Dental Credentialing Services Company
Dental practices must get their dentists credentialed in order to participate with a myriad of insurance companies and their different plans. There are different types of insurance providers including PPO, HMO, DHMO, DMO, Medicaid and within each type, there are several insurance providers. Not only that there are further different plans offered by insurance providers. It can all get confusing very fast!
What is Dental Credentialing?
Dental credentialing is a process of verifying a dentist’s professional record. This includes verification of their career, education, training history, malpractice history, license verification and so on. Whenever a dentist applies for practice within a dental office, they are required to complete an application with important details that are asked for.
In simple terms, “Dental credentialing is defined as a process of getting enrolled in an insurance company’s preferred provider network.”
The Need for Dental Credentialing
Gone are the days when dental credentialing was considered an optional factor in the growth of a dental practice. Earlier, practices didn’t gave much importance to dental credentialing as far as growing their patient base was concerned but now times have changed and it has become extremely important for doctors to get credentialed. Patients are 90% more likely to seek treatment from providers who participate with their insurance plans. Not only do you increase opportunities with potential patients in your area, insurances offer listing services to boost you visibility online and in-network. The benefit for becoming a participating provider increases the opportunity to obtain new patients for your practice. This increases your overall potential and revenue stream.
Why Is Dental Credentialing Important
for Growing a Practice?
Dental credentialing company is also referred to as “Provider Enrollment” or “Insurance Credentialing”. Dental credentialing has become a necessity because it is a procedure that allows patients to confidently place their trust in their chosen dental care provider. In addition to this, dental credentialing also allows dental practices to get linked with insurance companies so that they can accept third-party reimbursement. After being associated with an insurance company, you can easily become an in-network provider.
Getting credentialed with insurance firms has now become a necessity because most of the people in the US are covered by a dental insurance plan and they expect their dental service provider to accept their insurance. However, dental practices that are not in network with the patient’s dental insurance plan are at risk of losing their patients. This ultimately affects the revenue, patient base and bottom line of any dental practice.
What Is the Process of Dental Credentialing?
What All Documents Are Required?
The process of getting credentialed is both lengthy and challenging. This complex and time-consuming process often comes across as a barrier to patient care. While dentists are engaged in a tedious, paper-based credentialing process, their patients are left neglected.
At Capline Dental Services, we can help reduce the burden by taking the entire responsibility of paperwork related to credentialing. We follow a simple yet smooth process. Our dental credentialing experts work with your practice and assist in organizing the detailed information that is required to facilitate the enrollment process. We take the information from you and start working on it immediately. Our experts won’t drop out until they get everything done the right way.
The provider’s documents required for verification are:
- Dental School information
- Board Certifications
- Dental License
- Malpractice Insurance
- Documents Related to Internship or Fellowship
Creating Your Profile
We gather your information via a simple and secure online form.
Submitting Enrollment Applications
Our specialists prepare and submit enrollment applications.
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.
We provide bimonthly status updates and reports on each enrollment applications and keep you updated all the time.
Negotiate Fee Schedule
We assist you in negotiating a better fee schedule with the insurance providers whenever possible.
- Creating Your Profile: We gather your information via a simple and secure online form.
- Submitting Enrollment Application: Our specialists prepare and submit enrollment applications.
- Follow-Up: 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.
- Reporting: We provide bimonthly status updates and reports on each enrollment applications and keep you updated all the time.
- Negotiate Fee Schedule: We assist you in negotiating a better fee schedule with the insurance providers whenever possible.
How Long the Dental Credentialing Process Takes?
Getting credentialed takes 3-4 months of time because there is too much involved in the process. In addition to submitting the required paperwork, there are other steps that need to be fulfilled for getting credentialing accurate and error-free.
Our dental credentialing experts totally understand that a simple error in handling the clutter of paperwork can allow a dentist with an expired license to continue their practice. This can lead to some serious complications as far as patient’s safety is concerned. Therefore, we are here to focus on your paperwork so that you can keep your focus on your patients.
Let us take care of your dental credentialing services so that your team can dedicate more time on important tasks of building a healthy schedule, advanced treatment planning, managing staff members effectively, and delivering a better patient experience. We will prepare and send applications and follow them up with the insurance companies.
