Dental Credentialing
Dental Credentialing Services
From Next Level Consultants
Navigating the complex world of dental credentialing can be challenging for any dental practice. Credentialing is one of the most challenging administrative tasks for a dental practice. More often than not fee schedules are fluctuating and opaque, making it an extremely time-consuming and tedious process. Dentists can find themselves caught in a loop of administrative burden, dealing with insurance companies. Let Next Level Consultants' dental credentialing team help identify which PPO plans you should join or leave. Based on our comprehensive analysis of your patient demographics, historical fee schedules, and market conditions in specific zip codes, we can identify where to allocate resources that will provide the best outcomes for your dental practice.
Dental credentialing and fee negotiation are very time-consuming, so dentists should be prepared to start the process with enough time to avoid stressful last-minute deadlines. By not handling credentialing properly you can find yourself dragging the process out indefinitely. Setbacks include unexpected application rejections, and contacting insurance company representatives can be extremely frustrating due to poor communication and slow response times. This type of activity will drain your front desk resources and morale.
Next Level Consultants negotiates your fee schedules, which is also a tall order for someone without negotiation experience. Our dental credentialing specialists truly understand the leverage you hold as a provider and can effectively negotiate the best fee schedules on your behalf. We take on the frustrating task of credentialing, ensuring your practice is not only accepted by the right of insurance carriers but also ensuring you get compensated fairly for your hard work.
The Dental Credentialing Process
Dental credentialing is a systematic process that verifies a dentist's qualifications, ensuring they meet the standards required to provide quality care and participate in insurance networks or healthcare organizations. It begins with the dentist submitting an application, including documentation such as their dental degree, state licensure, malpractice insurance, and certifications. Background checks are conducted to confirm a clean professional record.
Submitted information is then reviewed by the insurance carrier’s review committee, which assesses compliance and regulatory duties for professional standards. Once approved, the dentist is granted credentials, allowing them to practice within the specified network or facility.
STEP #1 - CONSULT AND COMPARE OPTIONS
We provide you with valuable recommendations for making informed contracting decisions. Our approach includes breaking down plan options and defining networking opportunities. We empower you to navigate your contracting choices effectively avoiding the risk of being over-contracted.
STEP #2 - GATHER NECESSARY DOCUMENTATION
Collect your dental license, educational records, malpractice insurance certificate, DEA registration if applicable, NPI (National Provider Identifier) number, and any state-specific requirements. We have a complete list of documentation required to submit.
STEP #3 -Establish A Legal Business Entity
You need to identify the practice you are working at, including the address and tax ID number. This entity can then manage credentialing processes, ensuring compliance with regulations and facilitating provider verification for healthcare networks.
STEP #4 - ESTABLISH AN ONLINE PROFILE WITH CAQH
The CAQH is a centralized system. Establishing a profile on this system streamlines credentialing; storing data—like licensure, certifications, and malpractice history—reducing paperwork, ensuring efficient, accurate verification for insurance networks.
STEP #5 - INSURANCE CARRIER’S APPLICATION
Insurance companies require different documents and submission forms, the process is not uniform and requires the task of meticulously going through each insurance carrier's unique process.
STEP #6 - TRACK PROGRESS OF EACH APPLICATION
Keeping an accurate log of when things are submitted, follow-ups are made, and responses are given, we ensure a timely process by staying organized and responsive to each insurance carrier’s process after filing.
STEP #7 - Follow Up, Follow Up, Follow Up
Although we pride ourselves on submitting a complete and accurate application every time, we recommend doctors stay attentive and available in case there are discrepancies.
STEP #8 - FEE NEGOTIATION
If the initial offer does not meet our expectations, we negotiate for better terms. This might involve discussions with the insurer's provider relations or contracting department.
More From Next Level Consultant Coaches
Whether just starting up a dental practice, buying one, or planning on growing and optimizing the one you have, Next Level Consultants dynamic and team of coaches cover every aspect of dental practice management. We offer services that include hygiene department growth and hygienist training and an all encompassing front office training program. We have a clear aligner program that goes beyond industry norms and standards with new technology and an expert implementation program.
Reach out to discuss what goals you have in mind. Our diverse talent of coaches on the Next Level Consultants Team have you covered no matter where you are at.