Everything you need to know about MediClaim Works, dental medical billing, credentialing, payer enrollment, and how our platform works for your practice.
Unlike other revenue cycle management companies, our agreement is for 12 months with auto-renewal. Most other companies require a minimum contract of 3 years.
We want to continue to earn your business — which is why we keep our commitment period reasonable and focus on delivering value from day one.
Maybe. We will do a full audit of your information and determine whether credentialing is needed based on your specific situation.
Payer rules change frequently over the years, so if it has been over 2 years since you last billed, the best approach is to go through the credentialing process to make sure you are fully "billing ready." This helps prevent denials and delays caused by outdated provider information in payer systems.
Usually around 30–45 days if you have already completed the credentialing process.
The range depends on factors like payer enrollment timelines, the number of payers you need to connect with, and how quickly your practice can complete any outstanding setup steps. Our team guides you through each stage to keep the process moving as efficiently as possible.
Yes. We offer credentialing services through one of our trusted vendors. Whether you are setting up medical billing for the first time or re-credentialing after a gap, we can connect you with the right resource to get your practice ready to bill.
MediClaim Works offers several proprietary services that are not offered by Inovalon directly — particularly the dental-specific workflow support, reimbursement readiness validation, enrollment guidance, and claims intelligence that practices need to succeed in medical billing.
Additionally, if you as an individual practitioner were to select all of the services and infrastructure that MediClaim Works provides access to, the cost would be prohibitive for a single provider. We sign the enterprise-level agreement with Inovalon, then make those services available to our clients at a fraction of the cost — along with dental-specific claims support that Inovalon does not provide.
Reimbursement Readiness is the process of validating provider, practice, and payer information before claims are submitted. This helps identify gaps that may delay or prevent payment.
It includes reviewing:
Many preventable claim denials stem from issues that could have been caught before the first claim was ever submitted. Reimbursement Readiness is how we get ahead of that.
No — payer enrollment and in-network contracting are not the same thing.
Payer enrollment typically prepares the provider to electronically submit claims and receive claim responses (EDI connectivity). It does not automatically mean you are a participating, in-network provider.
In-network participation involves a separate credentialing and contracting process with the payer — including negotiating reimbursement rates and agreeing to the payer's terms of participation.
Many of our clients operate as out-of-network providers and successfully submit medical claims for eligible services without being in-network with a payer.
Yes. Practices can authorize approved users within their organization or approved business associates to access the system based on operational needs.
This allows your front desk, billing coordinator, office manager, and other authorized team members to work within the platform according to their roles.
Our platform is designed primarily for:
However, any healthcare provider can utilize our services. If your practice submits medical insurance claims for eligible procedures, MediClaim Works can support your workflow.
General dentists have an opportunity to bill medical insurance for many procedures. Here are just a few examples:
Yes. Depending on availability, MediClaim Works may offer temporary billing support, workflow assistance, training, or managed billing solutions to help practices maintain continuity during staffing transitions.
If your practice is experiencing a staffing gap, reach out to our team as soon as possible so we can assess how best to support you.
Yes. Many of our clients operate as out-of-network providers and use our medical billing workflows to submit claims for eligible services.
Being out-of-network does not prevent you from submitting medical claims — it simply means you are not bound by a payer's negotiated fee schedule. Patients may be responsible for a greater portion of the cost depending on their plan, but claims can still be submitted and processed through our platform.
MediClaim Works is primarily a technology and support platform — not a traditional billing company.
We provide the tools, workflows, training, and claims support that help practices submit and manage medical claims more efficiently. Your team remains in control of the billing process — including coding decisions, documentation, and compliance.
Some clients may also choose additional billing support services when available, but our core offering is centered on enabling your practice to bill successfully on its own.
MediClaim Works was built specifically for dental practices entering the medical billing space. Unlike generic clearinghouses, we focus exclusively on the dental industry and provide:
We also give your practice complete visibility into every claim filed under your NPI — something many billing companies don't offer. You know exactly what is being submitted in your name, every time.
MediClaim Works may provide general workflow guidance, but providers remain fully responsible for all coding and compliance decisions, including: