Resources for dental offices
Payers verify each dentist's license, education, and liability coverage during initial credentialing and every 24–36 months thereafter. Missing a credential renewal can result in payments being suspended or the provider being dropped from the network. State boards can cite or suspend anyone providing care on an expired license. Patients notice too—up-to-date credentials signal that you meet the highest professional standards. This ADA-aligned checklist gives you nine clear steps to keep credentials current, payers happy, and chair-time productive.
Aug 29, 2025
1. Collect Core Provider Information
You need complete, accurate personal files for every dentist, hygienist, and assistant on your team. When payers cross-check your paperwork against state boards and the National Practitioner Data Bank, even small discrepancies can delay enrollment for weeks.
Start by gathering these key identifiers for each provider:
Legal name (plus any previous names)
Date of birth and Social Security number
Home address, mobile number, and email
Government-issued photo ID
Complete five-year work history with no gaps longer than 30 days
Two current professional references
Store each document in an encrypted, access-controlled folder. HIPAA-compliant solutions like secure document management systems handle this easily. Give editing rights to one credentialing lead, but allow read access for anyone submitting applications.
Before moving forward, verify every detail matches across the CV, CAQH profile, and license copy. Provider verification portals flag mismatched names or dates, forcing resubmission and extending approval timelines. Double-checking now prevents weeks of corrections later.
2. Verify Licenses and Certifications
Licenses are the backbone of your credentialing file. Payers won't budge until each one is current and verified. Gather these essential documents:
State dental license
Dental hygiene license for any hygienists on staff
Specialty board certificates (orthodontics, pediatrics, etc.)
Anesthesia or sedation permits
Auxiliary certificates for radiography, nitrous, coronal polishing, and similar skills
Insurers contact state boards, the DEA, and the National Practitioner Data Bank directly to verify everything you submit. Any mismatch between your uploads and what regulators report puts your application on hold. Double-check names, numbers, and expiration dates before you submit.
Renewal timelines vary by state. Dentists in California renew every two years during their birth month, while Michigan uses a three-year cycle. Most payers re-verify credentials every 24–36 months, so an expiring license jeopardizes reimbursement just as quickly as an initial application.
Create a central license tracker with each provider's expiration date and set 90-day calendar alerts. Upload fresh PDFs the moment a renewal posts. This proactive habit keeps your payer portals green and your chairs full.
3. Document Education and Training
Payers won't load you into their network until they see solid proof of your schooling and ongoing learning. Keep these files ready, current, and easy to find:
Dental school diploma and transcripts
Post-graduate residency certificates, if you completed a GPR or specialty program
Current continuing-education transcript
Specialty training or board-eligibility letters
Insurers match graduation dates against your license issue date. Any mismatch triggers a manual review, so double-check that every file shows the same legal name and degree date. Scan each document at 300 dpi, save as PDF under 2 MB, and label files consistently ("Smith_DDS_Diploma.pdf"). Clean uploads to CAQH and carrier portals move faster through approval.
If you trained outside the United States, you must obtain a credential evaluation of your foreign degree, complete at least two years at an accredited U.S. dental school, and provide proof of a one-year U.S. residency.
Continuing education gets equally close attention. States set wide ranges—California dentists need 50 CE units every two years, while Texas requires 24 hours in the same period. Track these hours as you earn them and upload fresh certificates right away. Your file stays current without last-minute scrambles.
4. Secure Professional Liability Coverage
You cannot join payer networks without current malpractice insurance. Most plans require coverage of at least $1 million per claim and $3 million total. You'll need the declaration page to prove coverage.
Check that every name matches across your files—your legal name, any DBA, and the practice entity. Name mismatches stop approvals as fast as expired licenses. Insurers verify coverage directly with your carrier, so gaps show up immediately.
Set your policy to auto-renew, and upload new face sheets to CAQH and each payer portal right away. If you're switching carriers, make sure your old policy includes tail coverage or purchase it separately. This protects you from prior claims and maintains your network status.
5. Register Digital Profiles: CAQH and NPI
Digital profiles keep payers and regulators current with your credentials. Set these up early to avoid reimbursement delays.
Start with CAQH by opening your account, uploading core documents, and saving your CAQH ID with your licenses and malpractice coverage. Every 120 days, you'll get prompted to confirm nothing has changed. Miss that attestation and your profile locks, stopping payer reviews entirely.
Common problems include mismatched names, expired documents, or blurry scans. Keep files under 2 MB, scan at 300 dpi, and use clear labels like "DDS-License-2026.pdf."
Next, get your National Provider Identifier. Visit the NPPES application portal and request a Type 1 NPI for each dentist and Type 2 NPI for your practice. Have your EIN, practice address, and taxonomy codes ready—incomplete fields slow everything down.
