Credentialing Services
Credentialing entails busy work to fill out application forms establishing the qualifications of licensed professionals, organizations, and organization members to verify their professional qualifications are legitimate and within time allowances. Every dentist must be credentialed by every insurance payer they bill for services. Each provider in practice must be credentialed separately to provide services under the contractual agreement.
Credentialing is a necessary service often assigned to the office manager to complete the application(s). The office manager, being very busy, puts it aside to meet at a later date when “they have the time." If the practice hires a new associate whom a PPO or a Medicaid Payer does not yet credential, it would be considered fraudulent to use the owner dentist Type 1 NPI if the associate performed or supervised a procedure on a patient. The NPI 1 is a number that designates the provider of services on the insurance claim form. Each provider of services must have its NPI1 number.
Because several documents are necessary to complete the application, such as verifying and documenting the dentist's education and training, the graduate and residency programs, the dentists' state licensing, DEA certificate, and much more, this can be a significantly time-consuming process.