written by: Jill Shue, FAADOM

So you’re looking to add a new dental insurance network or perhaps you are purchasing a practice and looking to join a network to allow for continuity of care for patients through the transition. Be sure to plan accordingly, allow for the time needed to credential and know what joining that plan means. The proper timing and method of credentialing will help you to retain patients by avoiding frustrating misunderstandings of your network status, especially when purchasing a practice that was previously in-network with the prior dentist(s).

Not all insurance networks are built for you and you’re not built for every plan. Understand the contract you are agreeing to. Plans that have low reimbursement or poor contract terms can not only cost you money, but can be an ongoing frustration to you, your team and your patients. Knowing how the plan will affect your practice ensures you are winning the insurance game and not becoming a victim to the carriers’ games.

Do not sign the first fee or contract proposal. Review the terms and fees and ask for what you deserve. Reviewing these items will save you a significant amount of money when you’re able to negotiate before joining the network! (Pro tip: Knowing who’s around you that takes that plan helps in your negotiation tactics too!)

Allow for adequate time to credential your tax ID. Do not expect any insurance carrier to prioritize your credentialing over anyone else’s contract. You can expect up to 90 days for some plans to process your application; many plans are now taking longer to process now due to COVID-19 backups. Obtain the applications and prepare the documentation the carrier will request (License, DEA, Malpractice, W9 to name a few). Once you apply, follow up consistently and document all activities. An organized system will improve the process and decrease the credentialing time for you!

Once in-network, continuing to track insurance productivity, ROI and requesting increases are key in your success as a network provider. And when it’s no longer right for your practice, know when and how to drop that plan.

Published WDA Transitions Blog