CREDENTIALING SERVICES
Insurance Credentialing Services is a required process from all healthcare providers by all insurance companies for validating and certifying their personal identity, professional qualifications, post-graduate training, and legal accreditation to perform their healthcare professional specialty. This applies to new professionals joining a practice or existing practitioners on an annual basis. This is a required due diligence process consisting of validating, assessing, and reassessing the dental (or any other healthcare professional) professionals’ training qualifications and practice history, through the gathering and authentication process of all academic documentation; such as training certificates, diplomas, miscellaneous training records, awards, certified transcripts records, required professional licenses, personal identifications— birth certificates, naturalization paper, name change documentation –i.e. marriage or adoption certificates, background-checks– and professional and personal references.
Any new dentists who are independent contractors, need to be accredited by the different dental insurance companies they desire to be a participating provider of, and there is approximately an average of 16 desirable dental insurance companies in Florida, who have competitive reimbursement fee schedules. Therefore, you are looking at an incredible amount of paperwork and follow-up required during the Credentialing for “one” dentist into a new practice. Once a dentist is contracted by a dental practice or other healthcare organization, those accreditations for each insurance company, need to be validated and renewed annually for the healthcare provider to be able to continue providing services to patients covered under each insurance plan. Additionally, to complicate the “Credentialing” process, each insurance company’s plan, has its own specific detailed application process and policies which need to be completed and followed, as specified, by the healthcare provider—dentist—to be granted the privileged of becoming a dental provider for each plan.
Credentialing is a tedious authentication documentation gathering process, it is an extremely time-consuming and time-sensitive process since each insurance plan has different deadlines for the submission of documents. HMS and its subcontractors, handle the tedious tasks of following up with the different dental insurance plans, and we interact with the dental office to gather the required documentation, saving the practice precious administrative time, so they can dedicate this time to patient care and revenues generating tasks. We help dentists with their initial enrollment or their renewal credentialing insurance agreements, and we collect the enrollment forms from the respective dental insurance companies, to be completed by each dental practitioner. We complete the enrollment form for them, except for their signature; we request their signatures and once the dentists sign the enrolment application form, as instructed by each dental insurance, we submit the same to the dental insurance companies via email or facsimile. If for any reason the requested documentation is not submitted within the allotted time, the healthcare professional will need to re-apply by completing a new enrollment form and start the process all over again.
Subsequently, we are in direct and daily communication with all of Florida’s dental insurance representatives performing all accreditation-requested tasks accurately and expeditiously. We follow up periodically with each dental insurance company to inquire about the status of the individual dentist’s enrollment credentialing request, the results are shared periodically with the Dental Practice’s Manager in a documented spreadsheet report. Once we have completed 70% of the work, we submit a bill to the client for the charges of 70% of completion for the requested service. However, at this time, the remaining 30% of the work has already been submitted to the insurance companies and it is pending their review and approval, we will submit a final bill for the balance of the remaining 30% accreditation process once it is completed. We will continually follow through with the different insurance companies to see the status of the enrollment credentialing request and check if they need additional documentation or signatures to complete the process expeditiously.