ADA calls out UnitedHealthcare credentialing portal for doubling dentists’ paperwork

Association encourages payers to use CAQH portal for accessing credentialing data

The American Dental Association is calling on UnitedHealthcare to accept dentists’ credentialing information from the CAQH Provider Data Portal rather than force them to submit a payer-specific application through its proprietary portal.

The ADA Credentialing Service, powered by CAQH, is available at no cost to all licensed U.S. dentists. The service enables dentists to maintain a single credentialing profile in the CAQH portal and securely share it with multiple dental plans, helping to reduce administrative burden and streamline credentialing, recredentialing, onboarding and provider directory updates. By using the portal, dentists avoid having to reenter the same information for every plan with which they participate.

For close to a decade, the ADA has worked to make the CAQH portal the single, standardized source dental payers use to credential providers. However, payers like UnitedHealthcare continue to require in-network dentists to complete their initial credentialing and recredentialing through their own online portals rather than relying on the CAQH portal, which many dentists already use.

“The ADA recognizes that data collection is merely the first step in the credentialing process. The ADA is also not opposed to payers modernizing how they manage credentialing data, but dentists shouldn't have to maintain multiple accounts across multiple portals or rekey data into payer-specific systems when that data already lives in the CAQH portal and the dentist has authorized the payer to access it,” said Shelley Olson, D.D.S., chair of the ADA Council on Dental Benefit Programs. "Dentists already do this work once, correctly, in the CAQH portal. Asking them to repeat it in a payer-specific system isn't modernization; it's added overhead with no benefit to patients or practices."

While the UnitedHealthcare portal includes an option to import existing CAQH data, the ADA is urging the insurer to reconfigure its portal to accept a dentist’s CAQH provider ID as a complete submission in place of a full manual application.

“The option to import existing CAQH data is an acknowledgment that the underlying information already exists in a standardized, industry-wide source,” Dr. Olson said. “If a payer can pull a dentist's CAQH profile in with a click, that's the strongest possible case for simply using the CAQH profile in the first place rather than asking dentists to also open, populate and maintain a second account indefinitely.”

As of Aug. 12, UnitedHealthcare has not provided a rationale for asking dentists to rekey or upload information into a new portal while appearing to use CAQH for medical providers. The ADA is committed to reducing unnecessary administrative burdens on dentists and their offices and will continue to press UnitedHealthcare and other payers to use the CAQH portal for credentialing rather than other, duplicative applications that shift avoidable costs, inefficiencies and administrative responsibilities onto dental practices.

“These stand-alone portals shift costs onto providers as an added administrative burden and employee cost all while reimbursements to providers have not kept up with inflation. We believe efficiencies gained for both payers and their network providers for using CAQH outweigh any data access fees charged by CAQH,” Dr. Olson said. “UnitedHealthcare's leadership position on the DataSpring by CAQH board reflects its recognition of CAQH's value in supporting medical networks. We call on UnitedHealthcare to apply those same efficiencies and advantages to its dental networks.”

In the meantime, the ADA recommends dentists:

• Lead with their CAQH ID: Before filling out a new profile in the UnitedHealthcare portal, dentists should ask their provider relations representative if their CAQH provider ID and authorization can be accepted in place of a full manual application.

• Offer the CAQH PDF instead of rekeying data: If some data submission is unavoidable, dentists should ask if they can attach their current CAQH ProView PDF summary instead of reentering each field by hand.

• Keep their CAQH profile current: An up-to-date CAQH profile is dentists’ strongest leverage when asking a plan to waive duplicate paperwork.

• Report their experience to the ADA: Dentists should report delays, denials and manual reentry to dentalbenefits@ada.org so the ADA can bring concrete examples to UnitedHealthcare and flag the pattern before other plans consider similar moves.