Just recently, a massive 70,506,786 people enrolled with Medicaid, increasing the already huge number of health insurance patients, which totaled about 92% of the country’s population in 2023.
These stats clearly indicate that a majority of the population is enrolled in insurance services, and you can capitalize on that if you’re enrolled in an insurance network. For that, you can either hire credentialing experts or outsource dental credentialing services to third-party providers.
You might be wondering what the right decision is for your dental practice.
Well, worry not. We’ll discuss all these aspects in this blog to assist you with it. So, let’s dive in.
Can In-House Dental Credentialing be a Hidden Cost?
Hiring in-house staff for dental credentialing sounds appealing. After all, everything is under control and your staff is well-aware of your systems and payers, right?
But that’s not the case.
Your team is already occupied with a bundle of duties, including scheduling patient appointments, attending to visiting patients, managing essentials, and handling billing tasks. Due to that, credentialing is lost in the shuffle, as it doesn’t fit in everyone’s JD.
Incomplete applications with errors lead to credentialing requests being denied by insurers, minimizing your revenue opportunities, as you’re not enrolled with insurance companies to avail benefits and treat insured patients. For this reason, many practices prefer to outsource dental credentialing services for a smoother process.
Now, to prevent that, you may hire a credentialing expert, whose average annual salary, as per Zippia, is about $41,000, plus other benefits, costing you several dollars. Add software cost, staff turnover, hiring new staff, and potential manual errors to it, and your total cost spikes up high!
However, you can save up on that if you partner with a dental credentialing company. Such a company appoints credentialing experts to streamline your enrollment and charges you much less, among other benefits.
Want to know how? Let’s explore what you can achieve by outsourcing dental insurance credentialing services to a reliable partner.
Is Outsourcing Dental Credentialing Services Worth it?
Cost-Effective Solutions
Many practices now prefer to outsource dental credentialing services to reduce workload and avoid errors. Another big reason is cost., jJust imagine paying $41,000 to a credentialing expert per month, and getting the same job done at a fraction of the amount. Which is the more viable option?
Definitely, outsourcing your dental credentialing services is a cost-effective option here. You pay much less here. Initial credentialing with a third-party company costs you somewhere from $100 to $600, while setup fees range from $150 to $800. You don’t need to pay extra charges. The payment is pre-set according to your contract with that company.
Rates vary per credentialing company. But when you compare these charges with the salary of an in-house credentialing specialist, you find a huge margin.
Moreover, it also saves you the cost of hiring and training new staff, in case your previous credentialing experts have resigned. This allows you to avail quick enrollment with insurers by saving money, which you can invest in improving other areas of your dental practice.
Enhanced Staff Productivity
Outsourcing dental credentialing reduces your staff’s workload, allowing them to focus more on clinical tasks, such as catering to patients and providing them with quality care. There is no more burnout and stress, so the staff is fresh and free to perform other tasks efficiently. Subsequently, your patients get the care they deserve.
Proactive and Timely Enrollment
As you know, dental credentialing is a time-consuming process. Whether it’s a Medicaid or Medicare program, or a private insurance company, credentialing can easily take anywhere from 90-180 days, and even longer. So, the best approach is to start the process 3-4 months before it, ensuring you’re easily enrolled.
A dental credentialing company regularly works with insurance companies to enroll dental practices in their network. Therefore, the company stays updated with the insurance companies’ changing policies and adheres to them, making your enrollment a smooth process.
Up-to-Date CAQH Credentialing
Council for Affordable Quality Healthcare (CAQH) enables dental practices to set up their profiles via the ProView profile builder and add their credentials, like state dental license, certifications, dental history, and other key details. Insurance companies can access ProView to check and verify dentists’ details for enrollment, and proceed with the process after verification is complete and credentials match the current details.
However, CAQH credentialing requires dentists to update their details every 120 days, which is about 4 months. You and your staff may not be able to remember or get the time to do so due to your dental practice’s busy tasks. A third-party service provider assists you with that by frequently reviewing your CAQH profile and updating it with changes if necessary. With that, your details remain updated, and allow insurers to easily access and verify credentials.
Easy Application Submissions
While CAQH ProView is commonly used by insurers to verify your credentials, some companies may still follow manual processes, requiring you to submit verification and enrollment forms. Again, this is a hassle, adding all of your key details, including provider identification, practice information, education and certifications, professional history, references, and other attachments.
Nowadays, most credentialing companies make the process easier by leveraging AI to automate your enrollment. When you outsource dental credentialing services, the entire process becomes smoother because you avoid manual paperwork and reduce common errors. With AI, they scan and review all your documents and verify these with their sources. For example, if you’ve completed a Doctor of Dental Surgery (DDS) degree from the New York University (NYU) College of Dentistry, the robust AI systems can easily verify your details from NYU to validate your degree as a dental surgeon.
