Every dentist must complete the credentialing process before he/she can be an in-network provider. However, the headaches don’t end there. Recredentialing must occur every 2-3 years, or you risk claims being denied and patients heading out the door to in-network providers.
Forgetting How Often Recredentialing Must Occur
Recredentialing, depending on the provider, occurs every 24-36 months. If you are not on top of the process, it is very easy to fall behind and miss deadlines. If you miss a deadline, it might be a costly mistake. The default provider agreement and reimbursement rates may have changed since the last contract, and you will be required to apply again as if you were a new applicant. Until the new application is processed, which might take up to 90 days, your practice will be considered out of network.
Neglecting to Follow Up
Follow-up is a critical part of both the credentialing and recredentialing processes. If you are not contacting the insurance company to check on the status of your application and ensure that nothing is missing, they will not reach out to notify you. APEX Reimbursement Specialists specializes in following up on every step of the process. If paperwork has not been included or your application has been pushed to the bottom of the stack, our experts will catch the problem before it leads to your practice missing the recredentialing deadline altogether.
Assuming the Insurance Company Will Offer You the Same Rates
During recredentialing, some insurance companies will “reset” your reimbursement rates to reflect the rates that they are offering everyone else. If you are not partnered with a reimbursement rate specialist, your rates will return to lower numbers, and you might not notice until you see your reimbursement checks rolling in. With the right team on your side, the process could actually allow you a chance to increase your reimbursement rates across the board!
Skipping Steps
Did you know that the recredentialing process requires as much paperwork as the initial credentialing process? Many dentists don’t realize until it’s too late. Recredentialing is a time-consuming process that requires lots of documentation, application materials and follow-up. If you skip a single step, the insurance company will not hesitate to deny your materials or let your application linger without letting you know.
Don’t Let Recredentialing Become a Headache with Help from APEX
APEX Reimbursement Specialists can handle the credentialing and recredentialing processes and negotiate with PPOs on your behalf. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.