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Dental Startup Practices: Insurance Credentialing is the Key to Your Success

When you open a practice, you kind of need to know how you’re going to get paid right? Ummm yes! The insurance portion of starting your own dental office is very frightening for most new practice owners. So let’s talk about Insurance Credentialing. 

When you open a new dental practice, you kind of need to know how you’re going to get paid right? Ummm yes! The insurance portion of starting your own dental office is frightening for most new practice owners. So let’s talk about dental startup insurance credentialing . 

What does it mean to get your startup dental practice credentialed? 

Dental credentialing is an insurance company’s review process that qualifies a dentist for a  contract as an in-network provider. Entering a contract agreement includes accepting the negotiated fees set by the insurance carrier, in order to access a large population of patients.

It’s a process you’ve likely had zero involvement with during your associateship. And I know that you weren’t taught about insurance in dental school. 

There are different types of insurance providers including PPO, HMO, DHMO, DMO, Medicaid and within each type, there are several insurance providers. 

Why is it important for you (you and any future dentists you hire) to be credentialed?

Getting credentialing right is key to your future success and profitability. Understanding what it means to be in-network versus out-of-network with carriers in your area will be a major decision that impacts your practice and future patients. (By the way: If you plan to have multiple providers in your practice, each provider will need to be credentialed individually).

There are out-of-network options of course, but when you’re getting started, we like to remind new startup dentists that having your office listed in-network with a popular insurance carrier (for your area) is a powerful marketing strategy and will get your dental practice off to a strong start with an influx of new patients! 

Most patients don’t understand their dental insurance. It might be more confusing for them to use dental insurance than for you to get credentialed. And so patients often look for providers in-network. Plus as much as patients don’t understand their insurance coverage, they’re proud to have it.

So how do startup dental practices get credentialed?

First tip: don’t wait too long to start your dental startup insurance credentialing journey! Credentialing is a long process and it can take months. That’s why we start the credentialing process 5 months before your scheduled Grand Opening

Next step, research the popular insurance companies in your area. A quick way to do this is to call 5 local dentists and ask them what insurances they accept. You can also find the top largest employers in your city and county (hospitals and school systems are great examples) and ask which insurances they accept.

To become credentialed you will need to have personal information like:

  • Your practice history
  • Education
  • ​​Malpractice history
  • Certifications and
  • Licenses

Important: NEVER sign or turn in a contract without reviewing the fee schedule.

Once credentialed with the insurance company you are bound to the contract and will follow their fee schedules. So be sure to review the fee schedule and ensure you are comfortable being a part of their network. 

Dental Fee Schedules (they aren’t the same for new practices)

What is a fee schedule?

A fee schedule is a list of covered services and the specific contracted in-network rates that the insurance company agrees to pay you. There’s two things you should know about fee schedules:

  1. Dental startup offices start at the bottom of the fee schedule 
  2. Some fee schedules are negotiable

How is your fee schedule determined?

It’s important to understand what goes into a fee schedule. If you were in an associate position and that office had been established for many, many years, their fee schedules were probably decent. When you deal with fee schedules, it’s kind of like getting a new job – you get a little raise as you go along.

As a doctor of a startup practice, you might not realize that there are several factors that the insurance companies take into consideration, like:

  • How many doctors are in your area? 
  • How long have you been practicing? 
  • How new is your practice?

Accepting the first fee schedule you see is a mistake. You should always try to negotiate the reimbursement schedule prior to signing the contract.  After all, the worst they can say is no! Working with a skilled and well-connected negotiator can be a huge benefit.


How does Ideal Practices help with insurance credentialing for startup practices?

When you open a new practice, you have a few choices:

  1. Pull your boot straps tight, call up customer support and figure it out yourself or
  2. Hire a consultant to take on this big workload and get your credentialing done  the right way

When you become an Ideal Practices client, our Credentialing Advisor Carol Crooks works tirelessly on your behalf getting you credentialed with the insurance companies serving patients in your area.

Carol will work one-on-one with you to help you understand which insurance companies and fee structures are right for your practice and help you understand the billing process. Dental credentialing isn’t easy but Carol has spent years making sure our clients get this step of the process right to ensure a bright future for their new practice.

Not only will she ensure you get credentialed, she will also teach you and your new team how to manage your billing so you can get paid effectively. She will also talk about how to talk to non participating patients, because you still want to get them to come to your practice. 

When I asked Carol what her favorite part of helping new practice owners is, she said “​​They all have a different hurdle. Some of them are big. Some of them are small. Some of them, they don’t even know we’re going through a hurdle for them. And I guess that’s my favorite, is when something comes up with a carrier and I’m like, “Oh, I can answer this question. I already have the document because the doctor gave it to me. I can solve this for you”. And the doctor never even knows.

Credentialing is just one stage in our 13 Stages Process to successfully opening a Startup Dental Practice. Working with the Ideal Practices team, who have opened thousands of practices with dentists just like you, takes the guesswork and risk out of the process. We want you to be able to focus on preparing your Startup Dental Practice for patients and will be sure that you are ready for opening day.

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