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Patient Prism's Dental Industry Blog

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June 2018--Negotiating dental fees can be daunting. You may think you do not have the time to get credentialed or negotiate fees with new dental insurance plans. Still, looking for insurance companies may be worth it for your practice's increased profitability and growth.


There are many things to consider when deciding to go in-network with a dental insurance company.

And there are ways a dental practice can optimize PPO credentialing and negotiating fees to increase the benefits of their network participation.

The following tips apply to general dentists and specialists in private practice, group practice, or a dental service organization (DSO).

Table Of Contents

Tips For Dental Insurance Credentialing

How to deal with PPO insurance fees?

Contracting with insurance carriers costs dental practices time and money, so make sure each insurance plan under consideration is worth the effort.

Look at which plans have the most members in your area

Find out which employers participate in these plans. Credentialing with a plan selected by a large employer can make you close to hundreds of new patients.

Assess the size of the opportunity

  • Have other dental practices in your community already enrolled in the plan?
  • Will enrollment help you compete?
  • How many employees are in a target company or organization?
  • How easily can you communicate with their HR administrator to market your services?

Understand the details of the plan itself before credentialing

  • Will you be able to increase profitability?
  • Will your team be able to handle the workload of insurance claim processing?
  • What impact will that workload have on the entire practice?

Consider how a plan might negatively affect your current revenue

If many of your existing patients have that plan, could going in-network reduce the income you now receive from them out of network?

Consider how a plan might positively affect your existing patients and revenue

If many of your existing patients have that plan, could going in-network enable them to achieve more of the restorative dentistry they need?

Tips For Negotiating Reimbursement Fees

You can negotiate your reimbursement fees at the point of credentialing

For efficiency and best results, utilize a well-informed and skilled negotiator to credential and negotiate the reimbursement fee schedule.

If you are frustrated with your insurance reimbursement or unable to effectively select plans and optimize credentialing and fee negotiation, APEX Reimbursement Specialists can help you with this.

APEX Reimbursement Specialists also can help you find and correct under-utilization while providing you and your team with the knowledge you need to optimally carry this forward.

The reimbursement schedule for your dental services is negotiable

You can go back and forth before settling the fees and signing a contract. Fee schedules must be flexible.

While many dentists face capitation, flat-fee HMOs pay providers to participate

The emerging DHMO plans offer opportunities to negotiate if you are a specialist.

DSOs handle the credentialing and fee setting for their clinicians

They also have the negotiating leverage of simultaneously bringing many practices into the network.

For a solo dental practice to be competitive, it might make sense to outsource negotiations or at least ensure your staff is keeping up with the latest information they need and putting serious effort into the process.

Many dentists are considering third-party networks

They have become more popular because of the better fee schedules.

But there are hidden costs, and there is no guarantee that a sub-participating carrier will stay within that third-party relationship forever.

Some dentists say, “I have MetLife, but I heard I could get MetLife through a third-party network and the reimbursement fees are higher.”

You must be careful in making that decision because you may be 180 or more days out of network during that transition.

Other Opportunities for Profitability

Creating opportunities for profitability does not stop with fee negotiation or participating in more plans.

Many dental practices are unaware of all the insurance plans they are enrolled in.

Many dental practices are underutilizing the tools provided by their insurance carrier relationships.

Stop and ask yourself if your dental practice is among these?

You can find more money by coding reimbursement forms effectively

Your team should include someone who:

  • Is dedicated to knowing dental coding inside and out
  • Likes doing research
  • Is familiar with the reimbursement requirements of the plans
  • Motivated to optimize the reimbursement tools provided and doggedly go through the process

You may be under-utilizing specific codes

That could help create opportunities for patients to afford more treatment.

Have you or your team invested time and energy in researching this?

What income are you potentially leaving on the table?

Examine the fees being charged by dentists in your zip code area

Update your UCR if you have undervalued your usual, customary, and reasonable fees for out-of-network patients.

When was the last time you updated your cash rate?

Should you adjust this rate to remain competitive and be more profitable?

Communicating with local employers about the plans you carry

This is a must-do strategy to attract the new patients you desire.

Keeping a list of your in-network plans on your practice website will help attract the people you are targeting.

Final Thoughts

Whether private practice, group practice, or a dental service organization (DSO), optimizing credentialing and fee negotiations is vital for your practice's increased profitability and growth.

It's essential to decide carefully what dental care insurance to go in-network with. And dental practices should learn how to optimize their PPO fees & credentialing and negotiating for increased benefits.

If you’re looking to grow your practice even further, Patient Prism’s call tracking software helps practices of all sizes to optimize their marketing campaigns, train their front desk team, and book more patients over the phone with scrips and guides and excellent customer service.

Schedule a Patient Prism Demo with Brenton Paul

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Patient Prism provides your front desk team or call center with the tools and coaching they need to book more new patients on the first phone call. 

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