Q: What if I do not have my office phone/fax number yet?
A: We must have a phone number for credentialing – it can be your cell phone, but keep in mind, that patients may call your cell to make appointments until your permanent number is set up. We recommend obtaining a free number from Google Voice https://voice.google.com/ instead of using your cell phone.
Q: I don’t have my TIN number yet. Can we start credentialing?
A: No. ALL carriers require a valid TIN in order to credential a practice.
Q: I do not have my website yet. Is that ok?
A: Yes, your website can be added at a later date.
Q: Which email address should I use for credentialing? My current one at work, my personal one, or should I create a new one?
A: You should create a new one. It can be as simple as your name and can be forwarded to a future email later. (i.e.: firstname.lastname@example.org)
Q: How long does credentialing take?
A: Once all the applicable documentation is signed and submitted to the carrier, processing can be anywhere from 30 to 90 days until you have an effective date.
Q: How will I be notified once I become effective as an in-network provider?
A: We frequently follow up with the carriers to make sure they are smoothly processing your application for a timely effective date. As soon as we receive your effective date, we notify you immediately. You may also receive a welcome packet from the carrier in the mail.
Q: Why should I take insurance?
A: Accepting insurance opens up your practice to thousands of new patients. The carriers place you in their provider directories, so you get the benefit of free advertising as well.
Q: Are there certain major carriers that I should accept?
A: Depending on your location and the insurance offered by the employer groups in your area, recommended carriers will vary. If you are aware of any specific groups that you would like to target your practice toward, be sure to let us know what insurance they offer.
Q: Can you negotiate for us before credentialing? How long does that take?
A: Some carriers will allow us to have that conversation. Please keep in mind that it could add up to 2 months to the credentialing process.
Q: I’m already a provider at another location. Do I need to re-credential when moving/adding a new location?
A: When you move or add a location you have to notify the carrier of your new location. At a minimum, you will need to complete an ‘Add Location’ form or possibly, depending on carrier requirements, complete new credentialing paperwork.
Q: What is a leased Network Agreement? (Third Party Provider)
A: Some carriers lease their network the other carriers, so that you can see their patients even though you are not directly contracted. For example, you can see Liberty Dental Group through Guardian, and you would be paid according to your contracted Guardian fees.
Q: Do all the doctors in my practice have to be credentialed?
A: Yes, if they would like to submit claims to the carriers and be paid as an in-network provider. If they are not credentialed and treat members from an insurance carrier, they will be paid as out-of-network, and the patient will have to use their out-of-network benefits. In some cases, the payment for out-of-network treatment goes directly to the patient, and then the patient is responsible for reimbursing you, rather than getting paid directly from the carrier.