In these unprecedented times, dental providers move forward and learn, as the world in the dental industry looks different than six months ago. With all the ambiguity, as a dental provider, you want to provide the best patient care in the area and re-open your dental practice successfully as soon as possible.
The importance of credentialing is always there when you re-open the clinic. As a result of credentialing, most patients choose a particular dental practice because it is in-network. In-network provider ensures a broad spectrum of insurance plans and serves the patients in the best way in this changing employment landscape of layoffs, furloughs, and closures than ever before.
Things to check for the dental credentialing process to make it more palatable for the providers.
Ensure to apply to insurance carriers that you can handle at the same time:
Brand new dental practices apply to too many insurance carriers they can handle. It is exciting to tell your patients you are in-network with most insurance plans. By looking, it feels like it brings you more patients and more money. Too many applications result in lower fee schedules for a dental provider with smaller or not-so-known insurance companies.
Getting more business sounds exciting only if the billing process can handle it and does not bring more harm than good. Overbooking and overworking will slip through the cracks, like claim denials, delays in collecting payments, data entry errors, incomplete applications, coding errors, and incomplete documentation.
Staying on top of aging reports or downgraded payments results in high staff turnover and less focus on patient care. Enroll with four to five popular insurance providers where your practice resides to have accessibility as well as receive payment for all the work that you are doing.
Negotiate the fee schedule:
A fee schedule is a contract comprising a list of covered services and in-network rates that insurers pay dental providers to determine the maximum patient billed amount. It also has the maximum insurer amount of the covered services. The fee schedule during the credentialing process is negotiable before signing the contract. Some insurance companies do not negotiate the fee schedule. However, the provider can check the services, and insurance companies are more flexible on the fee.
Analyze the service area before offering service:
Dental providers must research the service area and the type of dental service before credentialing. What popular insurance companies in the area and the popular plan do people carry in the city to avoid later trouble? The easiest way to call other dental practices and check their in-network insurance providers depends on the area, city, and demographics.
Start early the credentialing process:
There is a time crunch here. It can take several months before your new provider’s start date or hire a new associate. The credentialing process takes 90 to 120 days before you are an in-network provider.
If the dental provider is not in-network, they might have to turn away the patients to different dental providers or ask them to pay out-of-pocket. In both ways, they miss out on opportunities to grow and on the revenue for the practice. The credentialing process is time-consuming, so do not wait to get credentialed. It may cause disruptions in the dental practice’s revenue cycle and lead to claims sitting for long periods.
Adhere to the provider’s information:
The wrong provider’s information can make the practice look bad. Credentialing is a vetting process, and incorrect provider details look like a fraud. For instance, if you are waiting for the new associate to get credentialed. Meanwhile, you use another provider’s NPI number for the claim. You are telling the insurance company that you performed the services which you did not.
Accepting payment on this claim by the insurer is messier because your dental biller can’t even send a legitimate explanation of who performs the service. The NPI number on the claim should match the dentist who performed the service to receive the payment if the office has correctly submitted all the necessary information.