Set a quarterly calendar reminder to re-attest on CAQH and check your NPI data. This critical task often slips between patient visits if you don't schedule it.
6. Complete Federal and State Registrations
Before billing insurers, clear every prescriber at both federal and state levels. Gather paperwork early, then move through each agency in one organized push.
Start with your DEA certificate, which you'll renew every three years to maintain prescribing authority. You'll also need state controlled-substance registration. If you treat Medicare Advantage patients, Medicare PECOS enrollment becomes necessary. For Medicaid beneficiaries, secure a provider number for each state where you serve patients.
Don't forget practice-specific permits that vary by location. Radiography permits, sedation credentials, and other auxiliary privileges depend on each state's scope-of-practice rules. You'll also need prescription-monitoring program login credentials for opioid compliance tracking.
Batch applications within a 60-day window when possible. Background checks often cross-reference the same federal databases, so simultaneous submissions can speed approvals. Make sure your DEA number matches the physical practice address—mismatched locations trigger rejections during verification.
7. Capture Practice-Level Details
Insurers verify your office itself before approving payments. Gather these five documents before you submit:
Business or facility license: Proves your practice operates legally; payers check this first during verification
IRS EIN letter or W-9: Ties your practice's tax ID to every claim you file
Type 2 NPI: Your unique practice identifier; keep it identical across CAQH and payer portals
CLIA certificate: Only needed if you run in-house labs
Banking details: EFT form plus voided check so deposits hit the right account immediately
Your state might require extras like facility permits or Business Associate Agreements for HIPAA compliance. Store everything digitally in a secure folder with access controls and renewal alerts. Update banking credentials the moment they change—outdated account info stalls reimbursements fast.
8. Submit to Payers and Track Deadlines
Once your paperwork is ready, you face a choice: electronic portals or old-school paper packets. Electronic submission through tools like DentalXChange CredentialConnect lets you upload forms once, push them to multiple networks, and watch real-time status updates. Paper packets still work, but you'll wait on mail delivery and manual data entry—delays that add weeks to your timeline.
Payer review times vary wildly. Some regional plans clear a clean file in 30 days, while national carriers may stretch to 180. This timing directly impacts your bottom line: every extra day keeps new providers out of network and delays reimbursements. Most offices should budget two to six months per payer.
You can't control the review clock after submission, but you can stay on top of follow-up:
Day 0: Log the submission date, payer contact, and confirmation number
Day 30: Call or email for receipt verification
Day 60: Request status, supply any missing items
Day 90: Push for supervisor review if the file is still pending
Keep everything visible with simple tracking tools like a shared spreadsheet that flags due dates in red, calendar alerts tied to each checkpoint, or verification software that pings you before deadlines slip by. Common snags like mismatched names, expired licenses, and fuzzy scans trigger immediate rejections, so double-check every PDF before you hit "submit."
Every provider you add multiplies your tracking workload. Pre-verified hygienists from Teero reduce that administrative burden, freeing your team to focus on patient care instead of chasing paperwork.
9. Monitor Ongoing Compliance and Re-credentialing
Once you're enrolled with payers, you need to stay there. Most insurers re-evaluate every 24–36 months, so mark your calendar now and missing it freezes reimbursements overnight.
You'll track five moving parts: license renewals, quarterly CAQH attestations, OIG and SAM exclusion checks, malpractice policy updates, and continuing education transcripts. Renewal timing shifts by state—California dentists renew licenses every two years, while Michigan stretches to three. Keep those variances in one master sheet so you don't scramble at the last minute.
Assign one person—or a verification partner—to own the deadline log. Automated reminder tools like DentalXChange CredentialConnect or the ADA's CAQH-powered profile keep dates visible and send alerts before documents expire. A quick weekly check prevents payment holds, network removal, and the reputational damage that follows. Staying current protects revenue, licensure, and patient trust all at once.
Stay Compliant and Fully Staffed With Teero
When you keep every item on the nine-point checklist current, you protect revenue, speed up hiring, cut administrative drag, build patient confidence, and satisfy regulators—all without surprises.
Yet even the best checklist needs daily attention. Licenses renew every two or three years, CAQH asks for fresh attestations every 120 days, and payers demand full re-verification every 24–36 months. Miss one deadline and reimbursements can stall or your practice can be removed from a network altogether. An expired state license brings even steeper consequences, including practice suspension.
Teero removes that risk. Our marketplace connects you with W-2 hygienists whose licenses, CE records, malpractice coverage, and CAQH profiles are verified and tracked in real time. Book the shift, seat the patient, and let us handle the paperwork. Ready to reduce your verification workload? Sign up for Teero today to fill your staffing gaps.