So, you’re starting a dental business or adding a dentist to the team, and you want to gather patients from an insurance carrier’s network. To do this, first you will need a contract with the insurance company as an approved provider, a process known as provider credentialing.
The process of credentialing is relatively straightforward, but there are small mistakes you can make that will have large consequences. The biggest consequence? You won’t get paid by insurance companies for treating insured patients, which makes a mess when it comes to collections — more on that later.
Once you understand mistakes, you’ll know how to avoid making them. That’s why we’re sharing 5 mistakes we see dentists make most often in the dental credentialing process.
DCS offers credentialing services that will manage the entire process for you, but it’s good to see exactly why our service is valuable before making the decision to sign up.
But first: What does it mean to “get credentialed”?
Before we dive into common mistakes people make during the credentialing process, what does get credentialed even mean? You already went to dental school, passed your board exams, and got your license — what else must you do to start working with patients?
Well, if you want to treat patients who pay through insurance, dental credentialing is an insurance company’s review process that qualifies a dentist for a contract as an in-network provider.
Entering a contract agreement includes accepting the negotiated fees set by the insurance carrier in exchange for access to their large roster of insured patients.
Why is it important to have your dentists credentialed?
By directly contracting with an insurance company, you will receive referrals for the carrier’s subscribers — the people who have insurance plans covering themselves and their family members. Being credentialed is a great way to gain access to a large pool of patients.
Credentialing is one of the easiest forms of marketing you can do as a dental practice. It’s so effective that for many dentists, joining a network is the only marketing they need do for their practice.
However, until the credentialing process is complete, a provider cannot accept insurance for payment. They can treat anyone, but insured patients would have to be billed at out-of-network rates. For an un-credentialed dentist, the options are patient billing or none at all.
On the surface, credentialing seems relatively simple. However, inexperience with the process can lead to avoidable missteps.
So, here are 5 mistakes we often see with solutions for each, and we’ll wrap up with one simple all-encompassing solution at the end of this article.
Mistake #1: Applying to too many dental insurance carriers at the same time
This typically applies to brand new dental practices. It’s exciting to finally be able to tell your patients, “Yes, we are in-network with your insurance! Come on in!” You start to bring in plenty of patients and money, and you’re excited that your practice is taking off. This is all good, right?
Well, obviously you want to bring in plenty of business, but getting yourself tied up with too many applications at once can work against you for many reasons. Here are a few issues you might face:
- You have to accept a lower fee schedule. When you choose to enroll with many insurers under an encompassing umbrella of payers, you could end up in-network with some smaller, not-so-well-known insurance companies that often impose lower fee schedules.
That said, enrolling directly with individual insurance companies could require an even lower fee schedule than what an umbrella offers. It’s best to take the time needed to choose insurers and study their terms carefully to negotiate profitably. You don’t want to accept low fees now that you’ll regret later.
- You’ll get more business than your billing process can handle. If your schedule is overbooked and your staff is overworked, your dental practice is going to suffer — and so will your patients. Important tasks will begin to slip through the cracks, including your ability to collect payments for all the work you’re doing.
Small and simple errors are a common cause of insurance claim denials. As you’d expect, more mistakes tend to happen when your team hurries through the claim filing process to make it fit into the little time they have available.
When working too quickly, it’s inevitable to see an increase in data entry errors, coding errors, and claims submitted without the needed attachments or documentation.
A time-strapped team also finds it impossible to stay on top of the aging report and overturn denied or downgraded payments. High staff turnover also causes tasks to slip through the cracks, and is a sign your billing team is overwhelmed — a common problem when accepting too many insurance providers!
Related: In-network or out-of-network: Pros and cons for your dental practice
Your Solution: Enroll with only 4 or 5 of the most popular insurance providers in your area
We’ll go deeper on this later in this article, but the key is to know your customer! Do your research on the most common insurance providers in the area where your dental practice resides.
Once you figure out which insurance most people have, enroll with just 4 or 5 of those providers so that you can be accessible to most people without being overrun with more patients than you and your team can handle.
Mistake #2: Failing to negotiate the fee schedule
A fee schedule is a list of covered services and their contracted in-network rates that insurance companies will pay doctors or other providers/suppliers. These fees are used to determine the maximum amount the patient can be billed and the maximum amount that the patient’s plan will pay out for covered services.
Did you know that the rates on the fee schedule proposed during the credentialing process may be negotiable? If didn’t know, you’re not alone — accepting the first fee schedule you see is a common mistake. It’s in your best interests to discuss the reimbursement schedule prior to signing the contract. Working with a skilled and well-informed negotiator can be a huge benefit.
Here’s the catch: You can’t negotiate with every insurance company.
Not every insurance company will be willing to negotiate your fee schedule. Some insurance companies will only adjust your top 20 CDT codes with your office’s Usual, Customary, and Reasonable (UCR) fee schedule instead of increasing the cost of all your procedures.
However, it’s important to know which services and fees the insurance company may be more flexible with, and to have a strategy for asking your fee-related questions. Again, a skillful negotiator can be a big help.
Your Solution: Ask the insurance company for what you want. They may agree to it.
