EZDDS Billing

Dental Credentialing

Let us help you get credentialed and enrolled quickly and effectively.

The Dental Credentialing Process

There are two phases to the dental insurance credentialing process:

1. Credentialing: Insurance companies verify your education, training and professional history to ensure you meet the necessary dental credentials requirements for an in-network provider.

2. Contracting: The insurance companies issue a participating provider agreement outlining specific terms for participation and receiving claim reimbursement.

The provider agreement is a requirement for in-network reimbursement, but it may be possible to bill as an out-of-network provider until the credentialing process is completed. However, the insurance company does not guarantee claim processing in this case, as acceptance depends on patient out-of-network benefits.

Here are the checklists and considerations to prepare for before beginning the credentialing process:

  • Establish a business entity like an LLC, S-Corp, or PC and obtain a tax identification number.
  • Sole proprietors should consider obtaining a federal tax ID to protect their social security number.
  • Purchase a professional liability insurance policy.
  • Obtain a personal and business NPI number.
  • Acquire licensure in the dental practice’s state with prescriptive authority.
  • Establish and maintain a CAQH profile.
  • Research and identify insurance networks for your practice.
Although determining the best insurance providers for your dental practice can be difficult, it may be helpful to inquire from other local practices or insurance billing office managers about which insurance companies provide an excellent patient base. Major dental insurance carriers to consider are Medicare, Medicaid, Blue Cross Blue Shield, United Healthcare, Humana, Aetna and Cigna. Additionally, major national PPO plans sometimes rent their networks in targeted areas, such as Multiplan. Small business consultants recommend seeking credentialing with multiple insurance companies to obtain a wide range of insurance coverages.
As advised by our dental credentialing specialist, outsourcing the process can save a dental practice time and effort which is better redirected to patients. Upon selection of the insurance carriers with whom to participate, follow the insurance credentialing checklist to complete the process.
  • Contact network providers to obtain a credentialing application and inquire about the process. Most insurance carriers have the application and additional information on their website.
  • Carefully review and complete the application, making sure to sign and date the application. Include location details for additional practice locations, as well as copies of required documentation.
  • Update your CAQH profile to include complete information about your practice location and necessary documentation, such as a business license, insurance coverage, board certifications, etc.
  • Keep a copy of your application once submitted.
  • Verify your application submission with the insurance company, then follow up periodically to inquire about the status until notified that credentialing is complete and a participating provider agreement is signed.
  • Promptly respond to the insurance company’s requests for additional information to continue processing.
  • Document your submissions, follow-ups, and additional activity.
  • Carefully review your participating provider contract details to understand the requirements of a network provider.
  • Maintain records of credentialing applications, submissions, and contracts, especially a final copy of the provider contract.

After completing the credentialing process you may begin billing for in-network services. Ensure proper insurance verification before treating any patient and submit claims within 24 hours through an efficient billing system for timely payment. Post the payment once received from the insurance company, and bill the patient or another insurance provider for the remaining balances due.

Why Outsource Your Credentialing To EZDDS

Faster payment

EZDDS offer the best dental insurance credentialing services to help you participate with insurance providers with extensive patient base for faster payments and better profits.

More Patients

Access more patients by being added on the provider list for insurance companies with extensive patient base and coverage in your area.

Build Trust

Get credentialed with the top providers to receive their vote of confidence in your practice as proof of quality and trust.

We are the Billing Experts that Make Dentists Smile

Skip to content