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Dental Credentialing Process

The credentialing process or provider enrollment consists of two phases called credentialing and contracting. Insurance companies verify your education, training, and professional history during credentialing to ensure you meet the necessary internal requirements for an in-network provider. Then, the insurance company issues a participating provider agreement outlining specific terms for participation and receiving claim reimbursement. A provider agreement is a requirement for in-network reimbursement. However, you may have the option to bill as an out-of-network provider until completing your credentialing. Unfortunately, the insurance company does not guarantee claim processing. Additionally, claim acceptance depends on patient out-of-network benefits. Below is a checklist of items to prepare before beginning the credentialing process.

Credentialing and Contracting Preparation Checklist

Insurance Companies with Whom You Should Credential

Determining the best insurance providers for dental practices may seem overwhelming. Therefore, contact a peer at another local practice or an insurance billing office manager to inquire which insurance companies provide an excellent patient base. Other major dental insurance carriers to consider are Medicare, Medicaid, Blue Cross Blue Shield, United Healthcare, Humana, Aetna, and Cigna. In addition, major national PPO plans sometimes rent their networks in targeted areas, such as Multiplan. The small business consultants recommend seeking credentialing with multiple insurance companies to obtain a wide range of insurance coverages.

Insurance Companies with Whom You Should Credential

Determining the best insurance providers for dental practices may seem overwhelming. Therefore, contact a peer at another local practice or an insurance billing office manager to inquire which insurance companies provide an excellent patient base. Other major dental insurance carriers to consider are Medicare, Medicaid, Blue Cross Blue Shield, United Healthcare, Humana, Aetna, and Cigna. In addition, major national PPO plans sometimes rent their networks in targeted areas, such as Multiplan. The small business consultants recommend seeking credentialing with multiple insurance companies to obtain a wide range of insurance coverages.

Credentialing with Insurance Networks

Credentialing can be time-consuming and may require hours of application preparation and process follow-up. Dental office coaches at Bryant Consultants advise clients to outsource the credentialing process to maintain patient or practice focus since it requires a significant time investment. Once you decide on the insurance carriers with whom to participate, follow the below checklist to begin the credentialing process.

Insurance Network Credential Checklist

Once Credentialed

After completing the credentialing process, you may begin billing for in-network services. Be sure to verify the patient’s benefits before the appointment and submit claims within 24 hours of treatment for timely payment. Once payment is received from the insurance company, promptly post the payment and bill another insurance provider or the patient for the remaining balances due.

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