The Credentialing Crunch

Walking into the office one morning, the doctor hands you a packet and tells you to review and complete it. After a brief scan, you see the materials contain at least twenty pages.

What is this?

You are informed that it is the credentialing application from a certain insurance company, and you soon discover that EACH of your participating insurance companies requires the office to be certified or recertified. Instead of getting a request from an insurance company, you will receive a request from a credential service company that will represent one or more health plan organizations. If approved, your doctor will be able to provide in-network dental services to their policyholders.

To better understand what is required, you must first read the cover letter. The application specifies the documents to be attached.

Note: To save time, it is better to gather these documents before beginning the application. I am listing the ones that are always required. You must read each insurance company’s requirements carefully since some vary.

The following documents are required:

• W9 Request for Taxpayer Identification Number and Certification. You can obtain this form from the IRS.gov website, under Forms.
• A copy of the doctor’s license to practice dentistry in their state. If multiple doctors are in the same practice, a copy of each doctor’s license must be submitted.
• A copy of their Controlled Substance Registration Certificate issued by the Department of Justice Drug Enforcement Administration. Some states also issue a Controlled Substance Registration – a copy of this registration must also be submitted.
• Proof of Liability Insurance. This certificate will show who is insured and the limit of liability. It must also show the policy period.

Once the documents are secured, you can start completing the information on the application. Keep in mind that you only have fourteen (14) days from receipt of the application to return the documents to the requestor. Failure to return these documents in a timely manner may affect your participation with the organization(s).

Fortunately, you should be able to answer most of the information on your own, however, certain information may require the doctor’s input. For instance, if they have any military service, they need to identify the branch of service, dates served, and the last location of service. Also, they need to list their professional degrees and from which university they came, along with three references.

Once completed, you can submit it to the requestor via email, fax, or mail. Credentialing is usually good for a period of three years, although you could get lucky with some longer.

Recredentialing is usually less time-consuming. The requesting company usually prepopulates the application, and you just have to make any necessary updates or changes. Current copies of the above-stated attachments must be submitted. Keep in mind that credentialing is very important to the practice since it’s the only way your doctor can participate in the in-network insurance plans.

Since we office managers have a goal of not only maintaining but encouraging growth while running a smooth ship, handling the credentialing crunch efficiently helps keep our offices afloat in a vital way.

About the Author

Veronica La Chapelle, FAADOM began her career in dentistry after retiring from a municipal government position she had held for 27 years. Of course dentistry was a new industry for her, but is happy to have learned so much, and continues to learn every day. Today, Veronica is the Assistant Manager for Advanced Premier Dental and Implant Dentistry in The Woodlands, TX.

She is a lifetime member of the American Association of Dental Office Management, (AADOM), since joining the association in 2009. Veronica received her Fellowship, (FAADOM) in 2013 and will receive her Mastership, (MAADOM) in September in Scottsdale, AZ.