Dental Credentialing Costs Per Provider, Per Payer — And What Delays Are Silently Costing You

Dental practitioners, when budgeting for credentialing, usually only focus on the invoice that they receive from the credentialing company. However, the service fee is only one part of the overall cost. The higher costs become visible when the delays in the payer approvals and patient billing come to light. 

Such delays lead to months of unbilled revenue, which can have a financial impact that is far beyond the obvious. The postponed reimbursements, decreased appointment availability, and slow return on investment affect both cash flow and patient access. 

So, while it is important to understand, compare, and find the best dental credentialing costs per provider, it is equally important to understand how delays in payer approvals lead to an increase in these costs.

This guide explains credentialing costs per payer, per provider, and the hidden costs that impact your practice’s overall financial performance.

How Much Does Dental Credentialing Typically Cost

In general, the dental credentialing fees usually range between $200 and $800, typically per payer. In comparison, the typical per-provider full-credentialing cost may range between $1500 and $2500, which also depends on the insurance networks involved and the complexity in the enrollment process.

However, note that the final cost varies according to:

• To the number of insurance payers
• Provider Specialty
• Whether it’s initial credentialing or re-credentialing

In simple words, the service fee for dental credentialing is straightforward, but the practitioners must also account for the operational costs involved with the delayed approvals, as it can have a major impact on the cash flow more than the credentialing expense.

Dental Credentialing Costs Per Provider

When analyzing the dental credentialing costs per provider, instead of just comparing the prices, the practitioners must also evaluate what is actually included in the service. A well-designed credentialing package typically covers the administrative work that is essential to enroll a provider across different insurance networks. 

Some of the standard per-provider credentialing services typically include:

• Collection and verification of the provider documents, including the medical degrees, licenses, residency training, board certifications from the institution, etc.
• Background and history checks for insurance claims, state or federal sections, etc.
• DEA (Drug Enforcement Administration) verification.
• Creating a CAQH (Council for Affordable Quality Healthcare) profile or updating it.
• Preparation and submission of payer application to enroll the individual provider with commercial insurance plans.
• Continuous application tracking.
• Regular follow-ups with the insurance companies until the approval is received.

Further, as the number of participants in the insurance plan grows, the overall investment in the credentialing also increases. For example, credentialing a dental practitioner with four commercial insurance payers will require less administrative work as compared to credentialing the practitioner for ten or more insurance networks, leading to an increased credentialing cost. 

The dental practice structure also has an impact on the credentialing cost. Solo-practice credentialing typically has fewer enrollment requirements as compared to DSOs (Dental Service Organizations) or multi-location groups that typically handle multiple dentists, practice locations, and tax identification numbers, all at the same time. In such complex environments, the dental credentialing services require efficient coordination between different facilities, providers, and payers.

Dental Credentialing Costs Per Payer

Not every insurance company requires the same amount of administrative work and verification process during the credentialing process. The credentialing cost per payer, in reality, actually varies between one payer and another because each insurer maintains its own documentation requirements, verification process, and timelines for review.

For example, large national players like Cigna, Delta Dental, Aetna, and MetLife each follow a different enrollment workflow. 

• Cigna: Depends heavily on CAQH ProView and requires formal registration through their provider portal once credentialed.
• Delta Dental: Mostly functions independently of CAQH. Use their own provider application and credentialing toolkit (PACT).
• Aetna: Accepts CAQH applications but requires submission through online ‘Request for Participation.’
• MetLife: Bypasses CAQH and uses localized provider forms and standalone questionnaires.

Such variations in the credentialing process impact the administrative efforts and the credentialing timelines.

Understanding the Difference Between Credentialing and Re-Credentialing Fees

Initial credentialing typically requires more documentation, background checks, primary source verifications, and consistent payer follow-ups. Since the provider is enrolling with the insurance payer for the first time, every step requires careful coordination to avoid missed documents, incomplete applications, or verification delays. 

