5 Common Mistakes Dentists and Other Healthcare Professionals Make During the Credentialing Process and How to Avoid Them?

If you’re a dentist or a healthcare professional looking to participate with insurance providers to grow your practice, going through a time-consuming credentialing process becomes a necessity, and it is something many practices can not afford. It is perfectly normal to be confused and concerned throughout the process. Most dental and other healthcare practitioners who try to complete this process on their own often end up making mistakes that usually take a long time to be rectified, mostly leading to denials necessitating to reinitiating the entire process, which in turn slow down the overall momentum you’ve been working so hard to build up for your practice. After helping healthcare providers in Florida for over 25 years with one of the best dental and medical insurance credentialing processes, we have outlined the top 5 credentialing mistakes that dentists make, and how to avoid them.

1. Not Understanding the Insurance Credentialing Process

One of the most common mistakes dental and medical practices make is diving into the credentialing process before completely understanding the complexities of the entire process. Many healthcare providers see this as a formality, but in reality, dental insurance and medical insurance credentialing involves several steps, such as: 

  1. Collecting Required Documentation:
    Healthcare professionals need to gather all necessary documents, including proof of education, professional licenses, resumes, letters of recommendation, liability insurance, and any certifications or continuing education credits.

  2. Completing the Applications: Healthcare professionals must fill out detailed applications provided by the insurance companies they want to be a participating provider, which ask for information about their qualifications, practice’s details, and personal background. HMS does that for dentists and all healthcare providers, all they have to do is review and sign the applications.

  3. Submitting the Application to the Insurance Company:
    After completing the application, it needs to be submitted to each insurance provider. This process may vary depending on whether it’s done online, via mail, or through a credentialing service.  At HMS, we have expedited this process by creating a detailed, record-keeping process necessary for proper follow ups, and timely documentation response, eliminating not meeting documentation deadlines which are the cause of significant credentialing delays. 

  4. Verification by the Insurance Provider:
    The insurance company will then verify the professional’s qualifications, including education, licensure, malpractice history, and liability insurance coverage. They may contact the appropriate professional board and other regulatory authorities for confirmation.

  5. Approval and Contract Negotiation:
    Once the insurance company verifies all credentials, they will approve the dentist or other healthcare professional and provide a contract outlining terms and reimbursement rates. The healthcare professional at this time can negotiate these terms before signing.

  6. Joining the Insurance Network:
    After signing the contract, the healthcare professional is officially part of the insurance network and can begin serving patients covered by that insurer.

In order to be successful in your credentialing efforts, it is imperative for dentists or other healthcare professionals, to complete all the requisite steps above mentioned. 

Most healthcare practices feel overwhelmed by the amount of paperwork, compliance requirements, and various deadlines that need to be met and cleared prior to getting their credentialing approval. This is particularly challenging even if the practice’s managers are familiar with the credentialing process, because they have to manage their patients’ care responsibilities, in addition to the tedious and demanding deadlines of a credentialing process. Failure to meet any deadlines, of course, can push out how soon you would be able to accept insurance from patients. At Health Management Solutions Inc., our expert team has successfully navigated these challenges for countless variety of healthcare professionals. We provide our clients expert guidance throughout the entire credentialing process, from collecting all necessary documents in a timely manner, to managing insurer requirements. Our goal is to ensure that every detail is handled expeditiously and efficiently, preventing unnecessary delays or rejections along the way.

2. Submitting Incomplete or Incorrect Documentation

One of the most common and frustrating mistakes healthcare professionals make during the credentialing process, is failing to gather all the required information and documentation. Inaccurate or incomplete forms, with missing details or incorrect information, often lead to insurance companies rejecting the application which entails reinitiating the entire credentialing process, or requesting corrections. Both cause unnecessary significant delays in the approval process.

Some healthcare providers tend to underestimate or under-appreciate the level of details needed to complete the credentialing process seamlessly. They tend to believe that minor omissions or errors are not important, but unfortunately, these errors can cause significant delays. Our expert team at Health Management Solutions Inc., has helped countless healthcare practices in mitigating such situations, by thoroughly reviewing all documentation meticulously prior to submission. We help healthcare professionals verify their licensing information and CE requirements meet the insurance provider’s expectations.  Also, we provide accurate practice details, and ensure that all liability insurance coverage information is up to date, and provide all of the requested information in the appropriate format.

3. Failing to Track and Meet Credentialing Deadlines

If you own a dental or other healthcare practice, one key element behind a seamless credentialing process is to meet deadlines. Missing a deadline or not responding quickly to insurance companies’ requests can add weeks or even months to the credentialing timeline.

Each insurance company has their own timeline for processing applications, and if you do not meet their deadlines to their specific time-line requests for additional documentation or corrections, your application gets canceled necessitating reinitiating the entire application process. This not only can limit your ability to see patients, under that insurance but also negatively impact your practice’s revenue stream. HMS commitment to you is to avoid unnecessary delays and get you credentialed as soon as possible with unnecessary delays.

To avoid delays, our team has devised a highly sophisticated system that allows us to monitor all credentialing deadlines. At Health Management Solutions Inc., we thrive on our ability to manage key dates, from application submission to license and certification renewals. We track deadlines, additional requirements, corrections, resubmission, and if necessary reinitialization of the entire process for your practice. Our goal is to make your healthcare practice’s daunting credentialing process seamless, so healthcare professionals can begin seeing insured patients without unnecessary delays.

