What Are the Pros and Cons of Dental Insurance Credentialing?

Posted by dentalRCM on February 18th, 2020

Credentialing is relatively very simple as a process. Here, details related to a provider’s/dentist qualifications such as licensure, work history, certifications, education and so on are divided with a payer for verification and review.

After clearing this via and rigorous vetting process, the provider avails verified by the payer and begins getting payments for the services provided by her or him.

Appears like an easier process, correct?

In reality, implementing a trusted and constant process of credentialing is not always that easy. Over the years, DentalRCM Services has worked with a huge number of independent practices and dental offices for their enrollment and dental insurance credentialing requirements. That enabled us to have gathered an excellent pool of knowledge on the subject. Deploying that knowledge, in this blog post, we have attempted to highlight certain Pros and Cons of credentialing that persons working in the industry must stick to.

First, we go with Pros

Stuck to the details- Dental insurance credentialing is a process of vetting this, there must be the pristine level of attention offered to complete examination. Application issues frequently result in potential denials and delays. A typical credentialing application will prompt the average patient profile, peers references, employment history, services provided, copies of licensure, contact details, and all records of prior legal issues relating to practice if any. Any issue in procuring or offering any of this information might delay the provider credentialing and can be a great discussion for denial. 

To ignore this, all provider tools must go via a high process of audit for accuracy certification before submitting it to the committee availing it correct for the first time results into instant credentialing. After the provider has finished the application for the process of credentialing by taking the self-supporting of the system there time must be taken to confirm the details provided by them. That can be performed by the self-reporting details of the provider and only posing it against originating or primary sources.

Here’s a look at some of the crucial elements that must be confirmed along with the accurate primary source that could be deployed to confirm that information.

Board Certifications – Source: American Medical Specialties Board

Medical License – Sources:  Health Department

NPI – Source: National Plan & Provider Enumeration System

Sanctions – State Sources: Medicaid sanction list in the state of practice provider

Federal Sources: System for Award Management and Office of Inspector General

DEA Registration – Source: National Technical Information Service

Board Certifications – Source: American Board of Medical Specialties

Provider Education – Sources: American Medical Association or Medical School

Ensure office is properly staffed: dental insurance credentialing is basically a labor-intensive process calls for no compromise on staffing. People are required to handle the process, data management, fact examine the reporting, etc. Any misses on having suitable staff allocation can lead to increased mistakes which reduces the entire process down. Credentialing as a process needs a lot of information checking and needs specialization at some points from the staff. To do any reduction in staff might jeopardize the entire process.

Thus breaking the credentialing process into various jobs and hire specialist peoples to finish these jobs Also, there should be correct training channels for staff/employees to upgrade their skills to do the job better.

Now, let’s discuss the Don’ts

Don’t be late in sending applications for review purposes: Once the application forms have been thoroughly finished, they should be sent for review without being late. The thing to be kept in mind is, there’s usually more to dental insurance credentialing than just sending in forms and then waiting for acceptance. Further any additional information requested or any question raised must be promptly answered or sometimes there might be rejection.

Communication is Necessary – Working on rapport establishment with the representative of the insurance organization dealing with your case may create things simple. Procuring that individual’s contact information and interacted daily to ensure that all questions are replied and pursue up has been done on applications that are in processing.

Don’t delay in beginning: Most practices get begin so late, which can be a matter of failure and success for the practice. At a minimum, you should want to provide yourself at least ninety days. Be aware that you are working on someone else’s timeline – that is the payer. The responsiveness of the payer to your application will be determined by their workload and their motivation to add new providers to their network. As payers have supersized and merged, a practice’s capability to accelerate an application has shrunk. More details click on our official website and contact us at toll-free number +1 888-315-2050

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Joined: February 6th, 2020
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