After verifying your credentials, AI systems automatically submit electronic credentialing requests, minimizing paperwork and making processes more accurate and efficient.
Frequent Credentialing Report
Dental credentialing companies offer frequent reports on your credentialing process, so you’re informed about it. Real-time insights and analytics strengthen trust between you and the company. It boosts your confidence that you’ve chosen a reliable partner for enrollment with insurance companies.
Best Contract Terms
Credentialing companies fully understand your dental practice’s needs and negotiate the best contract terms with insurance companies. The purpose is to ensure that you secure benefits in the contract with maximum reimbursements, empowering your practice with maximum collections and profits.
The best practice is to negotiate the terms while you’re signing the contract during enrollment. If you don’t negotiate these terms, you’ll have to avail the benefits as per the insurer’s policies as long as the contract is in place. But credentialing companies leverage their expertise to secure the best rates and reimbursements for your practice.
Consistent Review and Recredentialing
Most insurance companies often require you to recredential every 3-5 years. Missing out on it results in you losing your in-network status, which also affects your credibility among patients. You also miss out on opportunities for treating maximum insured dental patients, leading to significant revenue loss.
However, when you outsource dental insurance credentialing to well-known credentialing partners, for example, TransDental, you’re relieved of the recredentialing stress. These companies review your credentialing status and start your recredentialing process on time, so you retain your in-network status and continue seeing and treating insured patients while maintaining a positive reputation in the industry.
Now we’ve discussed some of the benefits of outsourcing dental credentialing to a reputable credentialing company. But identifying such a company can be challenging.
To assist you with that, we’ll share some tips on choosing the best credentialing partner.
How to Choose the Right Credentialing Service Provider?
Look out for the following aspects before outsourcing your dental insurance credentialing to a company.
Dental Credentialing Expertise
Most credentialing companies handle both medical and dental credentialing, but a dedicated dental credentialing company specializes in dental-related enrollment tasks. Such a company knows all the details about dental insurance companies, CDT terminology, and ongoing insurance trends, facilitating your easy enrollment.
Transparent Pricing
The dental credentialing company should be transparent about its pricing, offering you complete details on the spot. There should be no upfront or hidden charges, as it damages the trust established between your practice and the company.
Proven Track Record
When you’re outsourcing your credentialing services and paying a company for them, you’ve the right to know if a company can back up its claims with facts. Inquire if the company has worked with your insurance companies, like Aetna, Delta Dental, United Healthcare, and others, and has helped enroll dental practices with these insurers and negotiate the best contracts with companies, offering benefits and maximum reimbursements per claim. Ensure that the company has a decent track record that it can easily prove.
Positive Reputation
Inquire about the credentialing company from fellow dental practices to verify if it has a positive reputation in the industry, and if other practices have enjoyed a great experience while working with it. You can also look out for online reviews on Google or social media from previous clients, if available. Otherwise, you can check the company’s official website to look for pieces like user reviews, case studies, or testimonials from satisfied clients that prove a company’s credibility and specialization in dental credentialing.
Conclusion
Dental insurance credentialing is a key step for every dental practice to get credentialed with CAQH and enrolled with insurance companies to start seeing patients. And, outsourcing the entire process helps streamline the process. That’s why many practices choose to outsource dental credentialing services, as it keeps the enrollment process smooth and organized.
You reduce credentialing expenses to a greater extent while credentialing companies manage the entire thing for you. This relieves you of the stress, and you get enrolled easily, while continuing to treat insured patients and embark on the path to revenue growth!
Frequently Asked Questions (FAQs)
Is CAQH credentialing mandatory?
CAQH credentialing isn’t legally required, but most major dental insurance networks use it to verify provider information. Keeping your CAQH profile active and updated helps speed up approvals and simplifies credentialing with multiple payers.
How can I ensure that outsourcing my dental credentialing doesn’t compromise patient data security or HIPAA compliance?
With TransDental, you can outsource your dental credentialing confidently. TransDental is a HIPAA-compliant credentialing company, ensuring your patient data is in secure hands and is used only for billing purposes.
Can I outsource credentialing for just one provider or new associate?
By outsourcing dental credentialing, you get flexible options. You can enroll just one provider, or even an entire dental practice.
Will outsourcing dental credentialing limit my control or visibility into the credentialing progress with insurance networks?
Not at all. By partnering with TransDental, you can track credentialing progress through real-time progress dashboards, periodic reports, and regular updates. You can monitor the entire process. In fact, outsourcing gives you more visibility than in-house credentialing, where it’s overlooked due to daily practice tasks.
What are the key pieces of information needed for credentialing?
The main details required for dental credentialing include your current state dental license and certifications, proof of malpractice insurance coverage, and your provider or CAQH profile information, such as NPI number, education, work history, and tax ID. Having these prepared helps speed up the approval process with insurance networks.
