Frequently Asked Questions

Yes, we do work with any type of Xray Software Dexis, Vixvin, Schick, XDR or any other imaging software

Medical Billing regulations tend to be challenging, complicated, and are ever-changing in the healthcare space. Outsourcing is not a new subject. It is consistently fulfilling when it is about billing. If the billing process or function is inaccurate, the complete billing process becomes a failure.

When outsourced with a promising company, billing becomes remarkably effective and entitles maximum time for patient care.

Our team of professionals primarily executes eligibility verification to learn whether or not the services are covered by the insurance provider. At the later stage, we are well-versed in the process of submitting claims through flawless billing. By following the entire cycle religiously, we can assure reduced denial rates for you.

We have been in the healthcare industry for years. Our experienced professionals keep doing follow-ups to stay updated with the claim status. Other key steps include EFT, which further ensures that claim payments get directly credited to your account without any delays. Just in case there are questions raised by an insurance provider, we reply to them promptly to avoid any miscommunication or delays in claim approval.

Capline’s billing experts have hands-on experience in using various softwares such as Kareo, OMS Vision, Win OMS, Eaglesoft, Dentrix, Open Dental, CS Softdent, etc and streamlining the billing process as per every client’s needs.

Claims are submitted in 48 hours (excluding weekends) of seeing the patient and posted within 48 hours of getting the payment confirmation.

Insurance billing services include timely and accurate submission of claims, attaching relevant documents such as X-rays, periodontal charts, and narratives as per CDT codes, diligent follow-up on outstanding claims, including rebilling, reprocessing, or sending appeals where necessary. Additionally, posting of all claims in the practice management system (PMS), along with the explanation of benefits (EOB) and appropriate distribution of payments according to the CDT codes in the PMS.

Answer: We usually do end-to-end billing but depending on your billing, we may be able to do just one part as well.

Our team will review the daily and monthly work volumes and suggest the suitable system needed for efficient production. Even if only one system is available, we can manage to work properly.

Internet service is required for us to efficiently process and operate billing services for your office.Capline needs the remote access 24*7 and usually the system we utilize has to be left idle and staff cannot work on it. But if you have a system with good configuration, we could install a virtual machine which can allow simultaneous usage as well.

Yes, you will have to be credentialed again at your new office because the credentialing data that the insurance company has of you link your individual information with the current office you are working in, however, for the insurance to reimburse on the service rendered at your new facility, they will need you credentialed at your new office i.e. your individual information needs to be linked to your new office.

Generally, providers prefer to get credentialed by several insurance companies to grow their patient base and deliver more services.
Even if you choose to be credentialed with one insurance company, you will still need to get credentialed more than once. This is because providers need to get re-credentialed at least every three years by law to continue with their practice.

Yes, we can undertake fee negotiations for you. It is an additional service which we offer.

At Capline Healthcare Management, we use an encrypted database storage system wherein we temporarily store confidential details/documents to ensure a client’s privacy.

Yes, for detailed bucket pricing, get in touch with our customer support manager at 888-444-8041.

Yes, we can send a list of top insurance companies to choose from for our clients as per their requirements and help them in making the decision.

The usual TAT to complete an application is 45-90 days, depending on various factors. However, as per our experience, it takes an average 60 days. We send bi-weekly reports to our clients to keep them updated about the current status of their application until its completion. For any unprecedented delay, our team notify clients at the earliest. 

Suppose, a client has requested fee negotiations with 5 insurance carriers. Our team will contact all the 5 insurances the clients have requested for to negotiate the fee with them. In case, the insurance doesn’t allow the fee negotiation, we will not charge for that fee negotiation from the client. 

We can definitely start the credentialing process without the phone number and the Fax number, but we will advise on getting these details first if it can be done in a few days, as updating the information later will take extra time and effort, however, if it’s going to take longer to set up the Phone/Fax number, it’s best to start the process without it so that you can be ready as soon as possible to see the patients.

You will need all your licenses and certificates to start with, i.e., your dental/medical license, DEA Certificate, Insurance liability Certificate, e.t.c. and in addition to these, the insurance companies will also ask for a Bill of Sale and a letter from the IRS that will have your office Tax ID.

No, there is no time limit that you have to serve.

We sampled more than 1000 credentialing applications with different insurance carriers and the completion time ranges from somewhere between 60-120 days from the date of application submission. If done correctly, the time period can be near the lower limit of this range but there are a few insurance companies that even with everything done right still can take somewhere around 100 -120 days, so 60-120 days is the ballpark figure.

