Dec 19, 2023 3.5 min read

Get Started With Dental Credentialing

While running a practice, you may want to offer the finest patient care possible, and part of that may entail working with dental insurance companies. Dental Credentialing becomes important in this situation. It is the process of a dentist signing a contract with an insurance provider. Dental credentialing determines whether the practice is eligible for a contract as an in-network provider. Signing a contract agreement entails accepting the predetermined rates set by the insurance carrier so as to have access to a wider patient base.

Dental Credentialing

After receiving a dental credentialing application, the insurance provider will examine and confirm the data. Once your application has been approved, you are bound by the contractual agreement with the insurance provider that stipulates you will adhere to their fee schedules, contractual constraints, and standards for patient copayments.

Credentialing your dental practice with dental insurance providers might seem challenging and complex. However, dental credentialing has become essential as it enables your patients to securely put their trust in the dental care provider of their choice. Dental credentialing additionally enables dental practices to connect with insurance providers so they can accept third-party payments. You can quickly become an in-network provider if you have established a relationship with an insurance carrier. The dental credentialing process can be a demanding task that needs to be approached with attention and organization, followed by constant and frequent follow-ups, in order to get it  processed on time.

Why Is It So Important?

Getting your practice credentialed is one of the first steps you need to take if you decide to accept insurance. Patients are 90% more likely to seek care from practices that are credentialed. This not only broadens your opportunities with potential patients, but it also helps promote your visibility online and in-network. It thus, gives your practice a better chance of attracting new patients. Also, it can be a mess if patients are under the assumption that a dentist is in-network with an insurance provider and that is not the case. Although dental credentialing initially takes up a lot of time, when done correctly, it saves a lot of time and helps reduce patient frustration.

Credentialing Checklist

  • To acquire a credentialing application and learn more about the process, get in touch with a network provider. The application and other additional information are usually available on the websites of insurance providers.
  • Complete the application slowly and carefully, making sure to go through it thoroughly. Do not forget to include location information, copies of necessary papers, and other important information.
  • A detailed description of your practice location and any required paperwork, such as a business license, insurance policy, board certificates, etc., need to be updated in your profile.
  • Once you have submitted your application, keep a copy of it.
  • Verify that the insurance company received your application. After that, until you are informed that credentialing is finished and a participating provider agreement has been signed, periodically follow up to inquire about its status.
  • In order to speed up the process, respond quickly to requests for more information from the insurance company.
  • Maintain records of your submissions, follow-ups, and any other actions you deem necessary.
  • Keep track of all the contracts, applications, and submissions for credentialing, particularly the final version of the provider contract.

Common Mistakes While Credentialing

Sending Claims With Inaccurate Provider Data

Sending claims with the wrong provider information is a very serious error that could result in fraud charges.

Too Late to Begin the Certification Procedure

The procedure for obtaining credentials can take at least 90 days. This means you are not permitted to offer in-network services for three months. Since it can take several months, the application process should ideally begin earlier on.

Not Conducting a Prior Analysis of Your Service Area

Not doing any research into the most prevalent insurance payers in your service area is one of the most common mistakes. If you do not, patients may call to make an appointment, but go elsewhere for their treatment because you do not accept their insurance.

Failure to Discuss the Fee Schedule

These are used to calculate the highest amount that can be charged to the patient and the highest amount their insurance will cover. As the highest dollar amount chargeable to the patient and to the insurance per service can be negotiated, do not blindly accept the first fee schedule you see.

Submitting Applications to Too Many Dental Insurance Providers at Once

This can obviously bring in a lot of patients and money, but having too many applications open at the same time can be detrimental, as you may have to accept a lower fee schedule and your practice may have more work than your billing team can handle.

What Happens When You Have Credentialed

You can start invoicing for in-network services after the credentialing process is finished. Confirm the patient's insurance benefits prior to the visit and file claims within 24 hours after the treatment for prompt payment. Bill another insurance provider or the patient for any outstanding payments as soon as you get paid by the insurance provider.

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