Why Automated Credentialing is Imperative for the Dental Industry

Automated credentialing, a process in which a provider completes a plan enrollment application electronically, has seen slower adoption in the dental industry. Today, many dental practices are still completing paper-based credentialing applications and submitting them to plans via email or fax.

Since automated credentialing can reduce administrative costs for both dental practices and plans, and is widely adopted by physicians and the medical community, why has the dental industry lagged?

Dental plans may provide both electronic and paper-based enrollment application options to accommodate provider preferences. For dental practices, the use of paper enrollment applications may be related to the comfort of maintaining the status quo or the burden of not wanting to remember usernames and passwords for multiple plan-specific platforms.

In the medical sector, this problem has been largely addressed by the industry’s broad adoption of a single platform, CAQH ProView®. CAQH ProView currently serves more than 1.6 million healthcare providers and over 1,000 healthcare organizations. For participating organizations, it offers practical access to accurate and timely provider data for credentialing, network directories and more. For providers, it reduces repetitive paperwork by enabling them to enter professional and practice information one time and then share with plans they choose.

For many health plans today, CAQH ProView is the primary solution through which a physician can complete a credentialing application.

In 2017, the American Dental Association® formed an alliance with CAQH to offer ProView as the solution to any U.S. licensed dentists, regardless of their ADA membership status. Since then, CAQH ProView has also grown to become the standard for collecting and sharing self-reported dentist data.

However, for ProView to reach the same level of adoption in the dental industry as the medical industry, it requires a shared commitment from dentists and dental plans. A closer look at some of the differences between the medical and dental sector may offer additional incentives to both dental plans and dentists to work together to address this industry-wide challenge.

For example, in the dental sector, the primary practice model remains a solo dentist owner. While the number of solo practitioners has declined over the last 20 years, still, roughly 50 percent of dentists today run a solo practice. In contrast, only 15 percent of physicians do the same. For this reason, dental practices are more likely to have limited administrative support to assist with credentialing and other insurance-related inquires and a greater chance that the administrative burden falls on the provider.

Also, the use of fee-for-service plans has led to a demand for cloud-based solutions that enable dental practices to implement subscription-based, dental membership plans. Many of these solutions are at least in part driven by research that reveals dentists’ dissatisfaction with dental plans. Several business reasons contribute to this sentiment, including the labor and paperwork associated with managing dental plan contracts.

Addressing inefficiency and redundancy associated with credentialing would be a significant step in the right direction for the dental industry and both dental plans and dentists should play a role.

On the provider side, the ADA and CAQH continue to work together to make it even easier for dentists to enter and share their professional and practice data with dental plans and other participating organizations via the ADA® credentialing service, powered by CAQH ProView®. With participation of more than 80,000 dentists and the nation’s leading dental plans, CAQH ProView is the trusted source for accurate and up-to-date credentialing information.

Dental plans participating in CAQH ProView can eliminate the resource-intensive process of accepting provider information manually, then entering it into their systems. Through a streamlined online digital experience that is secure and free to any U.S. licensed dentist, duplicative paperwork is eliminated, potentially saving millions of dollars in annual administrative costs for dental plans and dentists alike.

To learn more about ProView for dental plans, visit our product page.