How Does Filing Claims Work When Credentialing?

The credentialing process presents unique challenges to dental practices and doctors who are currently in the process and not yet credentialed. How does the claim filing process work when you are waiting to receive credentials? Can you bill and collect payment for dentists who are currently waiting to receive insurance credentials? Here’s what your practice needs to know.

Can You Bill and Receive Payment for a Non-Credentialed Dentist or Clinician?

If you have a temporary hire or new provider who started immediately, instead of starting 4-6 months down the road once credentialing was completed, you might be concerned about whether or not you will still be able to bill and collect on the employee’s behalf. In this situation, every insurance carrier has distinct requirements. In some cases, you can bill for the new or temporary provider under the name of the practice or another doctor’s name.

If your new dentist is not replacing another employee and the insurance plan requires credentialed dentists to be the only ones providing services, you are not able to bill for services completed by that provider. However, if your insurance contract doesn’t require individual credentialing, you can bill and receive payment under your practice name for all new hires. The rules are much stricter for Medicare and Medicaid billing, so you should always carefully check your state’s rules before attempting to bill underneath another name or practice name.

What Can You Do in the Meantime?

First, you should always start the credentialing process as early as possible with a professional service like APEX Reimbursement Specialists. Beyond using the billing techniques described above, and if you are unable to bill under your practice name or another dentist’s name, you can try the following:

  • Temporarily reassign patients to a credentialed dentist while waiting for approval. Make sure that the patient, insurance provider and doctor understand that the patient will be moved over to the waiting-to-be-credentialed dentist once credentials have been extended.
  • Check your insurance contact to see if you are eligible for retroactive reimbursement. Some agencies allow you to hold onto reimbursement claims until the new dentist has received credentials and then submit them for approval.

Partner with APEX Reimbursement Specialists for Credentialing Help

The experts at APEX Reimbursement Specialists can help you to explore the best options for your continued growth and sustained success. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.