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Dental Insurance Credentialing & RetroActive Credentialing

Posted on April 25, 2017 at 10:45 AM

As the landscape of the Dental Industry changes, and we engage in increased insurance contracts, it is difficult for providers to repeat the credentialing process annually and remember the dates to re-credential. As a result, many providers found themselves receiving an out-of-network status notification and were dropped by the insurance. Recently, Delta Dental did a nationwide sweep of dropping providers and sending out-of-network status notices. This can be a devastating and costly mistake to the practice. When this happens, the insurance payments start going to the patient and the patients owe more money for treatment, therefore start leaving your office. You can outsource the credentialing process if

1. you want to ensure that you are in good in-network status, and

2. you would like to take the credentialing burden off of your team or yourself, or

3. you are hiring a new provider and need to enroll them in the insurances you are contracted with

4. you are interested in signing up for a new insurance, or

5. you purchased an office that you are not credentialed with the insurances the new office is in-network with

Our credentialing department uses specialized software that submits the information to the insurance companies in a professional, legible, accurate manner, ensuring the credentialing goes through fast without problems. The software communicates with the insurance companies to alert us when the re-credentialing process needs to be done. We specialize in RetroActive Re-credentialing. A most common credentialing issue is during practice transitions. The owner purchases a practice and the owner is not credentialed with the insurances the office is in-network with. Another scenario is when you hire an associate. The associate starts working but is not credentialed with the insurances. Insurances pay based on the in/out-of-network status of the Dentist provider that actually did the treatment. Therefore, if the associate is not credentialed, claims are paid to the owner, on an out-of-network status. Many owners enter themselves as the providers for the treatment performed (since they are credentialed in-network), but, as we know, that is illegal. Since the process takes up to 3 months, claims are paid on an out-of-network status. If your claims did not pay due to credentialing, we will appeal the case to push for a retroactive re-credentialing. We helped many clients with retroactive re-credentialing and re-submitted claims resulting in payment.  

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Categories: dental insurance, practice management, accounts receivable

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