5 Common Mistakes In Dental Credentialing Process

5 Common Mistakes In Dental Credentialing Process

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.

Insights On Dental Credentialing And Its Significance For 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.

Mistake - 1 - Approaching Too Many Dental Insurance Carriers Simultaneously

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:

  • Errors causing claim denials
  • Increase in data entry errors
  • Errors in coding and claim submission
  • Inability to stay on top of the aging report
  • Lack of managing denied payments

Mistake - 2 - Submitting Inaccurate Or Incomplete Information In The Credentialing Application

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:

  • Your CV
  • Drug Enforcement Administration (DEA) Certificate
  • Diploma
  • State Medical License(s)
  • Several Identification Numbers (NPI, Medicare, Medicaid, etc.)
  • Malpractice Insurance Policies with current date of coverage

Mistake - 3 - Lack Of Proper Negotiation On Fee Schedule

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:

  • The data that you need to negotiate effectively
  • Your advantages in terms of access
  • The desired fee amount that you think of on each procedure code
  • The business practices that are favorable to your payer
  • The ADA’s 2022 survey of dental fees

Mistake - 4 - Sending Claims With The Wrong Provider Data

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.

Mistake - 5 - Beginning Credentialing Too Late

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.

Automate Credentialing For Many Reasons

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:

Enhanced Accuracy And Efficiency

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.

Boosted Growth For Emerging Dentistry

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 In Dental Credentialing Saves Time And Money

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.

Get Error-free Dental Credentialing With Automation Transparency At MedsDental Billing

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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