Dentistry is on a spike, and so are the aspects related to dental care, such as the need for the dental credentialing process–while there are others, including the primary to deal with, which is dental
insurance or insured dental patients to take care of. Statistics show that almost 77% of Americans are
insured under one or the other type of dental insurance, signifying a positive business side for your
dental practice. However, being cautious is a must to lead the way! “Getting Credentialed” (meeting the
standard criteria of the dental insurance company to get proper reimbursement), offering your
credentials such as your education and experience, certifications, and training to the insurance
carriers that you contract with sufficient to make your work professional for the dental care services
delivery. Plus, your patients can have confidence in you to repeat their visits, and insurance providers
can offer reimbursement smoothly without hurdles.
However, don’t you think it’s all as straightforward as it may seem? Dealing with extensive
documentation, provider requirements, and regulatory changes sometimes makes the process challenging in
dentistry. Hence, be wary of some or even minor mistakes that can cause your practice, the dire
consequences being revenue loss on top, and you may compromise your practice reputation because specific
errors in the credentialing application may lead to legal complications. This guide explores the most
common errors in dentistry and ways to identify and avoid these mistakes with the best dental
credentialing practices, but first, let’s begin by understanding why dental credentialing is essential
to your practice.
Getting credentialed is somehow similar to getting approved by the insurance company to start a contract
for patient dental services. Dental credentialing is a review process of dentists’ credentials that
insurance companies perform to ensure they are in contract with a professional/ certified dentist to
deliver care and claim reimbursement. The steps of the process encompass verifying the dentist’s
professional record, career, education, training history, license, any malpractice, or any other record
as per the different verification standards of insurance companies. In simple means, dental
credentialing refers to “the process of getting enrolled in an insurance company’s preferred provider
network.”
Credentialing isn’t an option now, but it is more than a necessity of your practice, considering that
90% of patients prefer care from those who participate with their insurance plan. This signifies more
than an opportunity to boost online and in-network visibility and increase a new patient base because
joining a new network is the best strategy to keep boosting your dental practice and access an extended
number of insured patients. However, insurance carriers wouldn’t reimburse those providers without
completing the credentialing process. Plus, the insured patients are at risk of paying healthcare bills
at out-of-network rates. So, patient bills are the only option left of no option for your practice to
get paid for dental services.
Entering your professional and work experience details may seem simple, but there is little that
could save you from missteps in credentialing.
Following are some of the significant mistakes to get your hands off.
Having a business mind is a good strategy, but being cautious is a must. Despite considering the
advantages of getting credentialed, especially for your business increment, that is true. Credentialing
gets you more patients insured and, ultimately, more business. However, it counts as a big blunder to
apply to too many insurance carriers or in-network providers simultaneously. It may lead you to end up
in-network with smaller practices offering lower fee schedules. Make sure you are researching several
insurance companies available and studying the terms and conditions and fee schedules they offer before
deciding to choose a specific payer.
Moreover, applying to too many insurance providers simultaneously will find your dental billing
department in hard times due to handling large businesses and your ability to collect proper payments.
Consequently, your patients may suffer because they need to experience satisfactory billing and payment
processing. Plus, your billing team’s hurrying the tasks related to billing and claims cause:
The credentialing application carries all your data regarding your expertise and qualifications. Missing out on the essentials or inaccuracies in information submission will lead to health, financial, moral, and legal consequences. Credentialing applications already take an extended time to get approved, and errors make the matter worse. Ensure to include these additional documents while submitting the credentialing application:
A fee schedule provides information on the covered services and their contracted in-network rates that
doctors or other care providers receive from insurance companies. These fee schedules determine the
maximum amount that the patient will be billed and the amount the patient’s plan will pay for the
covered services.
In the process of credentialing, your practice has the best chance to negotiate the rates as per your
conditions and the conditions of your patients. Specifically, if you are a participating provider with
the patient’s one or more dental insurance plans, you must ensure you can negotiate the fee increase.
However, not discussing the fee before signing the contract will be considered a huge mistake. Try
working with a skilled and well-informed negotiator but be wary of keeping the top talking points for
negotiations including:
Mentioning the provider NPI that’s already credentialed is one of the biggest blunders you may cause to
your practice as it will be considered as a fraud rather than a mistake. When a fresh provider aspires
to get credentialed by the insurance company, offering the existing provider’s information such as
National Provider Identifier (NPI) and other credentials is a serious mistake that may cause damage to
your practice. Furthermore, you will likely be at risk of fraud by accepting payment on the wrong
provider data that hasn’t actually performed services.
In order to get reimbursement from the insurance company as an in-network provider, your new associate
must get credentialing as soon as the first date of performing services. Otherwise, the services
delivered by the new associate prior to the first date of their in-network status will be counted as
out-of-network.
Considering the lengthy approval process—at least 60 days to 180 days—starting the process late is more than a mistake. Instead, your practice should prepare by processing the credentialing application months before your new associate’s starting date. Start the process of getting an in-network contract several months before the day your new hire starts working on providing care to help you get rid of bad dental work.
Automation is the solution for many manually time-consuming, tedious, and repetitive tasks, such as dental credentialing in dentistry. Moreover, automation is the solution when dentists make a mistake, and to stay accurate, efficient, and compliant while contracting with third-party payers. Here are some significant reasons why your practice needs automation to get the best results:
For emerging dental groups or extensive dentistry, keeping a detailed record of provider credentials is necessary to ensure that providers are credentialed. Plus, keeping details and deadlines of the practices becomes a challenge for practitioners. However, automating various routine tasks to credential providers or re-credentialing eliminates a considerable administrative burden. So, credentialing doesn’t put an extra burden on practitioners to neglect other tasks.
When credentialing tasks are automatically handled, the process gets faster. Fewer errors in administrative operations and more speedy practice mean ultimate growth. Plus, the benefit of being in a network with insurance companies is doubled with free marketing of your practice. These payers promote your services everywhere under their policies.
Automation streamlines everything in credentialing and complex re-credentialing because it speeds up the
intricate paperwork and follow-up. Consequently, administrators spend more time caring for patients
rather than dealing with administrative tasks. Furthermore, automation saves your practice from the risk
of facing financial strains if your practice passes the credentialing application deadline.
Integrating automation technology in credentialing also saves your practice money due to the efficiency
of the process. When the practice is automated and efficient, your chances of getting paid increase, and
it streamlines the billing and cash flow of the services provided. In contrast, missing the application
deadline results in imbalanced revenue and patient trust due to the gap in the waiting period to get
your application approved. You may lose being in network with insurance companies and patient trust
because they likely have to pay out of their pockets. However, automation does not lose but saves your
money by reducing administrative expenses, including postage, time, and mailing, and avoiding delays in
insurance claims and reimbursement.
Approaching common mistakes frequently in credentialing is part of routine practices at dentistry. However, proper planning equipment and awareness of several issues may bring success with transparency. Ensure you are adequately informed on common issues in dental credentialing that may pose hurdles to a smooth cash flow and patient satisfaction. Your credentialing staff must stay focused on the latest updates and guidelines to stay competent and growing. MedsDental Billing Company shakes hands wholeheartedly with those looking for tools such as dental credentialing services. With facilitating dental practices for years, let us make your success possible. Our credentialing department strives to ensure your applications are accurate, complete, and submitted timely.
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