Costs Associated with Dental Credentialing
How Much Do Credentialing Services Cost?
Can Your Office Admin Do The Same Thing Cheaper?
For many dental practices, credentialing feels like just another administrative box to check. It’s tedious, yes, but is it really worth paying a specialist to handle?
Financially, credentialing costs can be somewhere from $4,000 to $5,000 dollars. But be aware there are a variety of business practices and fees involved. Some service providers charge per insurance carrier. Extra charges are induced for express processing and the list goes on and on….
That’s why many dentists default to common logic that usually sounds something like this:
“We have a capable office manager. Why pay an outside firm when we can do it in-house for free?”
But here is a hard truth:
More often than not, in-house credentialing is never free. In fact, when you start to drill down into what’s actually happening in your front office or administrative office, it’s often a very expensive way to get a provider in-network at your practice. So let’s attempt to break down the cost of dental credentialing.
We will look strictly at employee hours and more importantly “opportunity costs“. Many don’t consider the cost associated with delays and they start to become exponential. So DIY or in-office credentialing could actually be a very costly endeavor.
Looking at medical and dental industry reports statistics, we will attempt to put dollars and sense together in a very practical way. Most practice owners will overlook these facts, roll up their sleeves and jump right in. They don’t find out how much it cost them until it’s too late.
1. Cost of Credentialing Errors: Looking at The Numbers
You probably do trust your team implicitly, as you should, but the credentialing system is designed to be difficult. It is a game that rewards perfect accuracy where one small mistake results in weeks or even months of waiting periods.
Industry Statistics You Need to Know:
- According to industry analysis by the American Academy of Professional Coders (AAPC), up to 85% of initial provider enrollment applications contain missing, outdated, or inconsistent data
- The primary driver of processing delays.
- According to practice timeline surveys from the Medical Group Management Association (MGMA), a single administrative error typically triggers a 30–45 day processing delay.
- Effectively cycling the application back to the start of the payer’s review queue.
- Downstream Risk: It’s not just about the delays.
- Data indicates that nearly 1 in 3 (33%) – subsequent billing denials stem specifically from credentialing errors
- Such as the provider not being linked to the correct practice location.
Consider This:
A 3rd party credentialing specialist handles applications on an ongoing basis. Their whole job is to submit a “clean” application that sails through on the first review. Compare that to front office admins who handles one credentialing application every 2 or 3 years? DIY submission potentially falling in that “85% missing data bucket” get stuck in a “pending” loop for weeks before anyone even notices.
2. “Opportunity Cost”
Credentialing is a labyrinth of CAQH profiles, state-specific applications, malpractice verifications, and relentless follow-ups with insurance payers who are in no rush to approve you.
Looking at Data:
- Average Time:
- Industry analysis estimates it takes 20+ hours of focused administrative work to fully credential a single provider with a typical list of payers (Source: Assured Healthcare Analysis).
- The Hourly Reality:
- According to 2025 Bureau of Labor Statistics (BLS) and salary data, the average experienced Dental Office Manager or Insurance Coordinator earns between $25–$30/hour.
“DIY” Cost Calculation:
If your office manager spends 20+ hours chasing applications, waiting on hold times, or panicking resubmissions, that equates to a half a week of salary paid doing one thing, credentialing.
20 hours x $30/hour = $600+ labor costs.
That’s not bad at all! But, what does ’20 Hours’ actually look like? Let’s be clear – This isn’t 20 hours of typing. This includes the ‘Active Hold Times’. You’re paying your Office Manager to sit on the phone with insurance carriers for 45 minutes at a time, just to be told an application is ‘still in review.‘ It includes the chase for signatures, the CAQH updates, and the inevitable re-submissions. It is 20 hours of paid salary burnt on a complicated bureaucratic and cryptic process.”
“Lost ROI” – Time Lost Scheduling Patients / Confirming Appointments
Most front desk administrators are “doing it all” or maybe they have one other person to help out. The challenge is handling all the things efficiently and effectively at the front desk.
A “Revenue-Generating” Front Office Engine
An office admin is the gatekeeper to your schedule. They spend hours trying to fill your chair. That time they spend calling patients equals to $500 – $1,000 in production for each hour filled. NEXT LEVEL CONSULTANTS’ Front Office Training programs can help enhance your teams performance in this area.
When they are diverted away from those critical duties, and on hold with insurance carriers, that revenue opportunity is lost forever. For reference read this article from Dental Economics – “The Front Desk Advantage: Sales Skills Every Dental Office Needs” –
- The Power of Leverage:
- A skilled front desk administrator is your practice’s highest-leverage asset.
- Industry benchmarks from Dental Economics indicate that just one hour of focused outreach (calling on unscheduled treatment or hygiene recall) generates $500 to $1,000 in future production.
- Considering the math:
- By securing just one restorative appointment in one hour of time (like a crown) or even filling two hygiene openings during a 60-minute window achieves a $1,000 value.
- For every hour wasted on other duties, those opportunities slip away
PRO TIP: Most dentists calculate the cost of their admin team based on their hourly wage (e.g., $30/hour). The “true cost” of an employee isn’t their hourly wage; it’s the value they do not produce while working those 40 hours a week. The reality is: the cost of wages value is dependant upon the produced value in that position.
