Insurance Credentialing Tips For Dentists

How To Conduct A Competitive Analysis For Your Dental Practice?
How To Conduct A Competitive Analysis For Your Dental Practice?
March 7, 2023
Provider Credentialing-Why is it Necessary
Provider Credentialing: Why is it Necessary?
April 4, 2023
Insurance Credentialing Tips For Dentists

Put together a solid insurance credentialing process if you want to stay on top of communications with the insurance companies. As a dental care provider, it is vital to get credentialed to avoid possible payment delays. 

What is a Dental Credentialing Process? 

Dental credentialing involves verifying a dentist’s background and entering into a contract with the insurance company. Insurance companies vetting process includes verifying information like training, professional history, and education during the credentialing process as per the guidelines to be an in-network provider. 

Many patients prefer in-network providers with their insurance due to costs. The process requires regular follow-ups to get the paperwork done on time. 

Important Points Regarding Dental Credentialing 

  • Credentialing simplifies the dental billing process. If claims get sent to the insurance company with you being credentialed, the chances of your claim sitting for a longer time or eventually getting rejected are minimized to near zero.   
  • It is a lengthy process, and you would want to avoid going back and forth with the insurance company as it will affect patient care. 
  • If you have multiple locations and providers, each office location and each provider should get credentialed separately.   
  • All the submitted claims get considered out-of-network during the credentialing process. 

Which Insurance Company to Credential with and How to Decide? 

  • Credentialing with popular plans increases the patient base. Additionally, it is worth researching what the community needs. 
  • If you are on an in-network list of dentists, the chances of receiving new patients to the office increases, as the patients by their insurance companies receive the list of the providers in the area. 
  • You have the option of not credentialing with any dental insurance providers, as you are bound to follow the contractual agreement that states you will follow their fee schedule.  Unfortunately, the company only guarantees the claim processing if credentialed. 
  • Out-of-network providers receive larger payments, not bound by contractual agreements.  However, patients prefer in-network providers as they have fewer out-of-pocket expenses.
  • The best way to choose a dental insurance provider is to understand the competition in the  area and what best interest and profit of the patient and the provider. 

Contracting and Credentialing Checklist 

  • Obtain a tax identification number and register as a business entity. 
  • Obtain a federal tax ID if you are a sole proprietor to protect the social security number. 
  • Insure with a professional liability insurance policy. 
  • Get a personal and business NPI number. 
  • Consider getting a license in the dental practice states from the respective authority. Update the CAQH profile with all the necessary documentation. 
  • Identify and research the insurance network that fits your practice. 

Dental Insurance Credentialing Tips for Providers 

  • As a dental care provider, you invest enough energy and time with patients to ensure you get enough profit and opportunities. Get organized with a spreadsheet that includes details of each application’s status. The particular is as follows; contact information, call log,  insurance company name, and detailed notes regarding the communication with the insurance company. 
  • It is advisable to keep the malpractice insurance up-to-date in the credentialing process.  Credentialing can be time-consuming and take up to 90 days for approval. Verify your policy expiration date and if it is during this period, try extending it a bit. 
  • There may be a possibility of failing to complete every application process. However, respond to every application’s response, even with N/A. If any application response is left blank, the insurance company considers it incomplete. 
  • Optimizing the time for the approval of dental insurance credentialing is a way to avoid any unneeded stress in your practice. Be calm, as it is not a quick process. Around 3-6 months can be a frustrating period for many dentists. The approval can impact which patients in-network or out-of-network you will see. 
  • Stay up to date on the follow-up with the insurance company every week. Once you have the confirmation, you can focus on increasing the potential client gain. The best way to reach the insurance company is via email to have a written record of communication if something goes not as planned.