🦷 Why Credentialing Matters

Credentialing is one of the most critical — and most overlooked — parts of launching or growing a healthcare career.

Whether you're a brand-new dental graduate or the manager of a multi-location group, credentialing is the process that makes you legally and financially recognized by insurance companies.

Without it:

• You can’t bill insurance

• You can’t get reimbursed

• You may not even show up in provider directories

And for PPOs, Medicaid plans, and many private payers, being “in-network” is the only way patients will schedule with you.

Credentialing isn’t just about compliance — it’s the foundation of your revenue stream.

📋 What Credentialing Involves

Most people assume credentialing is just filling out a form. In reality, it’s a detailed verification process with multiple steps and moving parts.

1. Document Collection

Credentialing requires:

• Dental license(s)

• DEA registration (or waiver)

• Malpractice insurance (COI)

• NPI numbers (individual and group)

• W-9

• CV or work history (5 years minimum)

• Practice ownership or employment info

• Hours of operation, ADA accessibility

• CAQH or ADA profile

Every field must match across documents — even a typo can delay approvals for months.

2. Application Completion

Each payer (e.g. Aetna, Humana, BlueCross) has their own form. These are:

• Long

• Specific

• Often redundant

They must be completed accurately, signed, and submitted with supporting documents.

3. Primary Source Verification

Once submitted, the insurer verifies:

• Your licenses with state boards

• Malpractice coverage directly with your insurer

• Education and training via diploma or NPDB

This is known as primary source verification and it can take weeks — or months — if anything is missing.

4. Follow-Up & Revisions

Payers frequently request:

• Additional documentation

• Clarifications or re-submissions

• Multiple rounds of follow-up

And they don’t typically notify you — you have to chase them.

5. Approval & Recredentialing

Once approved, you’re considered "in-network" — but it doesn’t stop there.
Every few years, you must be recredentialed.
If you miss that window, you’re removed from the panel and must start over.

✅ Why Use a Credentialing Service?

Credentialing is time-sensitive, technical, and full of small details that can derail your approval if handled incorrectly.

At AlignNet, we make sure:

• Your documents are complete and consistent

• Your applications are filled, tracked, and submitted correctly

• You don’t miss follow-up calls, deadlines, or recredentialing dates

• Your CAQH or ADA profile stays current and attested

• You have real-time updates on where each provider stands with each payer

Whether you’re a solo provider, part of a DSO, or hiring someone new — we give you peace of mind that everything is handled.

🎓 Special Help for New Grads

New grads face a unique set of challenges:

• Navigating state licensure and NPI setup

• Understanding what PPO plans even are

• Being expected to start work before credentialing is complete

At AlignNet, we help you:

• Create your CAQH or ADA profile from scratch

• Guide you on state-specific steps (like Florida Medicaid enrollment or DEA waivers)

• Work with your future employer to streamline onboarding

• Prepare your paperwork while you’re still in school — so you're ready to bill from day one

Starting your first job shouldn’t mean figuring out insurance on your own. We’ve got your back.

This entire process may seem complicated — because it is. But you don’t have to do it alone.
That’s where AlignNet comes in.