How Often Should Dental Providers Undergo Re-Credentialing?

How does the dental re-credentialing process enhance the practice's efficiency? Staying with the dental re-credentialing process substantiates cost savings and achieves a streamlined operation. This article by Capline Services helps providers maintain compliance and builds a solid reputation with the insurance networks.

Credentialing and re-credentialing are where the payers invest heavily. The dental re-credentialing process feels redundant and creates problems in dental practices' operative efficiency, claims, collections, beneficiary safety, and dental billing. The ever-changing reality in the dental industry dictates dental practitioners be on their toes, and re-credentialing is time-consuming and costly. However, it ensures that the professionals have the skill before seeing patients.

The parties involved are verification sources and government agencies. That results in comprehensive background checks, past work history, references, and dental provider board certifications.

Managing the credentialing process guarantees the best patient care without compromising patient safety. The credentialing & re-credentialing process is daunting and complex. This article by Capline Services clarifies how to make re-credentialing less burdensome and more effective.

Re-Credentialing

Re-credentialing is a process to validate that dental providers continue to have the professional skills, knowledge, and qualifications by offering patient care with industry standards. It safeguards the patient and the practitioner. The process renewal takes place every 2-3 years to ensure high standards. There is daily technology and practice evolution. And to keep up with those frequent reassessments is a mandate.

Components of the Dental Re-Credentialing Process

• Authenticate State License: The authorized organization verifies the dental provider's license and confirms the validity according to the dental boards.
• Certifications: Check the dental provider's license properly before seeing patients. Work History: Verify the work trajectory to assess professional development and experience. That helps uphold integrity and ensure competent practice for effective patient care. Malpractice Report: Confirms whether the dental provider has a record of malpractice claims to ensure the patient is in safe hands.
• Board Certifications: Examines the dental provider's board certification to confirm the practice's commitment to the specialty.
• Exclusions and Sanctions: Verify if the practice has any sanctions to remain professionally qualified.

Factors Affecting Dental Re-Credentialing Process

Re-credentialing has many reasons, each distinctive. The factors affecting dental credentialing are the duration since the last credentialing, the type of credentialing provider is carrying, and any recent updates on industry standards. Apart from this, the organization's procedures and policies demand re-credentialing now and then.
Capline Dental Services learns how often the dental providers should go for re-credentialing.

Dentistry Standards

The dental industry is changing exponentially due to upcoming technology and procedures. The dental providers have to ensure that they keep up with the standards. Re-credentialing ensures dental professionals stay abreast of treatments and maintain excellence in patient care.

Patient Safety

A critical issue is the lack of knowledge, and the professions directly impacting patient safety require re-credentialing to confirm that the dental provider is fully equipped with protocols, safety regulations, and the latest procedures. Consistent assessments help minimize upcoming risks and elevate overall safety.

Advanced Research and Technologies

The dental industry is fast-paced with adherences, evolving technology, and scientific research. Re-credentialing standardizes the procedures for professionals to adapt to the latest methodologies and findings. Recurrent assessments help to integrate new findings and stay updated with the vast environment.

Regulatory Prerequisite

The authorized organizations are strict about re-credentialing if the dental providers want to maintain their licenses. The requirements have to have professional standards that ensure continuous improvement and accountability.

How Often Does the Dental Re-credentialing Process Should Occur?

Re-credentialing is a complex milestone, and it varies. So, it is not universal. However, insurance policies require re-credentialing every two to three years to confirm the patient receives accurate coverage. The occurrence is so that it aligns with the evolving standards and balances competence and growth.

Importance of Continuous Dental Credentialing

To avoid re-credentialing, the dental provider should implement a few practices that lead to quicker reimbursement and financial stability.

• Dental providers should proactively record adverse review actions such as suspension, revocation, or surrender of any affiliations to preserve the integrity of the insurers. The openness ensures that the dental practitioner is not deceptive, which saves the provider from implications. Unfavorable actions can damage the relationship with payers, which could eventually impact the practice.
• Re-credentialing takes a similar time as the original credentialing process. It is good to start early as dental providers fill out forms, obtain papers, and confirm the validity of the licenses and certifications. The criteria for credentialing submissions are strict, and delayed submissions can result in repeat credentialing or expired credentials. The deadline the insurers provide for the submission can result in lost revenue or patients finding another dentist.
• Complete applications are the key to the credentialing process. Avoiding errors in the applications is a way towards a successful business. The credentialing officials verify all the details and precisely relevant information that is accurate and complete.
• Dental providers must ensure that all practitioners associated with the practice are registered to avoid discrepancies. Every program offers its own registration procedure, and oversight of the information could impede the credentialing process. First, upholding compliance and staying updated on changes is very obvious for smooth credentialing.
• A rigorous process helps evaluate credentialing files, whether staying on deadlines or setting up reminders for renewal. But what about the setbacks? A structured way helps expedite credentialing and eliminates overlooking expired credentials.

Here at Capline Dental Services, the team of experts helps dental providers get credentialed and re-credentialed. It is undoubtedly the most used service. The stressful steps from application submission to verification of credentials, committee review of the credentials, and compliance with accreditation are all well-handled by the RCM partner.
Credentialing and re-credentialing are all about accuracy. Working with Capline Services empowers the dental practice with innovative solutions that enhance operational excellence and improve patient outcomes.