Transition Issues Related to Dental Insurance

11/4/2016 5:00:00 AM   |   Comments: 0   |   Views: 429

Transition Issues Related to Dental Insurance

We often get questions regarding the transfer of ownership and complications with dental insurance networks.  Here are some answers to the most common questions asked by clients:

Is the buyer able to bill under the seller’s information?

            Many buyers assume that they are going to bill under the seller’s tax ID number and this is often what they are asking when they want to bill under the “seller’s information.”  The ADA claim form has a location for the billing entity (Practice Name, Tax ID Number, NPI2, Billing Address) and a separate location to disclose the providing doctor (Provider Name, License Number, NPI1).  For this reason, the buyer can submit a claim form under the seller’s tax ID number but they still need to disclose that they are the provider rendering treatment.  To be reimbursed by insurance networks the “provider” not “entity” must be credentialed (Medicaid is an exception). 

Can the buyer bill under the sellers Tax ID?

Yes, the claim form can have the sellers tax ID.

*At the end of the year the seller will receive a 1099 from each insurance billed under their tax ID number showing income that really went to the buyer.

Can the buyer bill under the seller’s provider information (Name, License, Personal NPI)?

No, if the buyer is rendering treatment then they need to put their name, license number and personal NPI number on the claim form. 

Is insurance credentialing based on the Tax ID or Provider?       


*Medicaid requires the entity and provider be credentialed.

Can I starting credentialing with insurance before the office staff have been informed of the transition?

No, the insurance company will occasionally contact the office to verify the new provider and billing information.  This contact may be by phone, email, fax, or mail.  The insurance providers will not agree to maintain confidentiality. 

If I am in-network at another location, do I have to re-credential when purchasing a practice?

Yes, insurance companies do require full or partial credentialing when moving to a new location.  If you are moving from out-of-state then you will likely need to complete a full credentialing application with most insurance plans.

Can fees be negotiated after I credential at a new location?

Insurance plan that allow fee schedule negotiations usually require a submitted request during the initial credentialing application.

How long does the credentialing process take?
 30-120 days for most insurance plans.  Medicaid can take even longer depending on the state.

Can I bill as an out-of-network provider for a time until my credentialing is complete?

Yes, you can bill out-of-network

*Some insurance plans may send the payments to the patients if you are not-in-network.

info@ Dental Insurance Credentialing (303)829-1119

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