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Jaycee Brown

Jaycee Brown

Director of Communications

What is Dental Credentialing

First, one might ask what dental credentialing is and what does it mean?  Dental Provider Credentialing is the process of a dentist entering into a contract with an insurance carrier. When doing this you will need info such as practice history, education, certifications, licenses, and so forth.  

They will then review your information and verify it is correct. This is what you call the “Vetting Process”. When you become credentialed with them, you are bound to the contract and will follow their fee schedules and it determines what you can and cannot charge the patient.

It is important that you fully read and understand what you are agreeing to and it also allows the insurance company to audit your practice and your documentation in charts. If you have multiple providers in one office, each provider will need to be credentialed separately. They will then have to decide which insurances they want to be in-network or out-of-network with and complete the process for each.

When deciding which networks to join, it is always a good idea to do research to see what large companies are in the area and which insurance carriers they use.  By doing this, you will have a larger customer/patient base from those companies as many other dentists in the area may not take their insurance. Insurance companies are also likely to give employers/employees of these companies the office name as most are given a list of participating providers when looking for a dentist.

It can create quite an issue if doctors aren’t credentialed and you are submitting claims to an insurance that hasn’t received the doctor’s information.  This can lead to claims sitting for long periods of time without getting paid. It is always best to call and verify through provider relations that they have the needed info on file in order for the office’s claims to be processed in a timely manner.

This can be a lengthy process in the beginning, but when done correctly and you ensure all information is submitted it saves a lot of time.  You will see the payments arrive quicker than if you hadn’t completed the process.

Out-of-network providers may receive larger payments as they aren’t bound to contracted fees, but they also expose their practice to the possibility of  losing patients to in-network providers because the patient has less or no out of pocket expense. This is risk you take when not becoming a contracted provider. Only the dentist can decide which plans are in their best interest to participate with based on the companies and the competition in the area.  It is also a good idea to call other dentists in the area and see which insurances they are in network with. Again, this may take some time to do, but it may be a great benefit if you are the only contracted provider in the area.

Account Executive/Account Manager

Tami Grigg

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