Dental credentialing is the first step for your dental practice to get enrolled with top insurance companies and start treating dental insurance patients to avail in-network benefits.
But clearing this initial step can be a challenge for your practice. There are many essentials of credentialing you can’t miss.
So, it’s important to understand all these details, ensuring you’re able to treat maximum insured patients and maximize your revenue opportunities.
Considering that, let’s discuss some major challenges faced by dental practices with solutions to prevent hassles.
Top Credentialing Challenges and Solutions
Lengthy Credentialing Duration
Getting credentialed with insurance companies and programs takes a lot of time. You can find the details in the table below:
| Plan | Timeframe |
|---|---|
| Medicare Credentialing | 45 to 90 days |
| Medicaid Credentialing | 60 to 120 days |
| HMO Credentialing | 60 to 120 days |
| PPO Credentialing | 30 to 90 days |
As you can see, credentialing can take up 2 to 4 months, and you can miss out on several insured dental patients, leading to losing revenue opportunities.
Solution: Plan credentialing at least 3-4 months in advance, so you can save up time and be ready to start seeing and treating dental patients. Hire expert credentialing specialists for the task or avail dental insurance credentialing services from a third-party service provider.
Updating CAQH Frequently
Council of Affordable Quality Healthcare (CAQH) provides a database for practices to register with their dental insurance credentialing details, allowing insurers to access information from one source. Dental practices need to be registered with CAQH.
Dental practitioners need to update their data in CAQH, but they may forget to do so. Due to that, their CAQH profile may become inactive. Payers review CAQH details and process payments accordingly. An inactive CAQH profile can result in payment delays and even claim denials.
Solution: You must update your CAQH ProView profile every 120 days (4 months) to keep it updated. For that, set up a reminder every 90 days, so you can make the changes timely and avoid any hassle. It helps insurers find the latest, up-to-date information about your credentialing and facilitates claims settlements.
Maintaining NPI Record
The National Provider Identifier (NPI) is a 10-digit identification number for medical and dental practitioners. It is required for Medicare services, as per the Health Insurance Portability and Accountability Act (HIPAA) regulations. NPI is the provider ID, which is required by insurance companies to track practitioners as officially registered healthcare providers.
All the details against the NPI number should be updated in the National Plan and Provider Enumeration System (NPPES). However, due to the busy schedule of your dental practice, you or your staff may not remember to update your NPI details over time. Just like CAQH, missing out on NPI details can result in revenue loss.
Solution: Contrary to CAQH, you don’t need to change your NPI very frequently. However, if there are any changes in any of your details, you must update them in your NPPES profile against your NPI number. Set up a reminder for that. Dedicate staff or partner with companies for this purpose.
Submitting Improper Applications
In credentialing, it’s important that you submit all the required documents and answer all the questions in the applications. If your documents are invalid and expired, and if details are left unanswered, your applications can be delayed or restarted all over again.
Solution: Check each document and information related to your dental insurance credentialing, including dental license, CV, dental school diploma, training certificates, NPI number confirmation, CAQH profile details, practice details, professional references, and other key details. Make sure you’re transparent about each detail and share all the required information, and your documents are accurate and up-to-date.
Negotiating Fee Schedule and Benefits
When enrolling with insurance companies, it’s essential to negotiate the fee schedule and benefits. Once you sign a contract, you’re bound to follow the rates and benefits throughout its duration, and you can’t make any changes as long as the contract is in place.
If you don’t negotiate them on time, you may have to compromise on low reimbursement rates, limited scope of dental services, claim denial terms, and other contract loopholes. With that, you may not be able to recover the right amount for dental services rendered.
Solution: Negotiate all contract terms with the insurance company beforehand to ensure you receive maximum benefits from the dental services. Assign credentialing experts who settle terms and ensure the best reimbursement rates for your practice.
Staff Turnover
If your existing dental credentialing specialist leaves, you need to hire new staff and train them. It’s a time-consuming process, requiring effort and expenses to make them experts at the task. This affects your staff productivity, ultimately impacting your dental practice’s task management and patient care.
Solution: Outsource dental credentialing services to a reliable dental credentialing company. Reputed companies like TransDental assign trained specialists who are well-versed in all the requirements of credentialing. You don’t need to invest in training them. Partnering with a credentialing company reduces your costs and efforts. By doing so, you can save a massive $41,000 annually, the average salary of a dental credentialing specialist.
Staying Current with Insurance Policies
Insurance companies can change their policies at any time and may not even notify you. This can be a challenge if you don’t keep up with the latest changes in their policy, affecting your in-network status.
Solution: Assign your practice staff to frequently check the insurer’s policies and update changes in your enrollment as soon as they occur. It helps you retain your insurance benefits.
Identifying Recredentialing Time
Most insurance companies usually recredential dental practices every 2-3 years. Some insurers may extend the duration to 4-5 years. Identifying the renewal time and starting the recredentialing process can be challenging for a dental practice.
Solution: Start the recredentialing process as early as a year in advance. Insurance companies take up to 3-6 months to enroll a new dental practice. This depends on each company’s insurance policy. So, the right approach is to start a proactive process for timely recredentialing.
Conclusion
Your dental credentialing runs smoothly if the documents and applications are complete, CAQH and NPI details are up-to-date, the dental license is active, and contract terms are negotiated on time. In-house credentialing can be costly and inconsistent, especially due to staff turnover. But if you partner with a trusted dental credentialing company, it streamlines the process, reduces stress, and ensures timely enrollment with top insurers for maximum benefits.
Frequently Asked Questions (FAQs)
Is there a way to speed up the credentialing process?
Dental credentialing can be lengthy, depending on the insurance company. It usually requires 3-4 months on average. You can speed it up by starting the process a few months before, submitting complete documents, and following up with companies to track progress and ensure enrollment on time.
What happens if re-credentialing deadlines are missed?
An insurance company may terminate your contract if the re-credentialing deadline is missed. That may make it challenging and stressful for your practice to enroll with an insurance company all over again.
How often should we update credentialing files?
You should review your documents and details in credentialing every 6 months or year, to update them, and follow regulatory compliance according to changing guidelines by insurance companies.
Can a dentist start seeing patients without credentialing?
A dentist can treat patients without being enrolled in an insurance network. But patients are required to pay, and most patients may not be able to afford expensive dental procedures, and prefer to get treated at in-network practices. This can lead to a significant revenue loss for your practice.
What’s the difference between credentialing and contracting?
Credentialing is the process of verifying your dental qualifications and other relevant details, while contracting is the process of your enrollment in an insurance network.
