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.
Table of Contents
- Understanding Insurance Credentialing vs. Registration
- How to Register with Insurance Companies
- Steps to Prepare for a Location Change
- Steps to Prepare for Adding a New Provider
- Importance of Network Status
- Conclusion
1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
Conclusion
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.
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