Let’s be real. Credentialing is a drag. You’ve got a new provider ready to go, but they’re stuck in paperwork purgatory. The temptation is to bill their work under Dr. Established’s NPI while you wait.
Before anyone clicks submit, slow down. A claim going through your software does not tell you that the provider information or payer requirements are correct.
The case behind the headline
What actually happened.
On June 30, 2025, the U.S. Attorney’s Office for the District of New Jersey announced that Premier Dental Holdings, doing business as Sonrava Health, and four other dental entities agreed to pay $540,000 to the United States and New Jersey to resolve allegations involving claims submitted to Medicare Part D and NJ FamilyCare.
The allegations covered January 1, 2021, through July 31, 2023. They included billing for services by providers who lacked required credentials, sometimes using the NPIs of credentialed dentists who had not performed those services.
The announcement described a civil settlement resolving allegations. The amount in the headline belongs to this particular case. It is not an automatic fine for every credentialing error. Read the DOJ announcement.
An NPI is an identifier.
It is not an approval.
CMS specifically notes that issuing an NPI does not verify that a provider is licensed or credentialed. Having the number is one piece of the process. It does not settle the rest of the paperwork. See the CMS guidance.
Application submitted and approved to participate are two different statuses. Keep the applicable payer requirements and effective dates visible to the people submitting claims.
Get the roles right
Billing entity. Treating dentist.
Different fields for a reason.
The ADA claim form separates the billing dentist or entity from the treating dentist. A group’s billing NPI can legitimately differ from the treating dentist’s NPI. That difference alone is not evidence of improper billing.
The issue is whether each field accurately identifies the applicable role and follows the payer’s rules. The ADA’s instructions identify the treating dentist’s individual NPI separately. They also address reporting a locum tenens dentist. A temporary coverage arrangement is not a reason to assume you can swap in somebody else’s identity. Review the ADA claim form instructions.
If the situation involves substitute coverage, pending enrollment, or an unclear effective date, get the applicable payer’s requirements in writing and involve your credentialing specialist or qualified healthcare counsel when needed.
A calmer start
Four checks before the first claim.
Give the process an owner. “I thought someone else handled it” is not much of a filing system.
Confirm the provider details.
Check the dentist, billing entity, and treatment location. Make sure the setup reflects the actual arrangement.
Check each payer’s requirements.
Confirm which enrollment, credentialing, and network participation steps apply. Approval with one payer is not confirmation for another.
Record the effective date.
Keep written confirmation with the date it applies. If retroactive participation is being discussed, confirm what is actually permitted rather than assuming it.
Review the first claims.
Compare the provider fields with the clinical record and confirmed payer instructions. Correct discrepancies before submission.
Keep the written confirmation where your billing team can actually find it. Future you will appreciate the favor.
Support helps.
Accountability stays.
A billing partner can bring organization, consistency, and follow-through. Outsourcing does not remove the treating dentist’s responsibility for accurate claims. The ADA addresses that responsibility even when a third party handles billing.
At Paragon, we want a clear conversation about what your practice needs, where the process is getting stuck, and who needs to be involved. Sometimes that is billing support. Sometimes the next call needs to be to the payer, a credentialing specialist, or your attorney.
The goal is a process your team can trust, with fewer surprises waiting on the other side of “submit.”
Read it at the source.
- DOJ: June 30, 2025 announcement and settlement details
- CMS: NPI issuance and credentialing
- ADA: Dental Claim Form and completion instructions
- ADA: Responsibility for claim accuracy
General educational information, not legal advice. Payer, program, and state requirements vary.