FYI

Dentist blog from Delta Dental

Tag: re-credentialing

Re-credentialing reminder

Running a dental practice means complying with a host of state and federal laws and regulations. As part of our contractual and regulatory requirements (both state and federal), we are obligated to make sure our dentists are either credentialed or re-credentialed at least once every three years.

We will send you a letter and form when your re-credentialing date is near. When you receive your re-credentialing letter and form from us, please:

  • Take note of the due date indicated in the letter.
  • Complete and return the re-credentialing form (including any required document copies) no later than the due date.
  • Let us know right away if you received a letter for a dentist who is no longer at your practice location. The best way to reach us is with the email address or fax number included in the letter.

We are obligated to terminate your contract as a network dentist if your credential expires. You will still be able to apply to re-join under the terms of the current dentist agreement, as long as you meet the credentialing criteria.

Important reminders for 2018

Verify your TIN

Double-check that we’re using the correct taxpayer identification number (TIN) to report your Delta Dental earnings to the IRS.

Check the last four digits of the TIN on page 1 of the claim payment document you receive from us. If they don’t match exactly with your TIN on file with the IRS for your name/business name, notify us right away. Use the TIN Enrollment Form under Administrative Forms on our website.

Check out more TIN tips, too.

Use CDT 2018

Use the new codes on claims for treatment provided on and after January 1, 2018. Review the summary of new codes and other changes.

Report fraud

We work diligently to uncover fraudulent behaviors and prevent fraud from driving up the cost of our plans. If you suspect fraud has occurred, please contact us. You may remain anonymous.

  • Fraud hotline: 800-526-1852
  • Online fraud report form
  • Medicare fraud, waste and abuse hotline: 800-511-0831

Learn ways to protect your practice from fraud. 

Respond promptly to your re-credentialing letter

Re-credentialing is required by state and federal regulations and Delta Dental, and occurs once every three years. When you receive a re-credentialing letter from us, please be sure to reply by the due date indicated in the letter.

If we don’t hear from you, we’re required to take action, which may include contract termination.

Learn more about re-credentialing.

Credential department earns recognition

Certification from the National Committee for Quality Assurance (NCQA) is a widely recognized symbol of quality in the insurance industry. We’re proud to announce that our Credential department was awarded this certification on March 1, 2017, after demonstrating quality and consistency in its credentialing procedures.

Credentialing (and re-credentialing) are the legally and contractually required processes used to determine dentists’ qualifications to practice dentistry and suitability for our networks. Credentialing includes analyzing education, licensing and career history information that we obtain from dentists, databanks and state and regulatory agencies. We credential dentist applicants and re-credential contracted dentists every three years.

Re-credentialing FAQs

Got questions? We’ve got answers to help smooth the re-credentialing process.

How often are dentists re-credentialed?

Once every three years.

I’m in a group practice. Will one set of forms and documents satisfy the requirement for all of us?

No. Each dentist is re-credentialed individually.

What happens if I don’t respond?

We are obligated to terminate your contract as a network dentist, as mandated by numerous state and federal regulations and contractual requirements. You can apply to re-join under the terms of the current dentist agreement and you must meet all the credentialing criteria.

How can I request an extension or confirm that Delta Dental has received my submission?

Call the Credential Department toll-free at 888-858-5252, ext. 5325, during business hours.

Where can I get more information and a PDF with additional FAQs?

Visit our website.

Re-credentialing reminder

Re-credentialing is required by state and federal regulators and Delta Dental, and it’s important to your patients, too. When you receive your re-credentialing letter and form from us, be sure to:

  • Mark the due date indicated in the letter on your calendar and “To Do” list.
  • Complete and return the re-credentialing form and document copies no later than the due date.
  • Let us know right away if you received a letter for a dentist who is no longer at your practice location. Use the email address or fax number included in the letter.

Theme by Anders NorenUp ↑