Dental Credentialing is the process of a dentist entering into contracts with insurance carriers. Credentialing allows the insurance carriers to screen out dentists who may not be qualified to provide sufficient care and enables dentists to get paid for their services. Dental credentialing can be a confusing and time-consuming process. However, it is an important part of ensuring 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 his 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 Dental 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. Moreover, it also allows dentists to get reimbursements for their services. Credentialing can be a time-consuming process, but also the best way to ensure a smooth dental practice.

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, otherwise you may lose your patients.

Additionally, dental credentialing is also the easiest way to market your dental business. By signing a contract with an insurance company, the company will become your main source of referrals. Their subscribers will become your new major pool of patients. Hence, this is the best way to boost your dental practice.

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.

Things To Look Out For

Do not apply for too many dental insurance carriers at the same time

While this may seem like a good idea at first, it can have long-term consequences. Signing up with multiple insurance companies means more and more inflow of patients. However, at a certain point, an overworked and heavily crowded dental practice only does more harm than good. Rather than focusing on the number of patients only, focus on providing quality services and thus, creating loyal patients. Focus on signing up with 4-5 best insurance companies at best.

Look for the Popular Insurance Companies Around Your Location

This is very important to ensure better accessibility for the patients and you yourself. These companies will help you find patients from the area you’re located in. If you’re not registered with the insurance carriers in your area, then the patients in that area would have no incentive to visit you. Hence, choose insurance companies wisely whose main base is somewhere around your location.

Negotiate Fee Schedule

To maximize your benefits from dental credentialing, you need to work with those insurance companies that are more flexible. Try to negotiate the dental code fee structures before accepting the agreement. There is absolutely no harm in trying and what could be better than it going your way?

Starting Dental Credentialing Late

Dental Credential is a time-consuming process hence, it is advised to establish your new dental credentialing plan even before your previous one expires. You would not want to lose your existing patients in case your dental credentialing ends hence, it’s better to act early and wisely.

Conclusion

Dental credentialing is an important process that helps ensure that only qualified dentists are providing services, hence, if you’re one of them then it’ll boost up your dental practice image as compared to if you’re not. It sort of provides more credibility to your business. It also ensures a smoother flow of income through a broader pool of patients.

If you have any further questions or concerns regarding your dental practice or dental billing and coding, Zap Dental Billing is here to help. Contact us today to learn more about our services!