Credentialing a practice/Provider with Medicare can be a time-intensive and resource-draining process. Provider credentialing, or the process of getting affiliated with payers, is an important phase in the revenue cycle. To streamline this procedure and enhance transparency within your facility, we have prepared a comprehensive guide on provider credentialing.

Step 1: Once the client has officially partnered with Medi Dental, we will proceed by sending the initial checklist to the dentists. This checklist encompasses a comprehensive set of requirements, including practice and provider details, patient information, monthly practice collections, and insurance information.

Step 2: Additionally, for the purpose of credentialing and re-credentialing, MediDental mandates that each individual provider possess their CAQH login credentials and Practice Pecos login credentials.

Step 3: The web-based EHR/EMR credentials of the practice is mandatory, if utilized by the dentist. Please note that this requirement does not apply to clients using Medi-Breeze.

Step 4: Mandatory PM (Practice Management) credentials are essential if they were utilized by the dentist. Note that this condition does not pertain to clients using Medi-Breeze.

Step 5: Upon gathering all the requisite documentation from the dentist, we will proceed to dispatch the initial Medicare credentialing checklist. This checklist encompasses an array of essential Medicare application documents, such as Practice and Individual Business Licenses, Practice and individual W-9 Forms, IRS documentation, DEA Certifications, Professional Liability Insurances, Bank Attestation Letters, Check Voided Copies, MR Storage Information, and more. Please note that this requirement applies exclusively to Medi-Breeze Clients.

Step 6: Upon receipt of the Medi-Dental credentialing checklists from the dentist, we will undertake a thorough review of all documents and their respective expiration dates. Then we'll start the "In-Network application for the practice" through Pecos. In about 48 hours, you'll be able to see the results of the validation.

Step 7: After we submit the application to Medicare, we'll get the ATN (Application Tracking Number) so that everything's transparent throughout the process. This ATN will be promptly shared with the dentist.

Step 8: On submission of an application, Medicare typically requires 30 to 45 business days to process the practice application. Once the application is approved, we will promptly contact the Medicare credentialing team to secure the PTAN number, the effective date, and the subsequent revalidation date. This information will then be conveyed to the dentist. Simultaneously, the dentist will receive a comprehensive welcome email from Medicare, containing all pertinent provider information.

Step 9: Our next step will be to start applications for individual doctors once the practice application has been finalized. Each doctor will have to go through the same process and meet the same requirements.

Step 10: Upon the successful completion of both applications, both the practice and individual doctors will enjoy the advantage of receiving an In-Network fee schedule reimbursement from Medicare. Medicare will also transfer this reimbursement to their HMOs and PPOs, and these entities will follow the same reimbursement structure as Medicare.

Step 11: After the successful completion of both the practice and individual Medicare applications, along with all required documentation from the payer, we will commence the initiation of Medicaid Insurance Credentialing for both the practice and individual providers. This process will be the same as the Medicare procedure, with the exception that submission will be carried out through the respective state Medicaid portals for credentialing and contracting. Please note that Medicaid insurance processing times are expected to span 45 to 60 business days for both practice and individual applications.

Step 12: After successfully finalizing Medicaid credentialing for both the practice and individual providers, we will obtain crucial information from Medicaid. This information includes the effective date, provider ID number, and expiration date for both the practice and individual providers. Subsequently, this information will be promptly relayed to the dentist. Once this process is complete, both the practice and individual doctors will have the advantage of receiving In-Network fee schedule reimbursement from Medicaid.