The credentialing process is necessary to become in-network with one or more PPO insurance providers. This is good for your dental practice to obtain new patients and help the practice grow. Your main job is to provide quality health care service to your patients. But since you are running the business, you should also benefit from it as well.
The first step to become credentialed is to enroll with a company or companies you want to become in-network with. The information you will need to provide consists of such things as practice history, education, certifications, licenses, etc. You will need to complete a very thorough application for each company with which you have enrolled. Each application requires approximately 40 hours to complete. If you make an error when filling out the application, you must start over. Once you begin the application document, you have to finish it. This can be quite a daunting task and require your dental team to spend hours on completion.
Select An Insurance Company
In order to determine the insurance company or companies you choose to become in-network with, you will need to do some research. You may want to look to see what large companies are in your surrounding area and which insurance providers they use. When you do this, you will have a larger patient base from those companies. Because other dentists in the area may not accept their insurance. The name of your dental practice may also be given to the employers/employees of these companies on their list of participating providers.
Contact the Insurance Company
You might consider reaching out to the provider relations department for each of the insurance companies you have enrolled with. This is in order to assist you with their credentialing process. Otherwise, you will spend way too much time determining the following:
- who you need to speak with
- what is the best time to call
- where to send an email, etc.
The first item that has to be settled before submitting your credentialing application to an insurance company is to agree on a fee schedule. Always check to find out if fee negotiations can be done. At this point, if fee negotiations are allowed, you will want to speak with a rep to get the highest fee schedule they will offer. Once this process is complete and your credentialing application has been submitted, you will be locked into a fee schedule for 12-36 months before you are allowed to negotiate another fee increase.
Complete Insurance Application
All questions must be answered and all supporting documentation must be submitted when completing the credentialing application. If you fail to answer all questions or to submit one required document, you will have to begin again. The insurance company will verify if your information is correct. This is referred to as the vetting process. If you answer incorrectly or skip a question or do not submit all required documentation, this will only prolong the lengthy processing time with the insurance company.
Once you become credentialed with the insurance company, you are bound to your contract and must follow their fee schedules, which will determine what you can or cannot charge your patients. It is of most importance you read and fully understand your contract. It will allow for the insurance company to audit your dental practice. If you have multiple dentists in the office, they will all need to credential separately. If each of the dentists in the practice are not properly credentialed, the claims being submitted to the insurance company in question may be sitting somewhere for a long period of time and not get paid. It is a very good idea to contact the provider relations department. This is to make sure they have the needed information to process claims. Your payments will arrive much quicker.
The dentist has to make the decision which plans are the best to participate in based on the nearby competition. Dentists who decide to remain out-of-network will receive larger payments because they are not bound by contract. However, they could find themselves losing patients to in-network providers due to the patient having to pay less out-of-pocket for services.
Benefits of In-Network Status
Gaining in-network status can be very beneficial for your dental practice. If you are an in-network provider, you can post it on your webpage to inform prospective patients which coverage you accept. PPO providers might refer new patients to you as well. Being an in-network provider may give you leverage over other practices in the area if patients save money by visiting your practice for treatment.
As you can see, the entire credentialing process and gaining the in-network status is a very complex and time-consuming job to undertake. It can be very taxing for you and your team members. If your dental practice becomes in-network, it is very important to look at how you participate with insurance companies to maximize your profits. PPO Negotiation Solutions can help your bottom line. After all, they have 30 years of experience in handling PPO negotiation and participation optimization. Let them put their impeccable reputation to work for you!