The process of a dentist entering into contracts with insurance carriers is called dental credentialing. Credentialing is important to both the insurance carrier and the dentist. Credentialing allows the insurance carrier to screen out dentists who may not be qualified to provide care and it allows the dentist to get paid for their services. Dental credentialing can be a confusing and time-consuming process. However, it is an important part of ensuring that your dental practice runs smoothly and efficiently. By taking the time to understand the credentialing process, you can save yourself a lot of headaches down the road.
What is the Credentialing Process?
The credentialing process usually starts with an application. The insurance carrier will use the credentialing application to gather information about the dentist and their practice. After the initial screening, the insurance carrier will conduct a site visit to verify that the dentist meets all of their credentialing requirements. Once the dentist has been credentialed, they will be able to participate in the insurance carrier’s network and receive reimbursement for their services. Dentists’ practice history, education, professional training, and licenses are reviewed as part of the credentialing process.
Organizations that credential dental providers use a variety of methods to verify qualifications, including:
– Checking state licensure boards for disciplinary actions
– Reviewing malpractice insurance coverage
– Conducting on-site visits
– Speaking with references
– Checking with the provider’s state dental board
– Checking licensure status through the American Dental Association (ADA)
Why is Credentialing important?
This process is important for insurance companies, state dental boards, and other organizations that need to ensure that only qualified providers are delivering care. Credentialing is important because it ensures that patients are receiving care from qualified providers. It also allows dentists to get paid for their services. Credentialing can be a time-consuming process, but it is worth it to make sure that your dental practice is running smoothly.
It’s important to note that not all dentists are credentialed with every dental insurance company. Therefore, it’s possible that a patient may not be able to receive coverage for their treatment if they see a dentist who is not credentialed with their insurance. In these cases, patients may be responsible for paying the full cost of their treatment out-of-pocket. For this reason, it’s always a good idea to verify credentialing before scheduling an appointment.
What are the Credentialing Requirements?
Each insurance carrier has its own credentialing requirements, but there are some general standards that all carriers must meet. Dentists must have a valid dental license and be in good standing with their state dental board. They must also have malpractice insurance. In addition, dentists must meet the educational and experience requirements of the insurance carrier. Once you have the credentials, you can also hire a dental billing company to manage your insurance billing and verification.
1) Submit an application to the insurance carrier. The application will ask for basic information about the dentist, such as name, address, and phone number
2) Submit proof of training and education
3) Take and pass a written exam
4) Take and pass a clinical exam
5) Submit proof of malpractice insurance
6) Submit a list of current patients
7) Pay the credentialing fee
Once the dentist has completed all of these steps, they will be credentialed and can start seeing patients.
Credentialing is an important process that helps to ensure that your dentist is qualified to provide the care you need. If you have any further questions about credentialing, or if you need help with your dental billing, Zap Dental Billing is here to help. Contact us today to learn more about our services!