What Is Dental Recredentialing?
Dental Recredentialing is a process in which the dental provider is re-evaluated. Dental Recredentialing can be done in every 2-3 years or frequently depending upon the requirement. A dental recredentialing process done accurately helps dental practices to deliver secure and high-quality care to their patients.
Failing to re-credential can cause quite a bit of hassle and inconvenience for you. If you continue to see clients after your agreement with the insurance panel has expired, you may be removed from the panel or even locked out permanently. Additionally, you will not be reimbursed for any services you provide during this period of time.
How Outsourcing Dental Credentialing Service Can Help?
A large amount of paperwork involved in the process of dental credentialing makes it highly time-consuming. By outsourcing dental credentialing services to us, you will be able to reduce the burden on your staff.
If you lack the expertise and understanding to operate the dental credentialing process, our Credentialing experts can be of great help. Our provider enrollment services can help you get enrolled with the insurance carrier’s network. This saves your staff’s time and lets them focus on what’s most important, i.e. patient care.
With a team of professionals having talent in getting you credentialed without any hassle, your practice could be saved from any kind of financial loss.
Our Dental credentialing company has helped practices improve cash flow. We manage the entire dental credentialing process for you and perform all the follow-up. By hiring us for your credentialing needs, you can be rest assured that credentialing will be done efficiently, thereby saving you time and money.
What Services Do We Cover Under Dental Credentialing?
Why Choose Us for Dental Credentialing Services?
The process for dental credentialing requires a lot of paperwork and follow-up and some expertise. It demands your team’s frequent attention and takes away its valuable time. It involves tracking the applications at times over several months with insurance companies and follow-up too. Most dental offices find dental credentialing services burdensome and a distraction from providing the best dental care to patients. Often the result is that you may have to put up with delays and your providers not participating with the desired insurance.
By choosing our dental credentialing company, you will be benefited with:
- Updates on credentialing status within 24 hours
- Revalidated applications even when your submission got returned due to errors
- We can get you in-network with insurance providers like, PPOs, DMOs/DHMOs/HMOs, Discount Plans, Medicaid and CHIP (Children’s Health Insurance Program)
- Save time by letting us do all the paperwork for you
- Our experts will complete your medicare enrollment thoroughly
- Dental credentialing services offered by us are extremely competitive and carry a cost advantage over in-house dental credentialing arrangements that you may have
Give us a call at 888-666-0604 to receive a consultation with our team of credentialing experts. We have the expertise, time and resources to help you with this complicated process. Our experts will develop strategies to yield desirable reimbursement from each payer and maximize revenue for your practice.
Frequently Asked Questions – Dental Credentialing Service
We will need a signed agreement and some necessary documents from your end. Once we receive your documents, we will start requesting applications for you. This entire process takes approximately 1-2 days if completed without missing time.
Credentialing generally takes 45-90 days depending on the insurance types. PPO/HMO takes 45-90 days depending on the insurance provider.
First we have to credential the provider with State Medicaid which takes upto 60 days and then we will start with private medicaid which will take upto 45-60 days as well.
Few insurance carriers have an arrangement to utilize other insurance networks for credentialing processes. This arrangement is to add a provider in their provider panel so as to not credential the provider directly at their end. Such insurance plans are known as sub plans and the insurance through which the provider gets credentialing done is known as the main plan.
For instance, Dearborn National is an insurance carrier that does not have their own credentialing department and utilizes the credentialing services of DNOA to get the provider added to their provider panel. In this case, Dearborn National is a Sub Plan and DNOA is the Main Plan.
No, you do not have to pay extra to be enrolled in a Sub Plan. If you get yourself enrolled under the main plan, you will automatically be enrolled under the Sub Plan also.
Yes, we can undertake fee negotiations for you however that is an additional service which we offer.
Let's say you ask for fee negotiations with 5 insurances. We will contact all 5 to negotiate with them. In case the requests are not entertained by any one of the insurances, we will not charge for that insurance from you.
Your documents remain secure with us throughout. We simply delete every document from our database after insurance confirms that your Credentialing application is completed. You will also be notified regarding the same.
At Capline Services, we use an encrypted database storage system wherein we temporarily store confidential details/documents to ensure a client’s privacy.