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Dental Provider Credentialing 101: Common Application Mistakes to Avoid

As discussed in part one and two of my dental providing credentialing blog series, it’s important to fully understand the implications of providing in-network vs. out-of-network care, allow ample time for the application process and take a detailed, thorough approach with the insurance companies during the inquiry process to negotiate the best fees schedules.

Now that you have a strong foundational knowledge base of the dental provider credentialing process, it’s time to address common application mistakes, so your credentialing can be completed in a timely manner and patients can be seen sooner.

  1. Be sure to complete each application response, even if the question doesn’t apply to your practice (i.e. enter in N/A). If a response is left blank, the insurance companies often consider it an incomplete application.
  2. Ensure your malpractice insurance is current and up to date during the credentialing approval process. The approval process can often take up to 90 days, so contact your malpractice insurance provider and extend the policy if it is set to expire during this timeframe.
  3. Always include detailed supporting documentation that outlines the changes in the practice (full details below).
  4. Plan and allow ample time (~3-6 months) for the approval of your dental credentialing. Credentialing is not a quick process, which is often the biggest headache experienced by dentists, since approval can deeply affect which patients can be seen (in-network vs. out-of-network).
    • Ensure all forms (W-9 and attestation page) and signatures are up to date and as recent to the application submission date as possible. The application process could be delayed if your forms are too out of date (i.e. you might start getting credentialed with the big companies first, and wait 3-6 months until targeting and applying for the smaller ones. Even though the forms have been completed and collected already, since considerable time has passed, you need to make sure the dates are near the new submission date.)

The Importance of Supporting Documentation for the Dental Credentialing Application

Providing detailed supporting documentation is instrumental to the timely approval of a dental credentialing application. Specifically, a detailed letter on the dental practice’s letterhead should clearly articulate the details of the changes. I find it best to display this information in a table format with big, bold headings. Details to include in the supporting documentation are:

  • New doctor’s name, tax ID and license numbers.
  • What doctor(s) are staying at the existing practice, leaving the practice, their identifiers, and the effective date the change will take place.
  • If you’re changing locations or working at multiple locations, be sure to clearly detail and label the locations. You don’t want your new credentialing to cancel out your old credentialing, which can happen due to confusion on behalf of the insurance company. This is as simple as providing the new doctor’s tax ID number and adding it to the old practice as a new location.

Dental Credentialing Management Tips

Implementing a sound credentialing management and tracking process will help your practice stay on top of communications and status updates with the insurance companies.

  • Confirm the application was received by the insurance company. Follow up in a consistent, friendly manner until you have confirmation from the insurance representatives. Outreach over email is best so you have a written record of communications.
  • Follow up with the insurance companies on a weekly basis.
  • Keep a detailed spreadsheet that records the status of each application including, insurance company name, contact information, call log, and detailed notes.
  • Utilize an online calendar app to keep track of reminders for follow up calls, emails, etc.
  • Be professionally obnoxious and stay diligent in follow up, until you’ve received a response and confirmation of your credentialing application. If you do not receive a response, it often means they did not receive it!

Working with several practices over the years, I understand how painful the credentialing process can be with insurance companies. It’s a timely, detailed process that requires nonstop management and diligent follow up. Though the credentialing process is a bottleneck in dental practice management, it’s a necessary process for practices and doctors because so many people rely on their dental insurance to afford the dental care they need.

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