As dental offices begin a new year and leave behind a year of unexpected challenges, many are considering what changes they can implement to grow their practice. Everything from marketing to updated technologies is on the table. In 2021, COVID-19 was feared and ways to control spreading were the first priority. There were limits on treatments provided and on how many patients could be treated. People are trying to make up for the treatments canceled in the previous year. And now is a great time to consider ways to get your practice name in the forefront. One way to produce growth is becoming credentialed.
In-Network Status vs. Out of Network
If you become in-network, you open your dental practice to a whole new influx of patients. Entering an insurance contract with a particular insurance carrier can increase your patient base and business opportunities. Insurance carriers have their own vetting processes for dentists to become credentialed. Which includes providing proof of their dental degree and license, malpractice insurance, law compliance, and other factors.
When considering entering a new contract with an insurance carrier, the plan, fee schedules, and charges allowed to patients must be read carefully. The dentist is agreeing to certain contractual obligations, such as audits of the practice and their documentation and if certain procedures can be billed. It is essential to give their utmost attention to the contract before signing it.
Some dentists remain out-of-network, which results in direct payments and less insurance management but a smaller pool of patients. These patients generally pay higher out-of-pocket rates and fees. They may search for in-network providers to pay less or no out-of-pocket expenses.
How to Start
Look to the top larger employers in your city and county and their insurance carriers. This will put your practice into a large customer base. Review insurance carrier fee schedules before making a decision among the carriers to insure the fairest payout. The front office can assist in this process by making a list of the insurance plans most asked to participate in by patients and calling other practices in the near vicinity. This is a very important decision, so be selective and negotiate fees.
The Dental Credentialing Application
Getting the dentists in your practice credentialed is one of the first things you should do if you decide to accept insurance, whether you are a new practice, new dentist or just hired a new dentist. Dental credentialing is done on individual terms. In a dental practice with multiple practitioners, each must make the decision individually to be in-network or out-of-network and which plans to accept.
To become in-network with a PPO insurance provider, you must enroll with the company, and for each one, complete an application form. Each application takes about 40 hours to complete, so it is quite an ominous task. Also, if an answer to one question is incorrect, you have to start again from the beginning. Credentialing is a very tedious and arduous process because insurance companies want to confirm you are a practicing dentist and in good standing.
Upon completion and submittance of the application, the insurance carrier will review your information and verify it is correct. This is called the “vetting” process. If you do this correctly and ensure all information is submitted, it will save much time. Payments will be processed and arrive much quicker. Only the dentist can make the choice of which plans are in their best interest to participate with. This is based on the companies and competition in the area.
Without proper dental credentialing, practitioners in your office will have delayed claims leading to increased time in getting paid. Insurance changes are occurring almost monthly, so it is very important for your peace of mind to know someone is managing your credentialing making sure it’s accurate and up-to-date. If you choose to hire a third party to handle your credentialing, it would save your front office much time and stress by taking care of relevant forms and documentation. The third party will also keep pace with dental credentialing requirements and any new additions to your office.
Even if you are totally out-of-network, PPO Negotiation Solutions can often negotiate fees higher than your standard fees, putting you in-network and able to attract far more new patients. They help you operate with PPOs from a position of power! Hire PPO Negotiation Solutions to assist your practice with increasing insurance reimbursements and creating a larger patient pool. Their goal is to increase your revenue and increase your practice’s knowledge of insurance negotiations. They work full time on your dental contract negotiations so you don’t have to worry about neglecting other aspects of your dental practice. Save time and money and contact them today!