Credentialing Vs Enrollment: Highlighting the Difference

Credentialing Vs Enrollment: Highlighting the Difference

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:

What Is Credentialing?
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.

What Is Enrollment?
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 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.

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