Credentialing: How to Go From “Ugh” to “Easy Peasy”

Whether you’re having a new associate dentist coming on, re-credentialing a seasoned provider, or just picking up a new network, chances are you are not looking forward to spending your already scarce time on these projects.

If you are anything like me, you have a tough time giving up your organized binders of paper to take the credentialing system to a digital platform.

Oh, binders… may you rest in peace! Gone are the days of stacks of papers on our desks to be faxed in mass quantities.

Here are four tips to help keep you organized and turn your credentialing “ugh” into “easy peasy.”

Step 1: Make a Checklist of All the Things You May Need from the Provider

I have mine in a spreadsheet with a box that can be checked once I have received it.

A few examples of things you may want to put on this list:

• Copies of degrees
• Licenses
• Certifications
• Picture ID
• NPI
• DEA
• List of references
• Depending on what state you are in you may need a copy of the state-mandated credentialing application

For any providers new to your facility, I would recommend gathering this information and beginning this project at least ninety days prior to their official start date with your office or location.

Step 2: Place Your Information in a Folder in a Cloud-Based System

There are many options out there for this.

Each of our providers has its own folder with all the documents mentioned above including a Word copy of their credentialing application and a signed PDF copy. It is nice to keep the Word copy up to date.

I review these two to four times a year for any new expiration dates. Doing this from the beginning saves me hours upon hours of time having to redo all that information for each insurance company or each revalidation cycle.

By checking it twice a year, I know it’s always up to date and may only need a new signature when it’s time for revalidation (which usually occurs every three to five years).

Also, inside each doctor’s folder (I have eight doctors), I have zip folders for each insurance company. I copy the completed documents into the online folder and often email that entire folder directly to a rep at each insurance company for any credentialing/credentialing.

By using a zip file, you avoid any issues with files that are too large. If this is an existing provider in your office already, go ahead and scan these documents and keep them in a similar electronic folder as above for future ease of use along with the application.

Step 3: Follow Up!

I will be honest; this is still my least favorite step. For this reason, I have worked extremely hard to get a direct rep at each insurance company to who I can reach out directly, thus avoiding perpetual hold times with the general customer service phone numbers.

At this point during the pandemic, companies who have always allowed up to ninety days for a response have been known to take as long as SIX to NINE MONTHS to get a response!

If you are deciding which companies to participate with, I would consider reachability for their provider relations department as part of your decision.

You don’t want to work with a company that has zero provider relations options. This is of increased importance if you are a multi-doctor or multi-location practice, as I have seen many data entry errors occur by insurance companies causing claim delays for larger offices.

I would highly recommend reaching out two weeks after submission to just be sure they have received it and ask if they need anything else. What about all the documents that differ from insurance to insurance?

For instance, some companies require a specific location agreement per location, per provider. Or another company may require a specific opiate disclosure form.

For these, I have one empty folder next to all my doctors’ folders in my cloud-based system that says “blank” inside this “blank” folder are all the blank documents for each insurance company.

If they are location specific, I have them universally filled out with all the things that are NOT provider specific. This way if I have a new associate, I can just copy that folder to them and know everything I need is already in there waiting on minor editing.

Step 4: Outsource or Utilize a Fully Digital Platform (if Financially Feasible)

For us, it was not. That’s ok, there are some free online solutions I would recommend utilizing from CAQH and DentalXChange.

Both take a bit of time commitment to get set up, but after you do, they will send you emails reminding you to update expiration dates.

HQ will ask you to review your provider’s information every four months. It is simple and does not take long at all. If your provider is already an ADA member, they already have a complimentary account with CAQH through their ADA login.

Not all insurance companies use one of these two resources, hence why I recommend steps one through three for the companies that do not participate with CAHQ or DentalXChange.

By keeping as many documents as possible pre-filled and organized by the provider, by the company, and reviewing these things several times a year to inspect expiration dates, I have saved hours upon hours of time.

What used to be a full-day project takes maybe thirty minutes! If you would like any further information about anything mentioned here including the checklist or need help getting things set up, please reach out to me at Nicole.pdgco@gmail.com.

Meet the Author

Nicole Hartshorn, FAADOM, has served in the dental field since 2002. She has experience in orthodontic, periodontic, and endodontic practices.

She is currently a regional manager with a large group pedo practice in the Denver Metro area. Nicole started her career as a dental assistant and has worked in most areas of the practice including her current role as office manager.

She enjoys facilitating the orthodontic side of the practice. As a Colorado native, she enjoys the beauty that the Denver area offers her family throughout the year.

Nicole has been an AADOM member since 2016 and is the president of AADOM’s Denver Colorado Chapter… Opens in a new window to aadomchapter website… .

She earned her AADOM Fellowship designation in 2018 and is on track to be inducted as an AADOM Master, (MAADOM) at AADOM’s conference this September… Opens in a new window to aadomconference website… .