> ## Documentation Index
> Fetch the complete documentation index at: https://dso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.
# Credential each new dentist you hire
> A payer-by-payer per-hire pipeline for verification, CAQH, enrollment and provider linkage, effective-date tracking, and managing the gap without misidentifying who performed the service.
For each payer or program the group intends to bill, determine whether the dentist must be credentialed, rostered, affiliated, or otherwise authorized for the applicable entity and location. Contracting, credentialing, delegated credentialing, provider linkage, products, and effective dates vary by payer. This is the repeatable pipeline for onboarding an associate without assuming one national process.
## Prerequisites
* The group's current payer and program participation map; see [Enroll with dental payers](/guides/enrollment/enroll-with-dental-payers)
* A credentialing tracking grid
* The new dentist's documents assembled
## The per-hire pipeline
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.
* 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](/guides/enrollment/get-an-npi)
| Check | Source |
| -------------------------------- | ---------------------------------------- |
| License, active and unrestricted | State dental board's own verification |
| Disciplinary history | State dental board, every state held |
| **OIG exclusion** | [LEIE](https://exclusions.oig.hhs.gov/) |
| **Federal debarment** | [SAM.gov](https://sam.gov/) |
| State Medicaid exclusion | State list |
| Malpractice history | NPDB self-query, carrier loss run |
| Education and training | Primary source or a verification service |
| DEA registration | DEA verification |
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
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](/guides/enrollment/set-up-caqh).
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.
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](/guides/enrollment/enroll-in-medicaid).
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](/guides/enrollment/enroll-in-medicare).
Applications can go quiet rather than getting denied. Record the payer's stated follow-up channel and timing, and log every contact.
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.
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:
| Column |
| -------------------------------------------------------- |
| Entity (which PC) |
| Tax ID |
| Group NPI |
| Dentist |
| Individual NPI |
| Payer (Delta member companies and DBAs as separate rows) |
| Network tier where applicable (Premier/PPO) |
| Application submitted date |
| Last follow-up date and contact |
| Status |
| **Provider effective date** |
| Recredentialing due date |
| CAQH attestation date |
| Notes |
## Managing the gap
A salaried associate who cannot bill in-network is expensive. The options, with their limits:
| Option | Viability |
| --------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| **Start them on non-billable work**: training, chart review, treatment-plan calibration | Potential option; confirm scope, supervision, employment, and that the activity is not itself a billable professional service |
| **Hold claims** until the effective date, then submit | Only if the payer confirms later submission will be valid for that date of service and within timely filing |
| **Retro-effective dates** | Ask in writing at application; some payers grant |
| **Bill out of network under the associate's NPI** | Only when the payer contract, enrollment record, state law, and patient disclosures support it. Obtain the payer's written direction and do not routinely waive required cost sharing. See [Handle credentialing delays](/guides/enrollment/handle-credentialing-delays). |
| **Schedule them with payers where they're already credentialed** | Requires payer mix flexibility |
| **Cash-pay and membership-plan patients** | Only after checking payer and program beneficiary-billing restrictions, patient disclosures, membership-plan law, and applicable good-faith-estimate duties |
| **Locum tenens status** | May apply to a temporary substitute covering an absence, depending on payer policy. It is **not** a default mechanism for a permanent new hire. |
**Do not bill a credentialed dentist's number for work another dentist performed.** Misattributed-provider claims are an established False Claims Act pattern in dentistry, not a paperwork shortcut: the MB2 Dental settlement (\$\$8.45 million, 2017) included claims "using erroneous Medicaid provider numbers" that misrepresented which dentist performed the procedure, and the HQRC settlement (2022) included admissions of inaccurate servicing-provider information submitted to Medicaid plans.1 The pattern is a classic qui tam brought by the biller who was told to do it.
## 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
| Failure | Consequence |
| ----------------------------------------------------- | ---------------------------------------------------------------------- |
| Failing to map requirements at offer acceptance | Enrollment work starts late and planned participation may not be ready |
| Sequential rather than parallel submissions | Months added |
| Payer not authorized in CAQH | Application waits indefinitely |
| Delta member company or service area not identified | The required relationship or provider link is missing |
| Applicable plan or administrator step missed | A member population cannot be scheduled as participating |
| Scheduling insured patients before the effective date | Unbillable services |
| Billing under a different dentist's number | False claims exposure |
| No recredentialing tracking | Expiration or termination goes undetected |
| Exclusion screening only at hire | An exclusion after hire goes undetected |
## Sources
1. DOJ, [MB2 Dental Solutions and affiliated practices settlement, \$\$8.45M](https://www.justice.gov/usao-ndtx/pr/texas-dental-management-firm-19-affiliated-dental-practices-and-their-owners-and) (January 9, 2017); DOJ, [HQRC Management Services / Jacobson settlement](https://www.justice.gov/usao-nj/pr/pediatric-dentist-and-affiliated-practices-pay-over-750000-resolve-false-claims-act) (October 6, 2022). See [DSO enforcement and risk](/concepts/model/dso-enforcement-and-risk).
2. HHS OIG, [Updated Special Advisory Bulletin on the Effect of Exclusion](https://oig.hhs.gov/exclusions/special-advisory-bulletin-and-other-guidance/the-effect-of-exclusion-from-participation-in-federal-health-care-programs/) (monthly LEIE screening is risk-reduction guidance; applicable payer and state requirements may differ).
3. CMS, [Medicare Provider Enrollment](https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/EnrollmentResources/provider-resources/provider-enrolment/Med-Prov-Enroll-MLN9658742.html); [consolidated reassignment bulletin](https://www.cms.gov/files/document/consolidated-cms-8551-bulletin.pdf); [CMS-855S](https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms855s.pdf).