Prerequisites
- The group’s current payer and program participation map; see Enroll with dental payers
- A credentialing tracking grid
- The new dentist’s documents assembled
The per-hire pipeline
1
Start as early as each process allows
Payer processing can take weeks or months, and some applications require a license, location, executed agreement, or other facts that are not available at offer acceptance. Starting late can leave a salaried dentist without the participation status the schedule assumed.At offer acceptance, build the payer-by-payer requirements list and initiate each process as soon as that payer accepts it and the required facts are available.
2
Collect the document packet
- Current state dental license(s)
- DEA registration and state controlled substance registration where applicable
- Dental school diploma; residency or specialty program documentation where applicable (GPR/AEGD, ortho, pedo, OMS, endo, perio)
- Specialty board certification where applicable; most general dentists do not have one
- Malpractice certificate of insurance and claims history
- Complete work history with no unexplained gaps
- CV in the format payers accept
- Government ID, SSN
- Type 1 NPI with the correct taxonomy for the dentist; see Get NPIs
3
Run primary source verification and screening
Document each with a date. Screen at onboarding and thereafter at the cadence required by applicable payer, program, and state rules and the group’s risk policy. OIG updates the LEIE monthly and describes monthly screening as a risk-reducing best practice; analyze SAM debarment separately.2
4
Set up or update CAQH
New profile if they genuinely don’t have one; otherwise update the existing profile with your practice location and re-attest.Authorize each CAQH-participating payer that needs to retrieve the profile. A payer that does not use CAQH, or uses a separate plan or administrator process, follows its own instructions. See Set up CAQH.
5
Initiate each required payer process in parallel when permitted
Do not wait for one payer to finish before starting another. Initiate each required contract, credentialing, roster, location, or provider-linkage process as soon as that payer accepts it.For each carrier, ask whether the existing relationship supports a provider link or roster update, or whether the entity, product, or location requires a new agreement or application. Do not assume an existing group contract supplies the answer.For Delta Dental, identify the member company serving each practice location and follow that company’s current process. A dentist practicing across two service areas may need separate actions with two member companies. Confirm the available network products and fee schedules rather than assuming Premier or PPO participation transfers.
6
Complete the applicable Medicaid and managed-care path
Map the state’s current delivery model. Complete state enrollment and any separate plan, administrator, contracting, credentialing, or affiliation steps required for the dentist, entity, and location. Ask about committee dates only where the current program or plan actually uses them. See Enroll in Medicaid.
7
File Medicare paperwork only if the group bills Medicare
Most dental groups do not bill covered traditional Medicare services. For Part B professional services, use PECOS or the current CMS-855I/CMS-855B enrollment and reassignment workflow. CMS discontinued the former standalone reassignment form effective October 31, 2023. If the practice furnishes and bills DMEPOS, complete the separate PECOS/CMS-855S supplier enrollment for each applicable location and satisfy current supplier standards before billing.3 See Medicare and dental: when to bother.
8
Track and follow up on a documented cadence
Applications can go quiet rather than getting denied. Record the payer’s stated follow-up channel and timing, and log every contact.
9
Record every effective date
Obtain the payer’s written determination of the entity, provider, location, product, and date authorized for in-network billing. Do not infer the answer from the contract date or credentialing approval alone.
10
Enter the recredentialing date on the compliance calendar
Record the actual recredentialing or revalidation date and cadence supplied by each payer, program, member company, or administrator.
The tracking grid
At two dentists and three payers a spreadsheet is fine. At twenty dentists, ten payer or program relationships, and five entities, the provider-location-product rows multiply quickly and credentialing software can earn its cost. Columns you need:Managing the gap
A salaried associate who cannot bill in-network is expensive. The options, with their limits:Verify it worked
- Pipeline started at offer acceptance
- Full document packet collected
- Primary source verification complete and dated
- OIG LEIE and SAM.gov clear, documented
- CAQH complete, each participating payer authorized, attested
- Each required payer process initiated in parallel as soon as permitted
- Applicable Medicaid, plan, and administrator steps initiated, with actual committee dates noted where relevant
- Current Part B enrollment and reassignment workflow completed if the group bills covered professional services
- Separate CMS-855S supplier enrollment completed for every applicable DMEPOS location
- Follow-up log maintained
- Every effective date recorded
- Recredentialing dates calendared
- LEIE, SAM, and state-list screening cadence documented by source and risk policy
Common failure modes
Sources
- DOJ, MB2 Dental Solutions and affiliated practices settlement, $$8.45M (January 9, 2017); DOJ, HQRC Management Services / Jacobson settlement (October 6, 2022). See DSO enforcement and risk.
- HHS OIG, Updated Special Advisory Bulletin on the Effect of Exclusion (monthly LEIE screening is risk-reduction guidance; applicable payer and state requirements may differ).
- CMS, Medicare Provider Enrollment; consolidated reassignment bulletin; CMS-855S.