What is DDS credentialing?

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One may ask what DDS credentialing is and what does it signify? DDS, also called Dental Provider Credentialing, is the procedure of a dentist joining into an arrangement with an insurance provider, which needs information such as practice record, qualification, approvals, and licenses, etc.

This process usually takes between 30 to 180 days to complete. The insurance company will then inspect your details and demonstrate it is valid. This fundamental procedure is what you call the “Vetting Process”.

The process includes various arrangements of documentation during the vetting process to ensure 100 percent care to the patients in the network.

Understanding Networks to Start with Dental Credentialing:
When deciding which networks to enter, it is always good to investigate and research to know more about the gigantic organizations in the same region and which insurance provider they use. By doing this, you are positioning your dental practice among a considerable in-demand patients/customer base.

Credentialing Insurance Carrier Contract:
It is understandable if dentists sign the agreement without completely comprehending all the contractual accountabilities. For example, signing an agreement allows some of the carriers the authority to audit the records and dental practice.

So, it is essential to read the agreement before signing it. 

The contract briefs about:

  1. The plan that the dentist has opted for, 
  2. Fee schedules, and
  3. What and what not to charge from the patient. 

In-Network and Out-of-Network
Most dentists today belong to at least one insurance-providing network. Dentists can decide to operate out-of-network with more direct payments and less insurance control, but there is a possibility that the pool of patients will be quite less. Out-of-network patients will typically pay higher fees.

In dental credentialing, if a group of dentists resides underneath one practice, each can decide if they like to be in-network or out-of-network and what plans they want to opt for. Each dentist will have to be credentialed separately with each insurance network.

Already credentialed?
Are you already credentialed? If you have been performing in a dental practice before beginning a new practice, you may require only to complete an application to update it.

What goes wrong without proper credentialing?
If there are practitioners in your office with improper or without dental credentialing, it might become a reason for the delay in claims, leading to a stretch in time in getting reimbursed.

With insurance, modifications happen every now and then almost every month these days, it’s essential that you not only have ease of mind if somebody is examining after your credentialing, but also that it’s correct and up-to-date.

It is a vital step for assuring accuracy with a dental practice. Therefore, your fees structure and the position of your dental practice is more likely for patients to schedule appointments with you. It also keeps you up to date and allows you to focus more on other critical tasks and patient-related problems.