As a dental health care provider, you want to provide the best patient care in your area, and part of excellent patient care may include participating with dental insurance providers. This is where dental credentialing comes into play. Dental credentialing is the process of a dentist entering into a contract with an insurance carrier. The dental credentialing process can be a lengthy one that requires a focused and organized approach, followed by consistent and regular follow-up in order to get the paperwork processed in a timely manner. Many offices find themselves adding an associate and needing their new doctor to process as in-network with their existing contracts as quickly as possible.

Once the insurance provider has received a dental credentialing application, they will review and verify the information. This is called the “Vetting Process”. Once your dental credentialing application is reviewed and approved, you are bound to the contractual agreement with that insurance provider that states you will follow their fee schedules and contractual limitations and guidelines for patient copayments. It is recommended to fully read the contractual agreement that you are choosing to enter into.

How do I decide which dental insurance providers to credential with?

When deciding which dental insurance providers you want to credential with, it is always a good idea to research the needs of your community and patient base. A benefit of being credentialed with a dental insurance provider is that patients will likely receive a list of in-network dentists in their area. This helps drive new patients to your office.

You may choose to not credential with any dental insurance providers. While out-of-network providers may receive larger payments because they aren’t bound to contracted fees, 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. Only the dentist or practice owner can decide which plans are in their best interest to participate with based on the companies and the competition in the area.

Pro tip: Call other dentists in the area and research which insurances they are in network with. This may take some time to do depending on your area, but it may be a great benefit if you are the only contracted provider in the area.

Why is dental credentialing important?

It can create quite a dental billing mess if claims are sent to an insurance provider that has not received the dentist’s information. This can lead to claims sitting in limbo for long periods of time, causing disruptions in the dental practice’s revenue cycle. It gets even messier if patients are under the assumption that a dentist is in network with an insurance provider…and that isn’t the case.

Dental credentialing can be a lengthy process in the beginning, but when done correctly it saves a lot of time and reduces patient frustration.

Pro tip: If you have multiple providers in one office, each provider will need to be credentialed separately. If you have multiple locations, each provider will need to be credentialed at each location as well.

Adding an associate dentist

If you have a new associate dentist in your practice, the credentialing process with all payers chosen should be set in motion immediately to avoid possible payment delays. As previously stated, the dental credentialing process is lengthy, and some umbrella networks require an additional 30-90 days to process credentialing paperwork. It is important to note that claims submitted during the credentialing process are considered out-of-network.

Practice Booster’s Administration with Confidence has more information on submitting associate dentist claims, dental insurance contract provisions, fee positioning, negotiating PPO contracts, and so much more. CLICK HERE to grab this must-have resource.

Find dental credentialing specialists

The time to think about proper dental credentialing is now. eAssist’s platform has the credentialing specialists that know who to contact, what documents are needed, and how to navigate the various scenarios that can present when adding new associates to existing contracts or adding new contracts in general. Let us take the dental credentialing burden off your front office. Not only will we submit the paperwork quickly and accurately, but we will watch your EOBs to make sure that they are processing as they should.