Dental credentialing is the process of verifying a Dentist's education, training history, professional career, malpractice history, licenses, etc. The credentialing process is used by insurance companies to allow the provider to participate in their network.
Dental enrollment is the process of requesting participation as a provider in a dental insurance's network. It involves submitting an application along with supporting documents, completing the credentialing process, and signing a network agreement.
The process of getting credentialed can be both lengthy and challenging, and requires a lot of paperwork, follow-up (including tracking applications with each insurance company over several months), and some expertise. Most dental offices find this complex and time-consuming process to be burdensome, and a distraction from providing the best dental care to their patients.
In addition to submitting the required paperwork, there are other steps that need to be fulfilled for getting credentialing accurate and error-free. A simple error in handling the paperwork can have a dentist practicing with an expired license (which can lead to some serious consequences).
So, all in all, getting credentialed can take anywhere from 30-120 days from the date you submit your application. Without properly following up, failing to respond in a timely manner to additional requests from the insurance companies' credentialing departments, or other delays, though, it could take even longer: up to 180 days from the date your application was submitted.
Provider credentialing and enrollment are key components to any thriving dental practice. Patients are more likely to seek treatment from Dentists who participate with their insurance plans. Additionally, insurances companies offer listing services to boost your visibility online and in-network. Your benefit from network participation significantly increases your potential to obtain new patients--thereby increasing the overall revenue stream of your practice. On the flip side, if you are not in network with patients' dental insurance plans, you are at risk of losing patients...ultimately affecting your incoming revenue stream and the bottom line of your dental practice.
Improper credentialing, however, can lead to delayed or denied reimbursements for services you've already provided; or, even worse, it can lead to serious consequences (i.e., statutory compliance violations can result in monetary damages and criminal charges).
Dental Recredentialing is the process of an insurance company re-evaluating a Dentist. It can be done every 2-3 years or annually (depending upon the insurance company's requirements). Failing to re-credential can generate quite a bit of chaos and inconvenience for you. If you continue to see patients after your agreement with an insurance company has expired, you will not be reimbursed for any services you provided during this "non-contracted" period, and may have to wait for a specified amount of time before being eligible to be contracted again, or even permanently removed altogether from the insurance's network (per their discretion).