A dentist who is not credentialed with a patient’s plan is, to that plan, an out-of-network provider, no matter how good the dentistry is. Dental credentialing is the paperwork that stands between a new dentist, a new associate, or a new location and getting paid in network, and it is slow, detailed, and unforgiving of small mistakes. Maximum Billing provides dental credentialing services, including dental insurance credentialing and payer enrollment, from the first application to re-credentialing years later, so your dentists can see patients in network as soon as the plans allow.
We work with dental practices in twelve states, including Florida and Texas. Schedule a consultation or call 800-820-0364.
Why Dental Credentialing Matters
Most patients choose a dentist through their insurance. If your practice is not in network with the plans your community carries, many of those patients never call, and the ones who do face higher out-of-pocket costs or reimbursement paperwork. Credentialing problems also cost money quietly: an associate who starts before their effective date, a location that was never added to a contract, or a lapsed application can turn weeks of claims into out-of-network payments or denials.
What Our Dental Credentialing Services Include
- Choosing which dental networks to join, based on your patient base and goals.
- Collecting and organizing the documents each network requires.
- Completing and submitting applications, and following up until they are approved.
- Setting up and maintaining CAQH ProView profiles where networks use them.
- Reviewing contracts and fee schedules before you sign.
- Adding new associates, locations, and tax identification numbers to existing contracts.
- Medicaid and CHIP dental enrollment where you choose to participate.
- Tracking re-credentialing dates and expiring documents.
Credentialing is part of our full credentialing and payer enrollment service, and it connects directly to our dental billing services.
Documents Dental Networks Commonly Require
- Active state dental license for each dentist.
- Individual NPI (Type 1) for each dentist, and an organizational NPI (Type 2) for the practice.
- DEA registration for dentists who prescribe controlled substances.
- Professional liability insurance certificate.
- Sedation or anesthesia permits, where the dentist provides those services.
- Specialty training or board certification for specialists.
- Work history, education, and practice location details.
- W-9 and ownership information for the practice.
An expired certificate or a mismatch between the name, address, or tax ID on different documents is one of the most common reasons an application stalls.
How the Dental Credentialing Process Works
- Plan the networks. We look at which plans your patients and your area carry and which ones fit your fees and schedule.
- Gather documents. We build a complete, consistent file for each dentist and for the practice.
- Apply. Some dental networks use CAQH ProView; many use their own applications or portals. Each one is completed and submitted.
- Follow up. Applications move faster when someone checks on them regularly and answers requests for information quickly.
- Review the agreement. Once approved, the network sends a contract and fee schedule. We review them with you before signing.
- Confirm the effective date. Claims are only paid in network from the effective date forward, so we confirm it in writing before your dentist sees patients under that plan.
The process often takes 60 to 120 days per network, and longer when applications are incomplete. Starting early, especially for a new associate or a new location, is the single most effective way to avoid lost revenue.
Credentialing Is Not the Same as Contracting
Credentialing confirms that a dentist meets the network’s standards. Contracting sets the terms, including the fee schedule the network will pay. Being credentialed does not guarantee the fees are workable. We review the fee schedule for your most common procedures, compare it with what you collect today, and help you decide whether the volume a network brings is worth the reduction in fees.
Leased Networks and Fee Schedule Surprises
Some dental networks allow other plans to access their contracted rates, sometimes called network leasing or rental. A practice that joined one network can find itself paid at that network’s fee schedule by plans it never signed with directly. Knowing which agreements include these provisions, and what they mean for your fees, is part of reviewing a contract before signing it.
Adding Associates and New Dentists
Every dentist in the practice must be credentialed individually with each network. A new associate who treats patients before their own credentialing is complete cannot simply be billed under the owner’s name, because the rendering dentist on the claim must be the dentist who provided the care. We start associate credentialing as soon as a hire is confirmed and track each network until the associate is active.
New Locations, Acquisitions, and Ownership Changes
Opening a second office, buying an existing practice, or changing the practice’s legal structure can each require updates with every network. A new tax identification number in particular may mean new contracts or formal assignment of existing ones. These changes are easy to overlook in the middle of a transition and expensive to discover after claims start coming back. We plan the credentialing side of a transition before it happens.
Medicaid and CHIP Dental in Florida and Texas
Both states deliver much of their public dental coverage through dental plans, which means Medicaid enrollment and plan participation are separate steps.