On the other hand, re-credentialing is typically more organized and streamlined. Since the provider has already been credentialed before, the re-credentialing process mainly focuses on confirming the existing information, such as practice details, certifications, and professional history, and ensuring that it is still up-to-date. While the re-credentialing process may be less complex, it may still require timely submissions to prevent any network lapses.

What Delays Are Silently Costing You

You can measure the dental billing service costs, including the amount you need to pay for dental credentialing services, easily. However, calculating the cost you might need to pay while waiting for credentialing is difficult, as for many efficient practices, delay in credentialing has a far greater impact on revenue.

Until the credentialing process is complete, the newly onboarded provider will not be able to participate in the insurance networks fully. Because of this time gap or delay in credentialing, the practices might have to postpone patient appointments, conduct billing out-of-network, and delay claim submissions. That means even when the providers continue to see patients, the reimbursement process might be limited or deferred until the provider receives approval from the payer. 

Here are some of the common causes that can significantly extend the delay in credentialing time, even if the applications were submitted on time:

Expired CAQH Attestations

For insurance payers, the CAQH profile acts as the centralized repository for reliable provider information that might be required during credentialing. When the CAQH profile of a provider is expired, incomplete, or not re-attested within the timeframe, the insurance payers might suspend the credentialing process for the provider until the updated information is available on the CAQH profile.

Incomplete Applications

As discussed earlier, different insurance payers might have different documentation requirements, credentialing forms, and submission guidelines. Even minor mistakes in documents or missed information in the credentialing application or documents, such as an incorrect date, missed signature, or incomplete disclosures, can result in the return or rejection of the credentialing application for correction and resubmission.

Missing Follow-Ups

 A credentialing application submitted on time does not guarantee that the payer will review the application in a timely manner or quickly. Many times, the applications remain pending in the credentialing process at the payer side because of the administrative bottlenecks, pending documentation requirements, or just missed, without notifying the provider. That’s why consistent follow-ups with the payer regarding the credentialing application status are necessary.

To simplify how delay silently costs you, let’s understand through this example:

Consider a newly hired dentist who sees 12 insured patients per day, works around 20 days per month, and has an average insurance reimbursement of $180 per visit. 

That means,

The total number of patients who visit the dentist = 12 patients x 20 working days = 240 patients per month

Potential billable revenue per month = 240 visits x $180 = $43,200 

Now, if the credentialing process for this provider gets postponed with one or more major insurance networks, a significant amount of this revenue might get delayed or may get decreased through out-of-network reimbursements or even lead to loss of patient access.

How to Reduce Dental Credentialing Costs and Delays

The payer review timelines during the credentialing process cannot be controlled; however, many credentialing delays can be easily prevented by following a structured enrollment process for credentialing. 

Here are some of the practical ways that can help in minimizing the delays in the dental credentialing process:

Ensure to Keep Your CAQH profile updated

Leading insurance companies depend on CAQH profiles of practitioners to verify the information. Make sure that it is complete with all the documents required, accurate with current data, and has been re-attested at least every quarter. Expired or unattested profiles are the most common cause of administrative delays in the credentialing process.

Verify the Provider Credentials Before Submissions

Verify the professional licenses, including DEA, board certifications, educational records, and practice information. Check and validate all the documents for any missing data, information, or incorrect details before submitting.

Fill the Application Carefully for the First Time

Inaccurate or incomplete applications often lead to rejections or requests for resubmissions, leading to extensions in the credentialing timelines. Therefore, it is essential that the practitioner fill out the application carefully, ensuring there are no mistakes in the important fields, document attestations, or missing signatures or dates. This way, the dental practitioners can decrease the chances of costly resubmissions, which often lead to an increase in the dental credentialing fees or delays.

Curate a Well-defined Payer-Specific Documentation Checklist

Keeping track of the insurance enrollment requirements of each payer is difficult. To simplify this, create a checklist that clearly defines all the documentation and application requirements specific to the payer. This checklist can help ensure that you do not miss any essential documentation or paperwork required by the payer.

Consistently Track the Application

Your work does not end with the final submission of the credentialing application. Now, it is time to regularly track the status of your credentialing application with each insurance payer. By regularly monitoring your application status, you can quickly respond to the payers’ requests or address the credentialing issue that might be noticed during the approval process.

