Are yOU being buried in a mountain of paperwork?
Do you look forward to spending 10-20 hours of your time and waiting 30-120 days before you finalize your desired insurance participation?
We doubt it. Our clients let us manage their credentialing needs.
Simplify Dental Credentialing with a Strategic Approach
Dental credentialing is more than just paperwork—it’s the cornerstone of your practice’s financial success. Being out-of-network or incorrectly credentialed can cost your practice thousands in lost revenue, damage patient relationships, and create billing headaches.
From collecting the correct paperwork, completing tedious applications and following applications through to approval, your team members spend 10-20 hours per dental network…waiting 30-120 days for approval. This effort pulls them away from high-value tasks like patient care and practice growth.
At Five Lakes, we provide strategic dental credentialing services for dental practices, group practices, and DSOs, ensuring you’re credentialed in the right networks with the optimal fee schedules.
Credentialing Process: What to Expect
An important part of setting up your practice for success is to have a comprehensive understanding of what is around you. Five Lakes specializes in helping both new and existing practices to analyze important factors that will affect the potential growth of their business. This comprehensive evaluation is the foundation for creating a business strategy designed to maximize your revenue cycle management and patient flow.
Gather Required Documentation:
Preparing all necessary documents, which typically include state licenses and liability insurance.
Complete and Submit Application:
Fill out insurer-specific credentialing applications, which may be available via online portals or paper forms. Many insurers use the CAQH (Council for Affordable Quality Healthcare) database to streamline the process; maintaining an up-to-date CAQH profile is recommended.
Primary Source Verification:
Insurers must conduct primary source verification by contacting educational institutions, licensing boards, and certification bodies to confirm the authenticity of credentials and qualifications. Work history and reference checks are also performed to assess experience and reputation, with attention to any employment gaps.
Background and Peer Reviews:
Background checks may include reviewing malpractice claims, disciplinary actions, and criminal records. Some insurers require peer reviews, where other dental professionals assess the applicant’s competence and professionalism.
Application Review and Vetting:
The insurance company thoroughly reviews the application and all supporting documents. This vetting process ensures that the dentist meets all requirements for network participation.
Approval, Enrollment, and Contracting:
Upon successful verification, the dentist is approved and enrolled as an in-network provider. The practice receives a contract outlining fee schedules, billing procedures, and compliance obligations. Careful review of the contract is essential before signing.
Timeline:
Credentialing typically takes between 60 and 180 days (2 to 6 months), depending on the insurer, completeness of documentation, and administrative backlogs.
Why choose Five Lakes for your credentialing?
Five Lakes Dental Practice Solutions is one of the most comprehensive carrier analyses on the market. Our team has the knowledge and expertise to help determine the very best plans based on YOUR practice and YOUR goals.
We will do all the heavy lifting. And do it right!
- Boost Revenue: Coupled with our Revenue Cycle Consulting and PPO negotiations, Five Lakes will implement your payor contracting strategy to optimize patient access and reimbursements.
- Save Time: We handle over 5,000 credentialing applications annually, freeing your team to focus on patient satisfaction and practice efficiency.
- Protect Patient Relationships: Proper credentialing ensures seamless insurance claims, preventing billing issues that frustrate patients and harm your reputation.
- Avoid Costly Mistakes: We manage PPO plan participation so you don’t lose revenue to errors.
Common causes of delays include incomplete paperwork, slow background checks, or insurance company backlogs. Missing information can significantly extend the process. Five Lakes will submit your applications, track the status and handle any issues during the process.