Opening a dental practice is an exciting and rewarding venture, but it also comes with a range of administrative and operational challenges. One of the most crucial steps in establishing a successful practice is credentialing — the process of becoming an in-network provider with dental insurance companies. Many new practice owners underestimate the importance of timing when it comes to credentialing, which can lead to delays in reimbursements, revenue gaps, and frustrated patients.
In this blog, we’ll explore the optimal timeline for starting credentialing, why it’s essential to plan early, and how leveraging dental insurance credentialing services can streamline the process. Let’s dive in.
Why Credentialing Matters for New Practices
Credentialing is the process by which dental professionals become authorized to provide care under a particular insurance plan. It involves submitting detailed documentation about your qualifications, licenses, malpractice history, and more to insurance carriers. Once approved, you’re officially considered an in-network provider, allowing you to treat patients who have that insurance and receive reimbursements.
For new practices, credentialing is crucial because:
- It enables you to attract a broader patient base. Many patients prioritize providers who accept their insurance.
- It secures timely reimbursements. Without credentialing, you may be considered an out-of-network provider, leading to lower reimbursement rates or denied claims.
- It builds trust and credibility. Patients are more likely to choose a dentist who is in-network with their insurer.
When Should You Start the Credentialing Process?
The short answer: As early as possible — ideally 6–9 months before your practice opens.
Let’s break down the timeline:
6–9 Months Before Opening: Research and Prepare
This is the time to research the insurance carriers you want to work with. Consider your target patient demographics and which insurance plans are most popular in your area. Reach out to carriers to request applications and credentialing packets.
During this phase:
- Gather required documents, such as your dental license, DEA certificate, liability insurance, resume, and references.
- Establish your legal entity (LLC or PLLC) and obtain an EIN.
- Decide on the services you’ll offer and your fee schedules.
This preparation ensures you have everything ready when it’s time to submit applications.
4–6 Months Before Opening: Submit Applications
At this stage, you should begin submitting your credentialing applications to insurance carriers. Keep in mind that each carrier has its own process, and approval timelines can vary widely, from 60 days to 180 days or more.
Some carriers require:
- A complete application via CAQH (Council for Affordable Quality Healthcare).
- A site visit or additional documentation.
- Verification of education, licensure, and work history.
Submitting applications early allows for delays and gives you time to respond to any follow-up requests.
3–4 Months Before Opening: Follow Up and Monitor
Credentialing is not a “set it and forget it” process. Regular follow-up is essential to ensure your applications are progressing. Many providers find that they need to call carriers multiple times to check status, provide missing documents, or clarify information.
This is also a great time to consider outsourcing this task to a professional dental insurance credentialing service. Credentialing experts can handle the back-and-forth with carriers, reducing administrative headaches so you can focus on preparing your practice.
1–2 Months Before Opening: Confirm In-Network Status
By this point, you should begin receiving approvals from insurance carriers. Once approved, verify that your information, including your name, NPI, Tax ID, and practice address, is correct in the carrier’s system. Errors in these details can lead to claim denials or delays.
If you’re still waiting for approval from some carriers, continue following up and keeping meticulous records of communications.
The Risks of Delayed Credentialing
Starting credentialing too late can lead to:
- Revenue loss. Without being in-network, you may not get paid the full amount for services, or patients may choose other providers.
- Patient dissatisfaction. Patients may face higher out-of-pocket costs if you’re out-of-network.
- Administrative headaches. Trying to backdate claims or handle appeals adds stress to your team.
It’s far better to start early and ensure your practice is ready to accept patients from day one.
How Dental Insurance Credentialing Services Can Help
Navigating the credentialing process is complex, especially when you’re also focused on launching a practice. This is where dental insurance credentialing services come in.
These services offer:
- Expert knowledge of credentialing requirements for various carriers.
- Application preparation and submission assistance.
- Follow-up management, ensuring your applications don’t get lost in the system.
- Ongoing support, including re-credentialing and adding new providers.
By partnering with a credentialing service, you gain peace of mind knowing that experts are handling the details, helping you avoid delays and errors.
Final Thoughts
Opening a new dental practice is a significant investment of time, money, and energy. Don’t let delayed credentialing jeopardize your success. By starting the credentialing process 6–9 months before opening, you set your practice up for a smooth launch and early revenue generation.
If you want to simplify the process, consider working with a trusted dental insurance credentialing service. With the right support, you can focus on what you do best — providing exceptional care to your patients.
Ready to get started? Contact a credentialing expert today to ensure your practice is credentialed for success!
