Credentialing is what is necessary to become in-network in order to participate with a myriad of insurance companies and their different plans. There are various types of insurance providers including PPO, DMO, HMO, DHMO, Medicaid and within each type, there are several insurance providers. Dental patients are much more likely to seek treatment with a dentist who participates with their insurance plans.
Up to 50% of new patients come from insurance and other referrals. This benefits your practice by increasing your overall potential and revenue. By credentialing your dental practitioners, you will encourage patients to trust in your providers, enabling your practice to enroll with insurance companies so you will receive third-party reimbursement.
Roughly 77% of the population holds dental benefits. These benefits come from a variety of providers that include private payers and public programs like Medicaid. Licensed health care service plans are required to monitor the qualifications of their participating providers and follow National Committee on Quality Assurance (NCQA) standards. This is also one of many reasons for credentialing, as it places your dental practitioners in the best light to prospective patients.
These documents are necessary to complete your credentialing application:
- A copy of your state license
- A copy of your professional insurance face sheet
- Complete practice information
- Your practice NPI Number
You may also need the following:
- Hospital affiliation information
- A copy of your anesthesia license
- Your Medicare number
- A copy of your DEA (Drug Enforcement Administration) license
- Your Medicaid number
- A copy of your CDS (Controlled Dangerous Substances) license
- BLS (Basic Life Support) certification information
- ACLS (Advanced Cardiovascular Life Support) certification information
This information may be needed depending upon the state in which you practice, and sometimes, additional documents may be required.
When you obtain in-network status with PPO insurance companies, patients who are enrolled in these particular plans save money on their dental treatments. When the people in your community need to have dental care performed, this will give your practice an edge over other dental practices. Also, the insurance providers themselves will refer clients to your practice who are in need of an in-network dentist or dental specialist.
Once you obtain this status, you can advertise the plans you accept on your website and other social media. This marketing will attract new patients to your practice and result in more sustainable future growth. Every insurance company is different, and their applications and credentialing processes may not be entirely the same.
The American Dental Association (ADA) collaborated with the Council for Affordable Quality Healthcare (CAQH) Proview and created a one-stop-shop for all licensed dentists in the U.S. to be able to enter and share their professional and practice data with dental plans and other healthcare organizations. This service reduces the burden of the credentialing process.
Vital for Future Growth
Seeking credentialing helps to ensure your practice is in a good position to serve patients at reasonable prices and still profit from sizable reimbursements. Credentialing is vital for the future growth of your practice and should not be put off for very long. Reimbursements from insurance and Medicaid are a significant part of overall revenue.
Becoming credentialed to serve Medicaid patients can also result in significant benefits. This process is similar to an insurance company, but may require more information. Government health plans such as Medicare and Medicaid will not pay for any out-of-network services. Dental practices not in network with their patient’s dental plan are at risk of losing their patients. This affects the revenue, patient base, and the bottom line of any dental practice.
It is a standard process for dentists to receive requests for information regarding credentialing or recredentialing from a licensed dental plan. This is to ensure that enrollees who select a participating dentist can be assured their dentist has met minimum uniform requirements.
Many dental practices do not have the time nor the staff to handle the process of taking the appropriate steps to credential each practitioner in their office. There are many forms to complete and quite a bit of information to be gathered to complete the credentialing process. At this point, most practices will find it is very helpful and reduces stress to employ a credentialing service to assist them.
PPO Negotiation Solutions are trusted partners to hundreds of dental practices. They can negotiate your highest fee schedules and claims reimbursements upon credentialing. Strategic Practice Solutions and PPO Negotiations Solutions are experts at handling PPO negotiation and participation optimization. After 30 years of experience, they have an impeccable reputation and have it down to a science.
With PPO Negotiation Solutions as your credentialing partner, you can interact with PPOs from a position of power. This is because they handle the details of your negotiations. This includes:
- AUDIT your current PPO Payor Mix Percentage & UCR fees relative to competitors
- DEVELOP a Negotiation Plan outlining your participation directly or through rented networks
- NEGOTIATE directly through our highly cultivated PPO contacts to produce the greatest number of patients at the highest rate of reimbursement
- FILE AND TRACK credentialing forms until you are safely “in network”
- COACH your team remotely, online, and/or onsite for maximum understanding & ongoing results
Contact us at PPO Negotiation Solutions today and learn more!