when a new dentist is hired and the application is awaiting approval, the new dentist can shadow the core dental team and get familiar with the systems of the practice.

Incomplete Applications Can Result in a Longer Waiting Period

When a credentialing application is submitted with errors or pending information, a delay is inevitable. As the credentialing process takes time for approval, a practice must ensure that submissions are precisely filled.

Additional documents that might need to be submitted include the CV, the DEA (Drug Enforcement Administration) Certificate, the CDS (Controlled and Dangerous Substances) Certificate, and multiple identification numbers, among others.

It is also possible that a practice can assume that all applications for a dentist are alike and look the same. Credentialing does not work in such a manner, as all insurance organizations have their unique requirements and nuances.

To hasten the process, a practice must ensure that all the requisite data is correct and complete. All relevant documents should be attached while submitting the same. Every application across insurance carriers should be treated with equal attention and care.

Fees Not Negotiated Before the Application Process

Another challenge that the dental practice can encounter is the finalization in negotiations on the fees payable to the insurance organization. Once the practice is ready to commit on the dotted line after an extensive waiting period, the credentialing fee can come as a shock.

Fee finalization generally takes place during the credentialing process or a couple of years after the contract is in existence.

A practice must proactively agree on the best possible rate, as no insurance company would ever offer its best rates. A careful evaluation of codes most often billed can help negotiate the best fees and consider upfront, as well as all of your options for credentialing.

Starting on Time

The credentialing process can take between 3 to 6 months in specific cases. It requires a lot of time and follow-up from application to approval. This process also holds for re-credentialing. Insurance companies have their own rules and timeframes for renewals, usually varying from a year or more.

A practice must not wait until the contract expires to begin the renewal process. This can result in an interruption to the in-network status of a dentist.

Claim Submission through a Different Dentist

Fraudulent billing due to a lack of credentialing can create a dent in the reputation of the practice. Using another dentist’s name on an insurance claim while awaiting a credentialing application can result in an insurance fraud investigation. And if any patient is affected due to claim denial, they might be alerted about the network status due to credentialing delays.

A practice must follow guidelines from the authorized dental association and avoid wrongful submissions. Start the process early, and in case this particular dentist was credentialed earlier by the insurance company, then a request for credentialing to be expedited faster can also be made.

Network Coverage

A few insurance companies might restrict the number of dentists credentialed in a given area to maintain network adequacy. Additional dentists might not gain entry into the network.

A practice can look at all options available to them and decide on which insurance carrier to join hands with.