Your front desk is the driving engine of your practice. No one else in the practice is calling up patients and following up with them and selling the treatment on a daily basis. The best front desk admin fill holes in the schedule, call on unscheduled treatment, and maximize case acceptance.
3. Cost of a Delays in a Credentialing Application
Labor cost is just the tip of the iceberg. Lost recare calls or treatment plan follow-ups, is an additional cost. Now layer in the real financial danger: delayed In-Network Billing.
Credentialing is a game of perfect accuracy. A single missing digit on an NPI number, an expired document, or an unchecked box can cause an insurance payer to reject an application, setting your billing and ARs back another month in most cases.
- Standard Timeline (clean submissions): 45–126 days.
- Timeline with Errors: 150–180+ days.
- Delays can complicate billing best practices for 30 to 60 days!
Billing Difficulties & Decreases in Case Acceptance
When Out-of-Network (OON), you lose ~20% of the billed revenue due to uncollected checks. In many cases patients see a higher balance and do not want to pay. Because the increase.
- The Collection Gap:
- A healthy practice typically collects 98% of its adjusted production. This high success rate relies on insurance companies paying the bulk of the ARs and billied procedures.
- However, when a provider is Out-of-Network:
- the financial difference shifts onto the patients.
- Data from MetLife shows that the “Patient Responsibility” portion of the bill often spikes from a manageable 20% to a staggering 40–60% when out of network.
- The Risk:
- It’s statistically much harder to collect a larger balance from patients than from insurance carriers. If the patient’s bill increases significantly, your likelihood of collecting that payment decreases.
- This statistically creates a verified 20% drop in total collections.
Case Acceptance and Treatment Planning
It’s also reported statistically that offices also lose 10% of their patient volume/acceptance because patients don’t want to pay higher prices when out-of-network.
- According to the Delta Dental Plans Association’s ‘State of America’s Oral Health’ report, 85% of adults view dental insurance as essential to their overall wellness.
- When a provider is non-credentialed, patients face higher out-of-pocket costs.
- Industry trends show that even loyal patients will delay or decline treatment plans when they realize their benefits will not apply seamlessly, leading to a conservative 10% dip in scheduled production volume.
4. Cost of “We’ll Just Bill Out-of-Network”
A common misconception is that a non-credentialed dentist can simply work “Out-of-Network” while waiting for approval. While technically possible, this strategy is fraught with financial leaks that cost you more than you realize.
3 Reasons billing out of network is risky business:
1. The Patient Trust Breaker Patients expect to use their benefits seamlessly. When they are hit with surprise “Out-of-Network” deductibles or higher co-pays because your new associate isn’t credentialed yet, trust is broken.
2. The “Check is in the Mail” (To the Patient) With major carriers like Delta Dental, reimbursement checks for out-of-network providers are often mailed directly to the patient, not the dental office.
- The Consequence:
- Your office loses control of the revenue.
- You are forced to chase patients for payment, leading to uncomfortable conversations and uncollected balances.
- The Statistic:
- A disgruntled patient tells 9–15 people about their bad experience.
- You aren’t just losing that patient; you are damaging your local reputation.
3. The “Timely Filing” Trap Thinking about holding claims until the paperwork clears? Be careful. Credentialing delays often push past the “Timely Filing” window (often 90 days) set by insurance payers.
If your approval comes on Day 95, every claim you held from Month 1 is now uncollectible. You performed the dentistry for free.
5. The Value of a Specialist: Why It’s Worth Every Penny
NEXT LEVEL CONSULTANTS specialize in one thing – getting providers active in your practice and billing production hours as fast and accurately as possible. Outsourcing your credentialing can make operations continue seamlessly without a loss in production or collections.
In Dentistry Speed = Revenue
Because we know the specific requirements for every major payer (Delta, Aetna, Cigna, MetLife, etc.), we submit “clean” applications the first time. We know the shortcuts, the direct contacts, and the red flags to avoid.
- DIY Approach: High probability of error (85% risk).
- Timeline with Errors: 150–180+ days.
- Specialist Approach: Precision and timely execution.
Let’s look at the ROI (Return on Investment).
- $800 or more in staff wages
- Higher risk of unscheduled production ($500 – $100/hr)
- 20% drop in collections with OON billing
- 10% drop in case acceptance
- Patients lose trust and might leave the practice (if not handled properly)
- Delayed ARs potentially causing thousands in write offs
While hiring a qualified agent typically requires a $5,000 investment, this fee is minimal compared to the potential financial fallout of DIY errors. You could face upwards of $12,000 in lost revenue.
When factoring in a 30% risk on $40,000 in monthly production. These risks stem from increased out-of-network (OON) billing write-offs and patients declining treatment due to higher out-of-pocket costs.
It’s clear the investment in an outside expert pays for itself more than 2X. You can roll the dice and get your credentialing done for “FREE” by having an office admin handle it. Or you can have the peace of mind that it will be done right the first time!
The Bottom Line
You hire CPA’s to do your taxes because the cost of a mistake is too high. You use a lab to make perfect crowns because they have the right tools.
Credentialing should be no different.
Don’t step over dollars to pick up pennies and let your team do what they do best, care for patients, schedule treatment, and the already time consuming task of filing claims properly.
Contact us today for a consultation on how we can streamline your provider onboarding.