Don’t be afraid or shy about asking insurers for the rates you want, as taking the chance can pay off for you for years to come. For example, from our experience, a practice’s negotiator asked the insurance company to increase their fees…
The insurance company came back to the practice with, “We’re actually going to increase fees for everyone who accepts our insurance at their practice,” because so many practices had been asking them to increase their fees.
Read more: Can I negotiate a better PPO dental fee schedule?
What’s the key takeaway here? Negotiating the fee schedule is an important part of the process that you should be prepared to undertake before agreeing to the insurer’s proposed fee schedule.
Mistake #3: Not analyzing your service area first
A common oversight is not researching your service area for the most prevalent insurance payers and for the type of dental services you provide.
Remember, your service area is not just the square miles around your office. It’s a unique combination of your services, your city, and its demographics.
When you get started with your credentialing process, it’s critical to do research on the potential customers in your area. Which large insurance companies are popular within your area — and for your area of expertise?
If you don’t do research on this, you’ll have potential patients calling for appointments because you’re local, but going somewhere else because you don’t accept their insurance. You need to be accessible to the majority of insured people in your area.
Your Solution: Call or research local dental practices and ask what insurers they are in-network with
This is an easy task that most practices can accomplish. However, are you the only dental practice in your area? If you are, then it’s a safe bet to accept the 5 most popular dental insurances in the nearest bigger city.
Mistake #4: Starting the credentialing process too late
Starting the credentialing process too late is the most common mistake we see among dentists.
Because it can take several months to be approved, the application process should ideally begin months before your new provider’s start date. You need to begin the process of getting an in-network contract as soon as you establish your dental practice, or when you’ve hired a new associate dentist, before a new provider’s first day of work.
Why so much lead time? Well, the credentialing process can take at least 90 days and up to 180 days, perhaps more. And that’s 3 to 6 months during which you or your new associate can’t be paid in-network for services!
Read more: 3 steps for creating a successful start-up dental practice
Your Solution: Get started with credentialing as soon as you start planning your new practice or a new dentist joins your current one
Because the process takes so long, it’s crucial to get started right away, so that you can avoid extended delays in getting in-network with insurance providers.
If you aren’t in-network with an insurance company and file claims anyway, every claim will be denied and then billed to the patient — in full — as out-of-network. So, until your credentials are in place, you’ll have to turn away patients, have them pay out of pocket (and out of network), or treat them without billing for it.
The first two won’t encourage patients to choose your practice, and it’s not to your benefit to work for free. Don’t wait to get credentialed! Because being un-credentialied means missing out on revenue and countless opportunities to grow your practice.
Mistake #5: Sending claims with the wrong provider information
Sending claims with the wrong provider information is a pretty serious mistake because it can lead to being charged with fraud. We’ve seen it happen! And this is how it happens…
While a new associate dentist waits to be credentialed, the fully credentialed dentist says, “Oh, just put down my NPI number for the claim, it’s fine.”
Well… actually, it’s not fine.
When you use someone else’s National Provider Identifier, you’re telling the insurance company that someone who didn’t perform a service, did perform a service. Accepting payment on that insurance claim would be fraudulent because the payment is based on incorrect provider information.
Read more: 10 reasons your dental insurance claims are being denied
Your dental biller can’t send legitimate insurance claims for the work your new associate is producing until they, too, are credentialed with an insurance company as a provider. Any services a doctor performs prior to the start date for their in-network status will be considered out of network.
Your Solution: Always file claims with accurate provider information
If the NPI number on the claim does not match the dentist who actually treated the patient, that is inaccurate information sent intentionally to the insurance company. This could put your practice in legal hot water even if done by accident, so, don’t do It on purpose!
Get your dentists credentialed so you won’t have to worry about putting your business at risk.
So many mistakes to be made, but with one solution, you can avoid them all…
Your Solution: Automated credentialing services
Our exclusive automated DCS Credentialing service ensures cost-efficient, secure enrollment administration that goes from call center to data collection, data entry, and data integrity to integration and analytics.
Whether you’re in private practice, formed a group of offices, or run a DSO with dozens of dentists, you’ll find that automated credentialing is a major improvement over the traditional method, especially when it comes time to re-credential.
Through our credentialing services, you’ll have access to an up-to-the-moment view of your application status on an uncluttered, easy-to-use dashboard that’s available 24/7. Traditional credentialing, on the other hand, leaves you in the dark for the entire process — up to 3 months or more!
And with our re-credentialing subscription, you’ll never have to worry about missing the deadline. Our specialists proactively manage the process to ensure no interruption to in-network status.
Automated credentialing services eliminate the administrative headache that comes with credentialing and re-credentialing your dentists. Check out DCS’ automated credentialing services today.
Read more: Get your top 4 automated dental credentialing services questions answered
Transform your credentialing process and save yourself the headaches
To recap, here are 5 common mistakes made during the dental credentialing process:
- Mistake #1: Applying to too many dental insurance carriers at the same time
- Mistake #2: Failing to negotiate the fee schedule
- Mistake #3: Not analyzing your service area first
- Mistake #4: Starting the credentialing process too late
- Mistake #5: Sending claims with the wrong provider information
You can avoid these problems altogether by using DCS’s automated credentialing services. DCS Credentialing will take the workload and the paperwork off your plate, and we’ll ensure you are credentialed (and re-credentialed) on time and efficiently.
Confidently avoid costly mistakes: Book a free 30-minute call with one of our experts.
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