Dental Insurance Credentialing Process

4. Allowing Credentials to Expire Without Renewal

Most healthcare professionals believe that once they’re credentialed with an insurance company they can continue practicing without any further thought. But, insurance credentials like professional licenses, malpractice insurance and other certifications need to be renewed regularly.

If you fail to do this, the healthcare professional will lose the ability to bill insurances for services rendered. Consequently, your practice can lose thousands of dollars because it can take weeks or months to get re-credentialed after the credentials have lapsed.

Keeping your credentials up to date is part of a healthy Risk Practice Management process. At Health Management Solutions Inc., our goal is to assist our clients track and monitor their credential renewal dates. We proactively help healthcare professionals manage their credentials to prevent  lapses that negatively could impact patient care or the healthcare professional’s ability to receive reimbursement by insurers.

5. Poor Communication with Insurance Providers and Credentialing Services

Communication is key to an expeditious credentialing process. Many healthcare professionals assume once they have submitted their required credentialing documentation they can sit back and wait for approval.

Unfortunately, this approach often leads to misunderstandings or missing updates from insurance companies. Timely follow-ups is a must, clarifying information and promptly responding to requests for additional documentation are all critical to keeping the process on track.At Health Management Solutions, Inc., we assist healthcare professionals by managing the entire communication process for them.

We are thoroughly familiar with each particular individual insurance carrier’s nuances–deadlines and documentation requirements– so we can preemptively anticipate and respond to these requirements, by initially requesting from the healthcare professional, when they first enroll with our services, all of their required documentation. Also, we stay in touch with insurance providers to foresee any potential issues and ensure they are resolved, or if we need to address them, we can solve them quickly. We make sure applications are processed without delay,we maintain constant and clear communication channels with insurance providers.  Consequently, we can expedite the credentialing process and get the healthcare professional credentialed to see insured patients without delays.

FAQs About the Credentialing Process

1. What does credentialing mean, and how can Health Management Solutions Inc. assist?

Credentialing is the process of verifying a healthcare professional’s qualifications and ensuring they meet the necessary standards to participate in dental or healthcare insurance networks. At Health Management Solutions Inc., we simplify this complex process by managing the paperwork, providing the required documentation, ensuring accuracy, and handling communications with insurance companies, so healthcare professionals and their staff can focus on patient care, and not on highly time-sensitive, tedious and time-consuming tasks.

2. What role does a credentialing specialist at Health Management Solutions Inc. play?

Our credentialing specialists are experts in guiding healthcare practices through the insurance enrollment process. We ensure that all documentation is completed in the required format. Initially, we request all of the required documentation from the healthcare provider, and we fill out the application forms accurately for the healthcare professional, all they have to do is review the application for accuracy and sign it. Subsequently, we maintain constant communication with insurance providers and the practice, to anticipate any additional potential documentation requests. Our goal is to make your healthcare practice’s daunting credentialing process seamless by managing the paperwork processes. We help  all healthcare providers avoid the common mistakes that can lead to delays or denials.

3. What is the typical timeline for dental insurance credentialing with Health Management Solutions Inc.?

The timeline for dental or other healthcare professionals’s insurance credentialing varies depending on the specific insurance providers; whether it is a newly licensed professional; whether the professional had or is in the process of a disciplinary preceding, and whether the practitioner has been licensed under another location; however, on average, it can take anywhere from 60 to 90 days. Health Management Solutions Inc., works efficiently to streamline the credentialing process and minimize unnecessary delays.

4. How does a credentialing specialist at Health Management Solutions Inc. support healthcare practices?

Our credentialing specialists not only help various healthcare professionals’ practices get approved with dental and healthcare insurance providers, but also assist in maintaining compliance with insurance provider’s requirements. When HMS handles the complexities of insurance credentialing, they ensure that dental and healthcare practices are able to bill insurance providers as soon as possible for services rendered, avoiding delays and unnecessary loss of revenue.

5. What is the expected timeline for insurance credentialing when working with Health Management Solutions Inc.?

When working with us, the credentialing process typically takes between 60 and 90 days. However, we are committed to expediting the process, by ensuring that all required documentation  is submitted in the requested format, promptly and accurately.  Also, our experts are intricately familiar with each insurance carrier’s specific requirements and time-line, allowing us to pre-emptively respond to their guidelines, eliminating potential delays when they request additional documentation.

6. Why is regular credential renewal important?

Credential renewal or re-credentialing, is critical to maintaining your ability to bill uninterrupted insurance providers for services rendered. If a dentist or any other healthcare provider’s credentials lapses, they could lose insurance contracts, impacting both their ability to serve patients and a significant loss of revenue stream. Health Management Solutions offers services that track and monitor the healthcare professionals’ re-credentialing renewal dates, assisting professionals avoid lapses in coverage.

7. What are the potential consequences concerning credentialing?

Delays or errors in the credentialing process can prevent dentists or any other healthcare professional from accepting insurance from insured patients, which leads to significant lost  revenues, putting a financial strain on the practice. Partnering with Health Management Solutions Inc., helps you avoid and reduce unnecessary delays during a credentialing process.