How to Approach Credentialing with Medical Insurers-How to Approach Credentialing with Medical Insurers

How to Approach Credentialing with Medical Insurers

Pdf Summary

The document discusses the importance of understanding and navigating the credentialing process with medical insurers for implementing Dental Sleep Medicine successfully. It emphasizes differentiating between credentialing, out-of-network enrollment, and in-network enrollment. Credentialing involves providing detailed professional information but does not automatically make one in-network. Out-of-network enrollment may not require formal enrollment and has no contracted amounts for services, with a typical processing time of 30-90 days. In contrast, in-network enrollment involves a formal process, contracted amounts for services, and longer processing times. Key tasks include completing NPI assessment, updating CAQH profile, and assessing Availity & Navinet. The document also provides information on Type I & II NPI's, taxonomy codes, and the specifics of completing CAQH documents. Tips are given for maintaining updated profiles and enrolling in Medicare and commercial/private insurers as a DME supplier for oral appliances for OSA. The recap outlines the three essential credentialing tasks to complete: NPI assessment, CAQH assessment, and Availity & Navinet assessment. It provides resources and tips for practitioners to navigate the credentialing process effectively.

Keywords

Dental Sleep Medicine

Credentialing Process

Medical Insurers

Out-of-Network Enrollment

In-Network Enrollment

NPI Assessment

CAQH Profile

Availity & Navinet

Taxonomy Codes

DME Supplier