Be Proactive in Credentialing New Associates

Current trends in dental practice delivery include multi-doctor or group type practices versus the solo dentist model.  With that comes more credentialing requirements that many dentists overlook when they take on a new associate dentist.

https://www.ada.org/en/education-careers/licensure/licensure-dental-students/licensure-by-credentials

When you do decide you are busy enough and it is time to add an associate, be proactive, and inform all payers including both in and out of network.  Update the credentialing with all the insurance companies that are linked to your patient base. Update the practice’s billing entity information, name(s) changes or formation of a new billing entity, if applicable to the situation.

An NPI Type 1 number, https://en.wikipedia.org/wiki/National_Provider_Identifier, along with a completed W-9 Form should be obtained by the associate.  Particularly important to make sure the information on the Type 1 NPI number matches exactly to the credentialing document to avoid delay of payments or the payment being processed as an “out of network” and sent to the patient.

Being proactive in giving the new credentialing information to all payers in advance of seeing patients is highly recommended because it may take a few weeks or more to process the information into the insurance company’s system.

In advance of patient care, the new associate should be familiar with the PPO contracts and the processing manual of each payer to understand the terms of service and payment.  This is recommended prior to credentialing if time allows.

Notifying the out of network provider relations department will help to prevent delays in payments associated with the new associate as the provider of services.

This same process needs to be completed when an associate leaves the practice.  Correcting a payment to the wrong billing entity can take weeks to correct because it involves a stop payment,  a reissue of payment and any other corrections to the credentialing document.

Being proactive in credentialing saves you money which you need and eliminates headaches and stress which you don’t need.

Belle DuCharme, CDPMA, Dental Training Consultant

More articles on Credentialing – https://dentalcredentialing.us/credentialing-and-competence/