Dental Insurance Billing: Provider and Location Changes
When a dental office decides to change locations or add a new provider, it’s an exciting milestone.
However, these changes also require careful planning, especially when it comes to insurance credentialing and registration.
Proper preparation in these areas ensures a smooth transition without disrupting patient care or causing reimbursement delays.
If your practice is preparing for provider or location changes, you might want to consider the benefits of outsourcing dental billing to maintain smooth revenue flow during transitions.
Benefits of Outsourcing Dental Insurance Billing Services
Outsourcing dental billing services can save your practice time and reduce errors during provider or location changes.
Professional dental billing teams ensure claims are submitted accurately and promptly, helping prevent delays in reimbursements. By leveraging experts, your office can focus on patient care instead of navigating complex insurance processes.
Outsourced services also help maintain compliance with payer requirements, improve claim approval rates, and improve communication with insurance carriers. For practices expanding locations or adding providers, billing services provide a safety net to maintain cash flow and reduce administrative stress.
Understanding Insurance Credentialing vs. Registration
Credentialing is necessary for in-network status, while registration is necessary to ensure that claims are processed, regardless of network status.
It’s essential for dental practices to understand the distinction and the necessity of both processes depending on network status to avoid any interruptions in revenue flow.
Insurance Credentialing
Credentialing is the process that gives healthcare providers (including dentists) access to join insurance networks so they can provide treatment to patients under those plans. If a dentist is not credentialed with an insurance company, their treatment will be considered out-of-network.
This means that patients will have higher out-of-pocket costs and the dentist will receive less reimbursement.
Part of credentialing is registration, but they are not synonymous.
While providers may choose network status, and whether or not they wish to be credentialed, they MUST be registered by insurance companies in order to submit claims to them.
Insurance Registration
Registration involves notifying insurance companies about the provider’s details, such as name, location, and Tax Identification Number (TIN), even if the provider does not intend to become part of the network (i.e., an out-of-network provider).
Registration is essential to ensure that claims are processed correctly, avoiding delays or denials due to mismatched information.
When a provider or location changes, it can impact claim approvals - especially for procedures that fall into gray areas between dental and medical insurance, making it essential to understand dental vs medical billing requirements.
How to Register with Insurance Companies
- Gather required information: Before starting the registration process, collect all necessary details, including the provider's National Provider Identifier (NPI), license number, TIN, and practice address.
- Contact each insurance carrier: Each insurance company has its own registration process. Typically, you can find the necessary forms and instructions on the insurance company’s provider portal. If unsure, contact the provider relations department for guidance.
- Complete and submit registration forms: Fill out the registration forms with the required information and submit them to the insurance company. Submission methods vary by insurer and may include online forms, mail, or fax.
- Follow up: After submitting the registration forms, follow up with the insurance company to confirm receipt and verify that the information has been updated in their system. This step is crucial to prevent any disruptions in claims processing.
While credentialing is optional depending on whether a provider chooses to be in-network, all providers must register or update their information with insurance companies. Failing to complete registration can result in claim rejections or delayed payments, causing financial strain on the practice.
Steps to Prepare for a Location Change
- Notify all insurance carriers: When changing locations, your dental office must inform all insurance companies you work with, whether you are in-network or out-of-network. This ensures that claims are processed correctly under the new address and TIN, if applicable.
- Update your NPI: The NPI (national provider identifier)should be updated to reflect the new location. Insurance companies rely on NPI data to match claims with the correct practice information. If you are unsure of what NPI's you need to update, or maybe even register, start with the NPPES website. You will then need to follow up with insurance companies. Note that each company may have a different means or process to complete updates, and it is recommended to start with each insurance companies website, or by calling their provider relations department.
- Review contracts and re-credentialing requirements: If you are in-network with any insurance carriers, check if a location change triggers a re-credentialing process. Some carriers may require re-credentialing to verify that the new location meets their standards.
- Update your practice information with state and local licensing boards: Ensure that your new location is registered with the appropriate state and local dental boards. This step is often required before you can update insurance companies with your new details.
Steps to Prepare for Adding a New Provider
- Verify the provider’s credentials: Before starting the credentialing process, ensure that the provider’s credentials, such as their license and malpractice insurance, are up to date. Any discrepancies can delay the credentialing process.
- Register the provider with all Insurance carriers: Even if the new provider will be out-of-network, you must still register them with all insurance companies to ensure that claims can be processed correctly. This step involves submitting their details, including NPI, license number, and TIN, to each carrier.
- Begin credentialing early: Credentialing a new provider can take several months. If you plan to be in network, start the process as soon as possible to avoid delays in patient care or reimbursement. Remember that the provider must be credentialed with each insurance company you plan to bill.
- Plan for out-of-network billing: If there will be a period where the provider is not yet credentialed, develop a strategy for billing out-of-network claims. This might include informing patients of their out-of-network status and setting expectations for payment.
Importance of Network Status
Network status refers to whether a provider is part of an insurance carrier’s network (in-network) or not (out-of-network). In-network providers have agreed to the insurance company’s fee schedule and terms, while out-of-network providers can set their own fees but may require patients to pay more out of pocket.
Read this blog about the difference for more information about choosing between the two.
Preparing for a location change or adding a new provider requires careful attention to insurance credentialing and registration.
By understanding the difference between these processes and the importance of network status, your dental office can ensure a smooth transition with minimal disruption to patient care and practice revenue.
Always start the process early and communicate clearly with all involved parties to avoid any last-minute surprises.
Tips for Maintaining Accurate Dental Office Network Insurance Integration
Keeping your dental office network insurance integration up to date is crucial for smooth claim processing. Start by regularly reviewing in-network and out-of-network status with each carrier. Use electronic updates or clearinghouses where available to quickly notify insurers of location or provider changes.
Ensure that all provider credentials, NPI numbers, and Tax Identification Numbers (TINs) are current across networks. Regular audits of your insurance data help prevent mismatches that can delay reimbursements.
By proactively managing network integration, your practice reduces rejected claims, improves patient experience, and maintains optimal revenue flow.
Common Mistakes in Dental Insurance Credentialing and Billing
Even experienced practices can face setbacks in dental insurance credentialing and billing. Common mistakes include failing to update provider information after a location change, missing credentialing deadlines, or submitting incomplete registration forms. Out-of-network billing errors, such as incorrect TINs or outdated NPIs, can also delay reimbursement.
To avoid these pitfalls, double-check all provider and location details, follow up on submitted forms, and consider using billing services for expert support. Addressing these mistakes early helps maintain steady cash flow and minimizes disruptions during transitions.
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