Insurance Credentialing Service

We cater to start-up practices, dental practices undergoing acquisition, and actively participate in PPO fee negotiations for established dental practices.

New credentialing: A brand new or initial contract of the dentist requiring credentialing with HMO, PPO, EPO and Dent-Cal Insurances. Typically, PPO fee negotiations require 90 to 120 days, and an additional 3 to 12 weeks are allocated for the processing of credentialing contracts. It’s crucial to recognize that fee negotiation is a time-consuming process as insurance companies may not be quick to enhance reimbursement rates, and various obstacles need to be addressed. Moreover, each offer should be carefully assessed not only for its financial implications but also to evaluate the overall viability of remaining with the PPO plan. Therefore, meticulous planning well in advance is essential.

PPO Fee Negotiations: This intricate process typically spans 8 to 10 months, involving careful discussions with insurance providers to secure favorable fee schedules. PPO fee negotiations are a pivotal aspect of optimizing financial outcomes for dental practices. It is similar to any other major business negotiations. There are generally recognized “do’s” & “don’ts” to achieve the best negotiation solution. Given the nuanced nature of these negotiations, patience is key, as insurance companies may not swiftly adjust reimbursement rates. Successful negotiations demand a strategic approach, evaluating each offer for its financial impact and considering the long-term feasibility of maintaining a relationship with the PPO plan. Our team has learnt to determine if a negotiated solution is needed or not. Sometimes one or more issues can be better resolved with maximizing reimbursements with your current PPO network or participation with umbrella plans rather than trying hard to negotiate. Adequate planning well in advance is fundamental to navigating this complex terrain and ensuring the best possible outcomes for the dental practice.

Documents required for credentialing:

Personal Bio-profile (CV)
Dental License
Banking detail for EFT set-up
TIN (Tax Identification Number)
NPI (National Provider Identifier)
DEA (Drug Enforcement Agency) registration
W-9 form (needed for practice address)
Professional Liability Insurance (Malpractice liability insurance)
Bill of sale for acquisition practices
Lease document
Specialty school certificate-for specialists
Sellers UCR Fee if possible

BEANbite Credentialing and Fee Negotiations Workflow

Establish your office UCR fee: These fees set standard pricing, aiding insurance reimbursement while offering transparency to patients about expected costs, whether or not covered by insurance. We utilize a third-party fee analysis to generate UCR fees for your office zip code. Most insurance requires us to submit your UCR fees as part of the negotiation process.
Create an NPI type 2 if essential: This NPI is vital for seamless electronic transactions, particularly for claims submissions and compliance with HIPAA regulations. We’re here to assist in ensuring your practice complies with essential standards for electronic healthcare transactions.
Evaluate and choose the top 30 codes that can optimize revenue for your practice. We’ll collaborate with you to create a specialized list of codes tailored to your specialty, allowing us to concentrate negotiations on the most impactful codes for your dental practice. It’s essential to emphasize that we strive to initiate fee discussions for all CDT codes with insurance providers. Employing this focused set of 30 codes enhances the effectiveness of our negotiations and simplifies the PPO fee analysis process, offering a more manageable and insightful approach compared to assessing the entire spectrum of CDT codes.
Engage in fee negotiations with the “negotiable” PPO plans, conduct a comprehensive PPO fee analysis, and present participation options with a plan directly or through shared relationships. It is important to note fee negotiations can take up to 90 days.
Credentialing with planned PPO insurance & umbrella networks & (by choice, HMO insurance): Once the dentist has examined and given approval for the negotiated PPO fee schedules and chosen participation options, we proceed to the credentialing phase. It is important to note that credentialing applications will be submitted for processing without any delays for insurance that do not engage in fee negotiations upon review and consent of the dentist, as in the case of Delta Dental.
Properly Structure your participation to optimize with the highest paying networks as planned in phase 3 by submitting the necessary opt-out letter and ensuring the negotiated PPO Contracts are processed in a timely fashion
Fee schedule entry into the practice management software (optional & separate service)
Copies of all final fee schedules and contracts will be provided to you at the completion of the project.