Five Lakes provides dental practices and DSOs across Pennsylvania with expert PPO consulting, credentialing, and revenue cycle management. We help practices in Philadelphia, Pittsburgh, Allentown, Harrisburg, Lancaster, Erie, and communities statewide navigate complex insurance contracts.

Our dental PPO specialists have worked with over 6,000 dental offices nationwide since 2010. We’ve seen which payers negotiate, which ones dig in, and where the real opportunity hides in a Pennsylvania fee schedule.

Why Pennsylvania Dentists Lose Money on PPO Contracts

Pennsylvania has over 14,000 dentists with most working independently, which is good for patient care and terrible for negotiating leverage.

A solo practice in Erie doesn’t have the same pull with a payer that a multi-location group does. So they sign what’s offered, accept the fee schedule, and move on.

Then there’s the paperwork side. Credentialing delays and leased network policies have become real burdens for Pennsylvania practices. The Pennsylvania Dental Association has spoken publicly about these issues, noting that they drive dentists out of the state.

Delta Dental of Pennsylvania added another wrinkle. They proposed a weekly administrative fee for processing paper checks. The PDA pushed back, pointing out that most dental practices are small businesses and that the fee effectively forces dentists into electronic payments.

Small frustrations add up. Low fees, slow credentialing, and fees you didn’t ask for all eat into your margin. We help Pennsylvania dentists push back.

Dental PPO Consulting Services for Pennsylvania Practices

We start with a strategic market review. Your fee schedules get compared against what other Pennsylvania practices are earning. You find out quickly where Delta Dental, Highmark, and United Concordia are underpaying you.

Then we negotiate. Our team goes directly to the payers. We make the case using your patient volume and your local market. You don’t make the calls. We do.

Credentialing runs alongside negotiations. Pennsylvania payers each have their own process. Highmark uses ProView and has specific rules about practitioners moving between network practices. United Concordia uses CAQH ProView. Liberty Dental has its own timeline and re-credentials every three years. Our PPO experts know each one.

If you’re acquiring a practice, we manage the full transition. New tax IDs, new provider applications, and contracts that don’t always transfer cleanly. We make sure your billing doesn’t skip a beat.

And after you’re enrolled, we watch the money. Claims get followed up. Denials get appealed. Your revenue cycle stays healthy.

Our Services for Pennsylvania Dental Practices

PPO Management

We review your current contracts and negotiate better fee schedules with Delta Dental of Pennsylvania, Highmark, United Concordia, and other payers. With PPO management from our team, you get higher reimbursements and stronger contract terms without handling the back and forth yourself.

Advisory and Consulting

We build a payer strategy that fits your practice. Urban practices in Philadelphia need different network participation than rural ones in Erie or Lancaster. Our advisory and consulting services help you decide where to participate, where to renegotiate, and where to walk away.

Credentialing and Enrollment

We manage the entire credentialing process for Pennsylvania providers. Highmark, United Concordia, and Liberty Dental all have their own requirements. Our credentialing and enrollment experts handle the paperwork and follow up until you’re approved.

Project-Based Engagements

Need help with one specific problem? We offer short-term project-based engagements for fee analysis, network leasing reviews, or payer mix evaluations. You get expert help without a long-term commitment.

Acquisition and Transition Support

Buying or selling a Pennsylvania practice? Through acquisition and transport services, we align payer contracts, manage credentialing timelines, and protect your revenue during the ownership change.

Solutions for DSOs and Multi-Location Groups

Our team offers solutions for DSOs to standardize contracts across all your Pennsylvania locations. We use your patient volume to negotiate better rates. New acquisitions get integrated without revenue gaps.

Newly Affiliated Practices

Adding a new dental practice to your group? We align payer contracts immediately, fast-track credentialing, review office fees, manage tax ID changes, and uncover risks that weren’t visible during due diligence.

Strategic Market Reviews

We provide data on the Pennsylvania market through market reviews. Your performance gets benchmarked against local competitors. You get clear, actionable steps to improve your payer strategy.

PPO Consulting Across Pennsylvania

Pennsylvania looks different depending on where you practice.

• Philadelphia: Philadelphia is the largest dental market in the state. Nearly 2,000 providers compete for the same patients. Employer-sponsored PPO plans dominate, and patients have plenty of choices. Being in the right networks at competitive rates is how you stay booked.
• Pittsburgh: Pittsburgh has over 1,000 dental providers and a strong mix of independent practices and growing groups. Payer dynamics here lean toward commercial plans. We negotiate rates that match what those plans actually pay in western Pennsylvania.
• Allentown: Allentown and the Lehigh Valley have a growing dental community with nearly 300 providers. The market sits close enough to Philadelphia to feel its competitive pressure. We handle credentialing with Highmark and United Concordia so you’re not stuck waiting.
• Harrisburg: Central Pennsylvania have their own payer mix and patient base. State government employees bring a stable base of patients with strong dental benefits. We analyze your fee schedules against what actually works in this market.
• Lancaster: Lancaster has a mix of established practices and a growing population. The market rewards practices that understand their local payer landscape. Our PPO experts help you build a strategy that fits.
• Erie and Rural Pennsylvania: The rural parts of the state face different economics than Philadelphia or Pittsburgh. Lower patient volume changes how PPO participation works. We help you find the numbers that make rural practice viable.

Why Pennsylvania Dentists Choose Five Lakes

Our expert team has worked with practices of all sizes. Solo dentists, growing groups, and DSOs all trust us. Over 1,675 practices nationwide count on our PPO experts.

We’ve collected over $1.5 billion for our clients in 2024. Nearly 50 dental startups get credentialed by our team each year. More than 250 practice transitions are supported by our experts annually.

Pennsylvania dentists need a partner who understands the local market. Our PPO consulting experts bring national experience with a Pennsylvania focus. You get real results, not just promises.

Our process moves fast. Thousands of projects have refined it over the years. Shorter timelines, better collections, and less frustration for your team are the outcome.

PPO Consulting Questions from Pennsylvania Dentists

How Long Does Highmark Credentialing Take in Pennsylvania?

Highmark uses ProView and has specific rules about practitioners moving between network practices. If notification arrives within the right window, re-credentialing may not be required. Outside that window, initial credentialing kicks in. Our experts track those details for you.

Do You Help with United Concordia Credentialing?

Yes. United Concordia uses CAQH ProView and typically takes 45 to 90 days. We manage the application and follow up until you’re approved.

How Do I Opt Out of a Leased Network in Pennsylvania?

Leased network policies have become a real burden for Pennsylvania practices. We review your contracts, identify where leasing applies, and help you exercise opt-out rights where they exist.

How Much Can PPO Consulting Increase My Fees in Pennsylvania?

Every practice is different. Our clients typically see increases of 15% to 35% on negotiable contracts. We can show you where the gaps sit after reviewing your agreements.

Pennsylvania Payers Have Their Own Rules. We Know Them.

Our PPO experts have spent 15 years negotiating dental contracts, including on the payer side. We know Pennsylvania fee schedules and where the money disappears. Whether your dental office is in Philadelphia, Pittsburgh, Allentown, or somewhere in between, we work across the whole state.

Stop guessing which payer will pay you fairly. Call Five Lakes for PPO solutions at (440) 636-1378 or contact us online to discuss your practice.