CAQH is an online data repository portal where a healthcare provider can update their demographic and professional information and documents and use this secured database to directly share information with insurance companies making the process seamless and efficient for both the provider and the healthcare organizations.

Yes, but not for all insurance companies. There are a few insurance companies where you will be credentialed a lot faster, i.e., somewhere around 30-60 days, and this is since they already have your information with them, but most of the insurance companies still go through the whole process as they can’t be sure what might have happened in your previous practice, so they still do the whole background check to ensure that there is nothing that can limit a provider from giving excellent patient care.

The insurance company requests an update form along with a W-9 form that needs to be sent to their credentialing departments, and once they receive a completed form, they will initiate the process at their end. The process takes around 30-60 days, and this period will be different for different insurance companies. It can take longer if the information in the update form needs to be corrected, so it is advisable to take the help of an expert to alleviate any chances of such errors.

Yes, we can surely ask the insurance companies to negotiate the current fee schedule, and put it correctly, there is a good chance that the insurance company will give you an increase of around 7-12%. This figure might seem low, but this has an exponential impact on a practice's revenue. Now, not all insurances do negotiations, but it is worth negotiating with the ones that do rather than settling for an inferior fee schedule.

Medicaid insurance offers a standard fee schedule set by state authorities, and it is non-negotiable.

Out of the three, PPOs offer a superior fee schedule, and the good news is that they also cover 80-85% of the market. So, getting credentialed with these private organizations can be very beneficial for a healthcare provider, Medicaid comes in second when it comes to fees, but being a state government-governed plan, it comes with the benefit of high patient volume, so adding the Medicaid insurance in your list would be a good decision for your P&L. And the last comes the HMO as the reimbursements that this plan offers is based on capitation which is very low. The only benefit that an HMO plan comes with is that in an HMO plan the patient will only get the benefits if he gets to the primary care provider, so it gives a fixed amount of patients that will come to you.

No, you will have to either get a DDS or DMD degree or have to clear exams to obtain that particular state dental license for you to be able to get credentialed with insurance companies.

No, submitting claims on someone else’s is illegal, and there could  be consequences, both monetary, and it can also lead to termination of your license. You can always try to talk to insurance companies and see if they can give you a grace period where you can bill the claims under the current owner's Tax ID, but you should only do this if the insurance has given you the clearance for the same in writing.

Umbrella organizations are companies that can administer a lot of other insurance companies. These healthcare organizations have made such agreements that we can follow the umbrella company schedules and we don’t have to directly get credentialed with these companies, but we can see their patients. E.g., We can decide to directly credential with Ameritas, and in that case, we will be following the Ameritas fee schedule but there's another way to see Ameritas patients, and that is, getting credentialing with Ameritas through Dentemax. The benefit of getting credentialed through an umbrella company is we might be getting a higher fee schedule if we go through them, rather than getting credentialed directly with the insurance company, however, it does come with a drawback. You will be losing a significant amount of patients as these umbrella companies don’t cover all the sub plans which you might have covered if you have gone into direct contracts with these insurances.

 Credentialing through an umbrella company does take longer as it becomes a 2-step process i.e. first you will have to be credentialed with the umbrella company which is going to take around 60-90 days and once you are credentialed with the umbrella company then you will have to send a request to the insurance companies that you want to be credentialed through this umbrella company. Getting approval on this might take another 30-60 days, so it does make the whole process lengthier, so expert advice on this can save you a lot of time and loss of revenue.

Providers need to submit a credentialing application to the HMO they wish to enroll with. The HMO credentialing committee then verifies the qualification, work history, board certification, and licenses. This process may also involve an on-site visit to assess the applicant's location of the practice. It must be completed within 180 days. The applicant will be notified about the credentialing committee's decision within 60 days. Also, the HMO is required to re-credential the credentialed providers every 3 years.

When a single healthcare organization covers plans of different insurance carriers to credential the provider, it is called Group Credentialing. Whereas individual credentialing refers to when you are credentialed as an individual and not as a group with your own tax ID-number, and you are able to move between practices with ease.

Yes, you can choose to opt out from the insurance company if you're not satisfied with the fee schedule it is offering. 

 It is compulsory for getting credentialed with Medicaid insurance companies.

No, we do not have direct contacts for insurance representatives.

It can be in a few cases. However, the provider will be credentialed as an individual and not a group.

No