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What is Credentialing in Dental Care?

June 22, 2021

Dental credentialing is a process in which a dentist enters a contract with an insurance provider in order to offer those dental insurance benefits to clients. The benefit to the dentist is access to a larger client base and increased business opportunities. However, it can be a rigorous process to get credentialed by an insurance company. So, why would a dentist choose to be credentialed? If you choose to be credentialed, what is the process for doing so? This article will discuss the ins and outs of dental credentialing to get you started in the right direction for your dental practice.

Benefits of Credentialing

In order to enter a contract, dentists must provide proof of a dental degree and license, malpractice insurance, and law compliance. It is important to read through a contract before signing it. The contract gives details about the insurance plan and will also list what a dentist can and cannot charge a patient for specific dental services.

Sometimes, an insurance company will state that some services are not billable. For example, if a patient’s temporary crown becomes loose and needs to be replaced, insurance may state in its terms that this is not a billable service. But for self-pay or out-of-network, a dentist might bill a charge to replace a temporary crown. These may seem like cons to credentialing. However, many patients rely on dental insurance to afford dental care. Often, patients will refuse dental care based on their out-of-pocket costs.

Dentists within the same dental practice can choose to either be “in-network” or “out-of-network” with the same insurance provider. Each dentist will be credentialed individually if they choose to be in-network. Take time to explore which insurance providers are common in your area, and which ones will most affect your client base before entering contracts.

How to Get Credentialed

Once you have decided to move forward and join with an insurance company, there are a few steps that you need to take. First, you will need to do a full application before reaching out to dental insurance companies. This can be made easier by using the credentialing tool on the American Dental Association’s website. It will give you a list of documents that you will need. These include your NPI number, dental license, proof of malpractice insurance, DEA certificate, specialized degrees or certificates and professional references.

Once your application is submitted, you can reach out to dental companies and make inquiries. Begin by going to the company’s website and looking for an option to join their network. After submitting an inquiry, the company will send you a contract. Make sure you receive a fee schedule, and thoroughly review it. Negotiate to your approval. Sign only when you are satisfied with the results.

Tips for a Smoother Application Process

Now that you know the importance of credentialing and the basics of how to get started, let us discuss how to get the process done quickly and efficiently so that you can get to taking care of your patients.

First, make sure that you enter a response for each application question. Even if it does not apply to you, enter “N/A” rather than leaving it blank.

Next, make sure your malpractice insurance, all submitted forms, and signatures are updated. The credentialing process can take several months, and you do not want it to take longer due to a clerical error that was preventable.

Once you submit the application, confirm it was received. Routine follow-ups via email with insurance companies are important. Keep a log of who you contacted, when and what the details of the response. Routine follow-up will ensure you get the responses in the timeliest manner. It can be a painful process, but will be worth it for both your patients and your practice.

Beware of Medicaid

Depending on the size of your practice, there are some insurances you may want to look out for when it comes to choosing with whom you want to enter a contact. Medicaid insurances require a few more steps and a bit more effort to maintain and therefore may be recommended for larger practices. For one, it is two different application processes – one process with the state, and another with a managed care company. You will need a state Medicaid provider number. And typically, the credentialing process takes longer than other insurances. It may take more time in consistent follow-up emails and phone calls.

Getting credentialed for your dental practice is time-consuming and leaves less time to focus on your patients. There is another option. Consider outsourcing and hiring a third-party company to take over this process for you. Companies like Strategic Practice Solutions can provide company training for office managers to help dentists keep up with credentialing or manage it all for you. Contact them today for your dental practice needs.

Filed Under: Dental negotiations Tagged With: credentialing, dental insurance, insurance

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Shelby Township, MI 48317
Mon – Thu: 7:30 am – 5:00 pm
Fri: 7:30 am – 4:00 pm

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