Credentialing and recredentialing are vital to claims approval for every dental practice. If you try to cut corners when credentialing or recredentialing, you could run into serious claim submission denials in the future. At APEX Reimbursement Specialists, we work with numerous dental practices to ensure claim submission accuracy and proper credentialing.
Forgetting to Recredential
How long did it take your dental practice to credential for the first time? Recredentialing is just as important as credentialing initially, and it can occur as often as every 24-36 months depending on the insurance provider. If you are not proactive in starting the recredentialing process, it’s very easy to miss deadlines. Insurance companies will not track you down if you are late filing paperwork. Instead, you might start the claim submission process only to realize you are no longer an in-network provider at all. If you forget to recredential, you will need to start the process all over again and have claims denied or waiting to be submitted in the meantime.
Skipping Steps
The recredentialing process requires a fair amount of paperwork, so some dental practices run into trouble by skipping steps. Your practice must have all documentation and paperwork gathered together to submit at the same time. If you fail to work with a credentialing partner and miss a deadline or forget to include a form, the insurance provider will not track you down. Instead, they will not process your recredentialing request, and your claim submission process will be immediately impacted.
Avoid Claim Submission Problems
- Code to the highest level of specificity. All diagnoses should be coded with as much detail as possible and using the maximum number of digits for the code being utilized.
- Group transactions by each of your insurance payers so that you can identify potential claim submission or credentialing problems early on. If one payer suddenly starts denying most of your claims, you will be able to tell before it’s too late to adjust.
- Fill in all fields on every claim. Date information and other fields that are often accidentally left blank should always be completed fully, and your staff should double-check every form before submission.
- If you are waiting to be approved for a provider, see if you are eligible for retroactive reimbursement. Some providers allow practices to hold onto claims until their recredentialing or credentialing is processed and then submit.
Master the Claim Submission and Credentialing Processes
If you want to learn more about how APEX can help your practice improve your numbers and gain more insight into how you’re doing, contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.