The Importance of Timely Dental Credentialing For Practice Growth

Dental credentialing services in today's competitive market support practices that focus on patients rather than administrative tasks. The verification of a provider's education, board certification, licensure, and professional background is required to become an in-network provider with insurance plans. In this blog, we present a quick guide on credentialing and how automating the process improves efficiency and administrative speed.

Significance of Dental Credentialing

Credentialing is a mandatory process. Insurance has become a part of people's dental care routines. Patients prefer insurance plans to bear the cost of their dental service bills. To stay competitive in the market, the providers must get credentialed to increase the patient base and revenue. Once credentialed, the dental practice has high patient traffic, prompt reimbursements, a simplified payment process, lower claim rejections and denials, and improved earnings.

Understanding the Role of Dental Credentialing Services

An indispensable legal requirement that involves verification and examination of academic qualifications, career history, training, licenses, and practice experience. Capline Dental Services, as your dental credentialing service provider, eliminates the risk of errors. It is beneficial to utilize expert knowledge to streamline this complex process.
The practice saves time and high administrative costs in the credentialing process. By reducing administrative errors, the practice has more time to focus on patient care and avoid disruptions in revenue.

Let's have a look at the steps in the dental credentialing process!

• The first step is to gather documents such as certifications and proof of education and training. A CV outlines professional achievements, work experience, accreditations, an updated dental license, and professional references to identify the reputation.
• Each insurer has different requirements for documents, and once it's gathered, submit the complete application to different insurer networks that are easy for patients to access.
• Insurance companies verify all the submitted documents by contacting the educational institutions and licensing boards to authenticate the information. They also confirm the malpractice claims and criminal convictions to avoid any harm to the beneficiaries.
• Group credentialing is not allowed. Each provider submits separate applications to get credentialed. Keep a close look at the application status to avoid delays.
• After the proper vetting process, the provider gets approved to enroll in the network. The contract specifies the negotiated fees, and they are allowed to see patients.
• This time-consuming process takes between two to three months, depending on the application and network selection.
• An official in-network provider requires credentialing every few years to maintain standards. The practitioner does not want to miss the re-credentialing deadline, as it can affect patient access and revenue.

Impact of Dental Credentialing Services

Credentialing and re-credentialing are equally vital. One verifies the qualifications and compliance, and the other ensures it gets maintained throughout the practice journey.

• Dental credentialing services are time-efficient. Capline Services has advanced technology to streamline the application process and automate reminders for re-credentialing.
• As a result, the staff enhances listening skills to patients about their concerns without disruptions. The quality of care improves by offering personalized treatment plans and thorough patient education, resulting in fewer burnouts and enhanced team morale.
• Seek expert assistance to help with accurate application submission. Capline Dental Services ensures compliance, avoiding potential discrepancies and the risk of delayed payments.
• Filling out the form with current details is crucial to avoid higher rates of denied claims. The insurance network rejects the application with obsolete information, and without credentials, there is a high possibility of revenue loss. Working with the service provider as a team member aids in strategic planning for the practice.
• Handling patients takes time and effort. Professional settings encourage monitoring systems and automated alerts to prevent last-minute stress. To have an outsourced team that stays ahead with monitoring deadlines to receive quick reimbursement without disruptions.
• Capline Dental Services ensures a faster approval process to meet financial obligations and future investments, thereby enhancing patient outcomes.

Delayed Credentialing and How Dental Credentialing Services Can Benefit

Revenue and Patient Loss
Patients prefer in-network providers. Due to credentialing delays, the practice can face setbacks:

• Lower patient volume
• Choosing Competitor providers for care
• Revenue loss from patients who cannot afford out-of-network expenses.
• Increased reimbursement cycles are resulting in piles of unfinished claims.

Dental credentialing is a crucial early step in starting a business, typically requiring several months before a provider can see patients. And maintain the patient base without disruptions. Capline Services, as a partner, uses software solutions for notifications.

Administrative Burden
Working on rejected claims is tiring and requires extra rework for the team, which makes the process more difficult.

• Resubmission of denied claims
• Delays in payments can cause frustration
• Rigorous follow-ups with payers with no positive response
• Drain resources and affect operational productivity
• Trivial errors in documentation

The experts at Capline Services continuously track the credentialing status and take regular follow-ups with payers to accelerate the approval process.

Patient Dissatisfaction
Delays are a source of unhappy patients, resulting in negative perceptions about the practice. Patients may become dissatisfied if there are lengthy payment delays or surprise bills due to disruptions in provider networks. Capline Services ensures direct communication with payers to expedite it.

Recommended Approaches for the Dental Credentialing Process

• An early collection of application documents that are up to date and easily accessible when it is time to submit the credentialing process.
• Working with credentialing software is way easier than handling the paperwork. This solution improves accuracy and accelerates processing times without disruption.
• After applying, follow up on the application status through each review phase and remain in compliance.

Examples of Efficient Credentialing

Credentialing errors are a subtle depletion of reimbursements. Although identifying them early on can offer a solution. Why do challenges occur in credentialing? Because of inconsistent documentation, tracking manual deadlines, insufficient training, and ineffective communication.

Automating credentialing can reduce approval timings.

The problem the practice faces is that the application takes more than 90 days. It affects the recredentialing deadlines and billing disruptions.

The cloud-based system for securing data and implementing automated reminders to reduce approval timing from 90 days to approximately 45 days, achieving 100% compliance and eliminating manual errors.

High Claim Denials

The practice experiences 45% of claim denials resulting from credentialing errors. That means non-credentialed providers' claim submissions with inappropriate provider details. The best practice is to conduct an internal audit to identify uncredentialed providers before claim submission. It can save thousands of dollars and reduce denial rates by refraining from non-credentialed providers from billing.

Errors in Multi-Payer Credentialing

Each payer has specific requirements, and if you are dealing with more than 15 payers at one time. The added data requirements can cause extended delays in approvals.

Creating a document with payer-specific requirements and deadlines can reduce resubmissions. A dedicated team member is assigned to handle top-priority payers to increase approval rates. The payer-specific approach can foster trust and strengthen relationships.