Now more than ever, it is important for your FQHC to be paid for all services rendered.  As we’ve talked about in prior blog posts, the enrollment & credentialing process is a labor-intensive, often daunting task placed on an already-busy individual or team at your center.  It is also the foundation for a healthy revenue cycle. 

We at PMG Credentialing often hear about a variety of enrollment & credentialing challenges our clients are facing.  One of the most common is dental credentialing.  Many FQHCs tell us that this is one of the more confusing, error-prone specialties of the credentialing process and they often cite it as a source of lost revenue for their centers… but it doesn’t have to be.  Here are three of the most common dental credentialing issues we see and what you can do to help resolve them.

Make Sure You Allow Enough Time

Completing the credentialing process will typically take about 90 days. However, we find that in some instances, credentialing can take up to 120 days or more from application through approval. The bottom line is that credentialing takes time, organization, attention to detail, and patience. Not being prepared for this lengthy process or failing to start as soon as possible will only result in increased frustration, mistakes along the way, and an overall increase in time to completion.

It is also critical for FQHCs to keep track of their individual providers and ensure they revalidate or renew their enrollment records on time to maintain Medicare billing privileges.  Providers often wait until the end of the term before they start the renewal process, which can result in a hold on their Medicare reimbursement or deactivation of their billing privileges. 

Here are some things to help keep you credentialing process timelier and more organized:

●        Make sure your credentialing team is kept up to date on new hires (practitioners) so they can start the process asap.

●        Assign dedicated account managers/staff members who review all provider credentials and communicate well ahead of time when they are going to expire.

●        Have a dedicated team to keep provider CAQH’s up to date to ensure payers are getting the most up to date information. If this is not kept up to date, payers will not enroll or will drop providers.

Incomplete Applications/Outdated or Expired Supporting Documentation

Submitting incomplete or inaccurate applications is one of the largest mistakes made in the credentialing process. Applications are long and detailed, and each question must be answered. Even if a question does not apply, you should enter “N/A” rather than skipping it. When questions are left unanswered, insurance companies are likely to consider the application incomplete and send it back to start the process all over again.

Another common mistake is not having the most up-to-date versions of critical documents available. Establishing an organized process for gathering documents is critical, but you must also ensure the document dates are as close to the application date as possible (where applicable). As we discussed before, this is a long process. If a document is submitted with an expiration date within 60 to 90 days (the credentialing processing time), the payer can place the application on hold or mark it as incomplete.

Ineffective Management of the Dental Credentialing Process

In many cases, credentialing applications are submitted by your team and then it is checked off their “to-do” list.  Managing the process in this way will likely result in the application being sent back to start over or an outright denial. Consistent follow-up is required throughout the process to ensure things are moving along as expected and that all required documentation has been received, that the documentation is current, and that nothing is outstanding.

Keeping these things in mind as you manage your dental credentialing process will help ensure that applications are not falling through the cracks and you are getting your providers through the process in a timely manner. PMG Credentialing has been working exclusively with CHCs and FQHCs for many years and we have a dedicated team of account managers who are familiar with your unique needs, the state-specific rules, and processing times associated with the credentialing process. We would be happy to answer any questions or discuss your specific credentialing challenges. Simply call us at 401-616-2090 or contact us to reach a PMG Credentialing expert.