Credentialing – Getting Started With Dental Insurance Before Opening the Doors to Your Office

Dental insurance credentialing is your first step to getting enrolled with insurance plans.  If you’ve decided to accept dental insurance in your office and you’re wondering where you should start – this video will go over the basics of the credentialing process.

This is a second video in the series of videos on Getting Started with Dental Insurance Before Opening the Doors to Your Office.

If you have not watched our first video in the series, I discussed the basics of in-network vs out-of-network and how you should decide which plans you should be enrolled with.

In this video, let’s move forward with the first step becoming in-network with insurance plans where you’ll find the answers to the following four questions:

  • When should you start the credentialing process in your startup journey?
  • How do you go about applying with the insurance plans?
  • What documentation do you need?
  • What contact information should you use on the application while your office is being built?

Continue to read on for the full Video Transcript:

Download the Excel file with a list of Major Dental PPO Contacts so you can start on the credentialing process.

Welcome guys, this is your host Nilay shah with dental startup academy.

This is our second video in this series of getting started with dental insurance before opening the doors to your office.

The topic for the day is credentialing. What it simply means is the enrollment process of becoming in-network with specific plans.

In this video, I’m going to give you answer to specific questions [such as]:

  • When do I need to start this process in my startup journey?
  • How do I start applying to the insurance plans?
  • What documentation do I need to have my application completed on time?
  • And what contact information you should use on the application itself because you may not have your office phone system put in yet.

So let’s dive right into the topic for the day.

Let’s start with our first question of

When should You start this process of credentialing in your startup journey?

From what I remember, when I went through this, I had called up some of the plans and some of them said 45 days from the time they received the application. Some of them said 60 days. Some of them even said 90 days.

So what we’re going to do just to be safe is to make sure you’re enrolled with the plans before you anticipate seeing your first patient – we’re going to use three months as an average time.

So the answer is, you should start three months before you plan on seeing your first patient or before opening the doors to your office. 

So let’s move onto the next question.

How do you get started in this process?

To answer that question, let’s talk about who you need to call and which plans you need to start calling up.

So, I’m assuming you watched our first video in this series, in which I talked about the differences between in-network and out-of-network.

When I did this in my startup journey, I called up the biggest offices around me and I made a list of the plans they were taking.

I wanted to make sure I was enrolled with those plans as well. And that was my starting point.

Who you need to call? You need to call the provider relations department. The provider relations department deals with the entire credentialing process as well as the fee schedule, and also the re-credentialing process that you’ll need to update every year.

So what you can do is start calling them up and request the application packet. Some of the plans actually allow you to request the application packet online, which will be much faster so I would recommend you go that route as well.

I’ve included a file which lists the major insurance plans as well as their corresponding contact information, so make sure you download that file.

To speed things up, you ask the insurance companies to either email you or fax the information so you can print and get started immediately.

Now on the next question,

What documentation do you need to have in order to make sure you application is complete?

You should see the list on your screen. You are going to need copies of these individual items. So start with your state license, you need a copy of your DEA, you als0 need a copy of your CDS.

CDS stands for controlled dangerous substance registration number. It’s state specific. So check with your state and if your state requires it, you are going to need to submit copies of this to the insurance plans as well.

You also need your office tax id, as well as your malpractice policy information. Specifically, you’re going to the need the page that dictates the exact coverage amount as well as the expiration date of the malpractice policy.

You should keep about 10-15 copies of each individual item so it’s easier for you when you’re filling out the application paperwork for the different plans.

And, moving onto the next and the final question,

What contact information do you put down on the application?

The reason why i bring this up is because you may not have your office system set up because the construction is going on.

You may not have an office number. So you should put down your personal cell phone number, home number and also include your personal email. But, soon as your office system is set up and you have an office phone number, make sure to call up the provider relations department right away and give them the phone number.

Once you get a confirmation from the plans that you are enrolled in the plans now, you should check your listing online. Which means, go to the specific plans and pretend to be a patient and you’re looking for a dentist.

Now what you’re going to do is verify all the information is correct – which is your address, your hours, languages spoken if you speak multiple languages and also your phone number. Make sure your contact information is correct because that is how your patients are going to get in touch with you.

And that’s about it guys for the topic of credentialing!

For the next video, I’m going to get into all the things that you MUST have in place before you start seeing your first insurance patient.
So don’t forget to tune into our channel for all the latest updates. That’s about it!
Take care guys, thank you very much!