Dental credentialing services are at play when a new practitioner, nurse, physician, or other staff joins a new practitioner. This crucial process verifies the practitioner's skills, qualifications, and credentials. It also helps to secure approval from the insurers with whom they collaborate. Credentialing is not a one-time process. There are regular screenings and verifications in compliance with federal and state guidelines. Credentialing is a way to verify the dental practitioner's expertise in seeing patients. The ongoing scrutiny is re-credentialing, which defines that the practitioner is updated with the qualifications and fosters compliance to reinforce patient trust.
The dental practices ensure that their insurance claims are processed correctly, and providers undergo credentialing.
The process vets the provider's qualifications and standards of equipment for the services. It also verifies the provider's education, training, experience, and certifications for no disciplinary or criminal actions.
Credentialing is crucial, especially for uninsured patients or those dealing with out-of-pocket service payments. It is for the patient's safety and shields the provider from liability. A non-compliant provider can harm patients.
Re-credentialing is equally crucial in verifying that the provider continues to meet the requirements and is up to date with new changes.
To operate the practice smoothly, dental credentialing and re-credentialing should be done on time, and here are the steps to follow so that patient service does not get hindered.
Documentation and the forms required by each insurer are the foundation of credentialing and re-credentialing. Complete and accurate application as per the insurer saves time and resources. Some insurance providers ask for additional information for the credentialing process. The comprehensive list of documents for the insurance providers includes:
Different insurance agencies require separate documents for credentialing and re-credentialing, and prioritizing them at first is beneficial. The practice can follow the steps:
Successful credentialing is the key. To start filling out the credentialing and re-credentialing forms and preparing documents, remember to double-check the details and to ensure everything is correct, take the following steps:
Manual credentialing is time-consuming, so consider leveraging credentialing software or outsourcing to Capline Services for a more efficient turnaround.
If the insurance provider partners with CAQH, a CAQH number is mandatory for application submission. Completing and submitting the CAQH is crucial to avoid errors, delays, or rejections. Lastly, re-attest the post-submission to reaffirm the accuracy.
Sitting idle and waiting passively for credentialing and re-credentialing approvals cannot account for the time. Instead, follow-up and connect to the knowledgeable contact to check the status. Following up via phone or email helps expedite the process. It clarifies any additional information. These decisive steps can streamline credentialing and re-credentialing, ensuring the practice thrives and provides excellent care.
Let's consider that Capline Dental Services handles the dental provider credentialing. The aim is to provide comprehensive solutions with accuracy and compliance. It serves providers of various sizes.
• To enhance the credentialing process.
• Ensure all providers get approved.
• The existing credentialing system is lengthy.
• Compliance challenges for new onboarding providers.
• Enhance the credentialing process.
• Provider credentialing with accuracy.
• To reduce onboarding time for new dental care providers.
• Strengthen compliance and accreditation standards.
As a solution to the challenge, the practice implements an automated credentialing system that integrates advanced technology and software tools for the credentialing lifecycle from initial application to ongoing monitoring and re-credentialing.
Partnering with Capline Dental Services eliminates laborious documentation, checks, and verifications that comply with the insurance company's terms. It allows the practice to focus on patients. The collaboration boosts revenue and maintains consistent cash flow.
Re-credentialing is faster than initial credentialing. Since most of the required information is already accessible and verified, only minor updates related to licenses are necessary. Re-credentialing can stretch up to 30 to 90 days, whereas the span for initial credentialing is 90 to 180 days. However, the insurance company sends the provider a re-credentialing notice via email in advance, usually within 60 days. Mistakes in documentation can lead to delays in the re-credentialing, or else, it is a smooth experience.
The insurance company already has the details. The provider needs to submit updates regarding billing or physical address. Also, include the updated dental and DEA license and an updated phone number if applicable. These changes maintain accurate records.
The credentialed status expires every 2-3 years. The insurance company ensures that the practitioner in the network is consistently qualified and confirms the qualifications. This process is equally vital for in-network providers. The practitioner cannot take the chance of missing the re-credentialing deadline, or else they will start losing patients.
