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Understanding Dental Insurance Provider Set-Up

Kiltesh Patel
August 3, 2018 | 1 min read

Understanding Dental Insurance Provider Set-up

There's a lot to know about setting up your practice to accept insurance. Unfortunately, the process can be complicated and frustrating—if you don't know what you're doing. Here's a quick overview of how to set up insurance providers for your new practice.

Credentialing

Each practice has to submit to each individual insurance provider to accept their insurance. This is called credentialing, and the process can take a couple of months to work out. You'll submit the details of your dental license and other information, then work out a contract with the insurance company.

Since you have to work this out for each insurance company separately (and renegotiate contracts yearly), most dental offices just credential with the top 5 to 10 providers in their area. These are different based on geography, but many of the players are the same across the country: Delta Dental, AARP, Aetna, Aflac, Cigna, MetLife, and a few more. Doing a little research will help you narrow down the most popular providers in your patient population.

Credentialing is worth the time and energy for your practice. Not only can you accept the patients with the insurance plans, but the plans will list you as a provider. This is free marketing to a group of people that you may not otherwise reach. 

Setting fees and billing

Practices should set their fees higher, and bill insurance for the UCR (Usual, Customary, and Reasonable) in their area. Even if you've worked out a lower fee for your insurance provider, you want to bill higher. Here's why: when you go to renegotiate your contract with the insurance company, you can show them your record of higher billing. The gap between what the procedure costs and what they're paying you for it is where you gain ground. If you bill simply what you've negotiated, they won't see that gap.

The whole process of credentialing and contract negotiation can take a couple of months. And since you need your licensing information as well as your business entity set up to get started, you'll want to start that process at least six months before you want to open your practice. 

Questions about insurance or billing? Want to see how tab32 makes submitting insurance claims easy and quick for your staff? Contact us today for a free demo!

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