Quickly respond to the payer requests.

The insurance companies may request additional documentation, corrections, or clarifications during the review process. Responding promptly to their requests helps in moving the application forward quickly and completing the credentialing process.

Consider Outsourcing to an Experienced Dental Credentialing Company

Managing the credentialing process in-house can be time-consuming and prone to errors, especially when enrolling with multiple insurance payers. Partnering with a reliable dental credentialing company that has experience in understanding the payer-specific requirements, preparing accurate information, and performing consistent follow-ups with the payers can increase the chances of timely credentialing application approvals.

Note that credentialing requires continuous maintenance of records, data, and documents. So, always keep your licenses, certifications, insurance policies, and data up-to-date. This can make your future re-credentialing process simpler and faster.

How CEC Prices Credentialing Services

CEC believes in keeping the credentialing pricing transparent, accurate, predictable, and aligned with the practices’ onboarding requirements. Instead of offering a one-size-fits-all package for all credentialing requirements, we create customized packages for dental credentialing services depending on the number of providers, practice locations, participating insurance networks, and the complexity of the payer enrollments.

Our dental insurance credentialing services include:

• Creating provider-specific setup, such as completing the paperwork, filling out applications, and handling documentation.
• Managing applications with major insurance players, including Cigna, Delta Dental, and Aetna, while making sure every application satisfies their unique requirements.
• Handling the enrollment process to make sure the payment flows without any confusion or missing details.
• CAQH management with regular attestations to maintain data accuracy.
• Group credentialing to support multi-provider and multi-location practices.
• Managing consistent payer follow-ups to check the application status and identify any payer requests.
• Renewals and re-credentialing services to keep providers active in the insurance networks.

These services help minimize the cost of credentialing delays while providing support to bring new and reliable providers into the insurance networks.

Conclusion

The dental credentialing fee is only the visible cost for credentialing. The hidden costs due to delays because of incomplete documentation, incorrect or missed fields on the CAQH profiles, late response to the payer requests, or delays in the approval process on the payers’ side can have a greater financial impact on the overall credentialing cost.

Practitioners must understand the dental credentialing costs per provider and the cost of credentialing delays to make informed operational and financial decisions for dental credentialing.

CEC offers services to help practitioners enroll with reliable insurance payers without unnecessary delays and accelerated costs. Whether you want to enroll as a single dentist or want credentialing across multiple locations, we provide transparent, customized, and efficient dental credentialing services that align with your practice’s needs.

Contact us to get started with dental credentialing today.

Frequently Asked Questions

1. What is dental credentialing and why is it important for practitioners?

Dental credentialing is the process of enrolling the practitioner with the leading insurance payer companies. This process involves verification of the practitioner’s education, licenses, CAQH profile, DEA, application submission, and consistent application status tracking until it is approved by the payer. The credentialing process is important for practitioners because without credentialing, the practitioners might not be able to receive the reimbursements, thus impacting the revenue cycle and patient access.

2. What is the typical cost per provider for dental credentialing?

The typical dental credentialing cost per provider depends on factors such as the practice structure, number of insurance payers, and provider specialty. Some credentialing companies charge on a per-provider basis, while others may charge according to the per-payer application. 

3. What do professional dental credentialing services include?

Typical dental credentialing services include document gathering, CAQH profile creation, license verification, payer application processing, enrollment submissions, application status tracking, and consistent follow-ups until the enrollment is approved. 

4. How much time does dental credentialing usually take?

The credentialing timeline typically depends on the insurance payer company and application completeness. While many enrollments get completed within a 30- to 60-day timeline, several others may take up to 3 or more months, depending on the pending documentation requirements, verification requests, etc.

5. Is outsourcing dental credentialing services cost-effective?

While outsourcing dental credentialing services can minimize the administrative workload on the practitioner and improve application accuracy, it can also help decrease the cost due to inaccurate data and incomplete documentation, leading to delays in the credentialing process.