- Florida provides Medicaid dental benefits through dental plans under the state’s Medicaid program, so a dentist enrolls with Florida Medicaid and then with the dental plans they want to participate in.
- Texas requires enrollment through the state’s Medicaid administrator, and children’s Medicaid and CHIP dental benefits are delivered through dental plans with their own credentialing and documentation requirements.
For more on how each state’s payers work, see our Florida dental billing and Texas dental billing pages.
Medicare Advantage Dental Benefits
Many Medicare Advantage plans include dental benefits, and the dental portion is often administered by a dental network rather than by the health plan itself. Treating those patients in network usually means being credentialed with the network that administers the plan’s dental benefit, which is not always obvious from the patient’s card. We identify the administering network so your practice can decide whether to join.
Re-Credentialing and Ongoing Maintenance
Credentialing is not a one-time task. Networks re-credential providers on a regular cycle, licenses and insurance certificates expire, CAQH profiles need periodic re-attestation, and any change in address, ownership, or staff has to be reported. We track these dates for every dentist and every network, so nothing lapses because no one was watching the calendar.
Common Reasons Dental Credentialing Is Delayed
- Missing or expired documents, such as a liability certificate or DEA registration.
- Names, addresses, or tax IDs that do not match across documents.
- Gaps in work history without an explanation.
- Applications that were submitted and never followed up.
- Networks that are closed to new providers in a given area.
Should Your Practice Go In Network?
Joining a network is a business decision, not a formality. In-network participation can bring a steady flow of new patients, especially for a new practice or a new location. It also means accepting that network’s fees and following its rules on everything from frequencies to write-offs. Some established practices choose to participate with a few networks that make up most of their patient base and remain out of network with the rest. Others drop a low-paying network once the practice is busy enough to replace those patients. Before you apply, it helps to know how many of your current and prospective patients carry each plan, what that plan pays for your most common procedures, and what you would realistically collect out of network instead.
Credentialing for Dental Specialists
Periodontists, endodontists, orthodontists, pediatric dentists, prosthodontists, and oral surgeons are credentialed as specialists, and networks often apply different requirements and fee schedules to them. Specialty training documentation, sedation permits, and hospital privileges may all be requested. Some specialties also bill medical plans for certain procedures, which requires separate enrollment with those medical payers. We credential each specialist for the networks and plan types that match the procedures they actually perform.
What Happens to Claims While Credentialing Is Pending
Until the effective date, a network treats your dentist as out of network. Depending on the plan, claims may be paid at out-of-network benefits, paid to the patient instead of the practice, or denied outright. Some networks will backdate an effective date and some will not, so it is never safe to assume. The safest approach is to know each dentist’s status with each network before scheduling their patients, and to tell patients honestly when a dentist is not yet in network with their plan. We keep that status current so your front desk can schedule with confidence.
What to Look For in a Dental Credentialing Company
- Do they review fee schedules, or only file applications? Joining the wrong network at the wrong fees is a long-term cost.
- Do they track effective dates and re-credentialing? The work does not end at approval.
- Do they handle Medicaid and CHIP dental, if you want it? Public programs have their own rules.
- Are credentialing and billing connected? When the team that credentials your dentists also bills their claims, enrollment problems are caught the first time a claim reflects them.
Frequently Asked Questions
How long does dental credentialing take?
It commonly takes 60 to 120 days per network, and longer when an application is incomplete or a network requests more information.
Can a new associate see patients before credentialing is complete?
They can see patients, but claims for plans they are not yet credentialed with will generally be processed as out of network or denied. Starting credentialing early avoids this.
Do you negotiate fee schedules?
We review fee schedules with you before you sign and help you understand the terms. Whether a network will adjust its fees varies by network and market.
Do you handle Medicaid dental enrollment?
Yes, including enrollment with the state program and the dental plans that deliver Medicaid and CHIP benefits in Florida and Texas.
Do oral surgeons need to be credentialed with medical plans too?
Often, yes, to bill medically necessary procedures in network. See our oral surgery billing services.
Which states do you serve?
We work with practices in twelve states: Colorado, Connecticut, Florida, Georgia, Illinois, Missouri, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, and Texas.
Start Seeing Patients In Network Sooner
Whether you are opening a practice, adding an associate, or cleaning up credentialing that has fallen behind, we can help. Schedule a consultation with Maximum Billing or call 800-820-0364, and we will review where each of your dentists stands with each network.