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We understand that navigating the credentialing process can be complex, and you may have some questions along the way. To help you better understand our services and how we can support your practice, we’ve compiled answers to some of the most common questions we receive. If you don’t find what you’re looking for, feel free to reach out to us directly!
Credentialing is the process of verifying a dental practice’s qualifications to ensure compliance with insurance companies’ standards. It’s essential because it allows you to join insurance networks like PPOs or Medicaid, expanding your patient base and ensuring reimbursement for services provided.
Credentialing typically takes between 60 to 180 days, depending on the type of insurance (PPO or Medicaid) and the completeness of the application. Dentsential handles the follow-up and tracking to ensure the process goes as quickly as possible.
PPO credentialing is specific to joining private insurance networks, which typically serve a broader population, while Medicaid credentialing allows your practice to serve low-income patients covered by state-funded insurance. Medicaid credentialing can vary significantly by state and often requires more complex documentation.
It’s best to begin the credentialing process as early as possible, ideally several months before your practice opens. This ensures that you can start seeing insured patients immediately without delays in billing and reimbursements.
Yes, we provide consultation services to help new practices determine which PPO and Medicaid networks align with your patient demographic and financial goals, ensuring you maximize your revenue potential from the start.
The key steps include gathering all necessary documentation, submitting applications to the desired PPO and/or Medicaid networks, and completing any additional requirements specific to your state or insurance provider. We handle the process from start to finish.
PPO optimization reviews your current PPO contracts to ensure you’re getting the best reimbursement rates. For established practices, this can lead to increased profitability without needing to increase patient volume, helping you maximize your existing relationships with insurance networks.
Yes, we assist with credentialing new providers so they can be added to your existing insurance networks. This ensures a smooth transition and allows new providers to bill under your contracts as soon as possible.
Yes, recredentialing is typically required every two to three years to maintain your status with PPO networks and Medicaid. We manage the recredentialing process to ensure there are no disruptions in your ability to bill for services.
We provide scalable credentialing services for DSOs, ensuring that each location is properly credentialed with the appropriate PPOs and Medicaid programs. We handle the credentialing for each provider and location, streamlining the process for your organization.
Absolutely! We specialize in managing complex credentialing needs for DSOs, ensuring that all providers across multiple locations are fully credentialed and able to bill under your networks.
Yes, we offer ongoing credentialing maintenance, including recredentialing services, updates for new providers, and help with expanding into new insurance networks as your DSO grows.
PPO optimization involves analyzing your existing PPO contracts to identify areas where you may be underpaid for services. We then negotiate with insurance companies to increase your reimbursement rates, ensuring that your practice gets the best value from each PPO contract.
Medicaid credentialing requires submitting detailed applications to your state’s Medicaid program. Each state has different requirements, and the process can be complex. Dentsential handles every aspect of Medicaid credentialing, from documentation to final approval, allowing your practice to serve Medicaid patients.
Yes, we provide full support for recredentialing, ensuring that your practice remains compliant and active with insurance networks. We track deadlines and manage the submission of recredentialing applications so that your status with insurance companies remains uninterrupted.
Medicaid credentialing typically takes between 60 and 180 days, depending on the state and the completeness of your application. Dentsential ensures timely submission and follows up with the state Medicaid program to keep the process moving.
Medicaid credentialing allows your practice to serve a broader range of patients, including low-income individuals and families. Medicaid participation also increases your practice’s visibility and accessibility in your community.
Yes, Medicaid revalidation is required periodically (often every 1-3 years) to maintain your eligibility to serve Medicaid patients. Dentsential manages the revalidation process, ensuring that your practice continues to meet Medicaid’s requirements and stays compliant.
Pricing for our services varies based on the complexity of your needs, such as PPO credentialing, Medicaid enrollment, or PPO optimization. We provide personalized quotes during our initial consultation, ensuring that our services are tailored to your practice’s specific requirements.
No, Dentsential is transparent about our pricing. Once we provide a quote, there are no hidden fees. We’ll clearly outline any additional costs if your needs change or if you request additional services.
For most credentialing services, there are no ongoing fees after the initial process is completed. However, additional services such as recredentialing or PPO optimization may incur fees, which will be discussed upfront.
Credentialing requires several documents, including copies of your dental license, malpractice insurance, DEA certificate, NPI number, and other supporting documentation. Dentsential provides a complete checklist and assists you in gathering all necessary paperwork.
We handle all follow-ups and stay in constant communication with insurance companies and Medicaid programs to keep the process moving. Our team tracks every step of the credentialing process to ensure applications are processed as quickly as possible.
Yes, if your application is rejected, Dentsential will work to identify the issues, correct them, and resubmit the application. We aim to ensure successful credentialing for every client, even if challenges arise during the process.