Credentialing is a requirement for any dental practice. It enables them to get verified with a vast network of insurance organisations and companies, as well as the policy coverage options offered to patients. Dental credentialing services are vital to achieving in-network status with insurance companies, and registration ensures that the dental team's submissions are processed for reimbursement.
Dental credentialing services aid in building trust in the practice among patients, and this helps to promote the brand and reputation of the practice. You also play a vital role in promoting your brand. Given the high costs of treatment, most patients prefer a dental practice with verified credentials.
The dental practice needs to consider several key parameters when getting credentialed with various insurance companies.
This is generally observed with newly opened dental practices. To garner more patients at the earliest, the dental team is keen to inform patients about the insurance companies they have partnered with and have received in-network status from. Such an approach can create a pipeline of patients and cash flows and might appear as a fabulous approach for running the practice.
There can, however, be a flip side to such an approach, as, besides the walk-in of patients, the team could be trapped and tied up with more applications than it can handle. This could work against the practice for various reasons.
The practice might have to accept a lower fee schedule when one spreads an enrollment across multiple insurance organisations. A practice can end up becoming in-network with smaller, not well-recognised insurance organisations that demand lower fee schedules.
The dental team must spend some time selecting the right and appropriate insurance companies and reviewing all terms cautiously. This puts the team in a position to profitably negotiate the terms and avoid agreeing to low fees that could be detrimental later.
When the schedule of the dental practice is packed and the team is overworked, service and treatment can be impacted, and the goodwill of patients can take a hit. The ability to collect timely payments for services rendered might suffer. The team could commit simple errors that would result in claim denials and delayed payments.
The dental team that is stretched will find it tough to manage the ageing report and might miss out on denied payments. The practice should get enrolled with five to six insurance companies that are popular in the vicinity. This ensures that the practice is accessible to a large volume of potential patients and not overrun with patients that the practice is unable to handle.
The dental team needs to prioritise the fee schedule. This schedule consists of all the services covered by the insurance company. The in-network rates that the insurance firm will pay the dental practice are finalised in the fee schedule. The fees form the basis of the
maximum amount the patient can be billed for services rendered, as well as annual limits that the policy will cover for a patient.
The dental team needs to understand that the rates fixed on the fee schedule can be negotiated during the provider credentialing process. The team must not accept the initial fee schedule without deliberation with the insurance company. The practice can assign the best negotiator in the team to interact with the insurance company or outsource dental credentialing services to a third-party specialist.
It is critical to note that not all insurance organisations negotiate across all elements of the fee schedule. Some firms might negotiate the leading codes only, and hence, the dental team must finalise the fee schedule accordingly. The team can suggest demands from the insurance company, and based on the demands, the insurance company may comply with them.
When multiple dental practices ask for a hike in fees, many insurance companies might then increase fees periodically. Hence, the dental team must realise the role and importance of negotiation during the credentialing process.
It is very important for the dental practice to conduct quick research on the popular insurance companies in the vicinity.
The dental team must also match the kind and range of dental services provided by the practice with the coverage provided by insurance companies. It is important to note that demographics and lifestyles of different areas are different, and patient requirements might vary across different areas.
The dental team can survey other local dental practices in the area to identify potential insurance companies with which they can be in-network.
A typical mistake that a sizable number of dental practices make is commencing the credentialing process too late. The dental practice must realise that the provider credentialing process can take several months to complete. Hence, the process must ideally begin much before the joining date of the new dental practitioner. The team can start the process of getting an in-network contract as soon as the new appointee has been finalised.
It is wrong on the part of a dental practice to submit claims with the wrong dental practitioner information. In addition to being a serious mistake, it can also be considered a fraud. There are instances when a dental practice incorporates the NPI number of a credentialed practitioner on a claim submission for a dental practitioner who performed the service but is not yet credentialed.
Acceptance of payment by a dental practice for a claim based on incorrect provider information can lead to a charge of fraud. Moreover, any service or procedure performed before the start date of in-network status will be deemed out of network.
Some of the primary benefits of beginning the provider credentialing process early, and other benefits, are as follows:
This is the paramount benefit that drives cash flows for the practice. A large majority of patients prefer to receive services from in-network providers, as it reduces the amount of any out-of-pocket expenses that need to be borne.
When the dental practice does not have any credentialed practitioners, it cannot become in-network with insurance companies. As a result, the practice will not have a presence in the directories of insurance companies. Moreover, patients will have to pay higher amounts, and claims could be delayed or denied.
The credentialing process helps the practice to stay visible to patients. It also agrees to a fixed contracted rate for services rendered. Timely and accurate claims submitted by the dental team help reimbursements get processed faster. This results in smoother cash flows for the practice.
As a lot of patients are digitally savvy, before making an appointment, they may check the credentials of the dental practice or might ask the staff if their insurance plan is accepted. Getting credentialed is an indicator that the dental practice has qualified and experienced dental practitioners, which is also verified by insurance companies.
This leads to better patient retention and higher case acceptance, and credentialing leads to credibility, which in turn builds confidence and trust.
A dental practice that has a team that is credentialed helps to hire better associates and dental practitioners. It can help in the expansion of additional branches or in becoming a member of a dental group.
When credentialing lapses or incorrect details are submitted, the number of claim denials increases. There are payment delays. The team needs to start credentialing early. This, combined with precise billing, can foster faster payments and help boost cash flows.
Sending claims with incorrect credentialing details or billing an insurance company with a non-credentialed dental practitioner can result in charges for fraud or breach of contract. The dental team must maintain proper credentialing and avoid the risk of audits, fines, and damage to reputation.
Credentialing is a must for acquiring and retaining patients who depend on insurance firms. It helps to achieve in-network status with insurance companies. Besides building credibility, patients prefer a dental practice with verified credentials.
