Disclaimer: Insurance administration and dental billing recommendations, as well as interpretations of the CDT codes, represent the opinions of our experts. For the latest CDT codes and official interpretations, contact the American Dental Association or visit ADA.org. You are responsible for your own use of the CDT Codes, insurance administration, and dental billing.

Credentialing: Don’t Let Paperwork Pause Your Profits

Finding the perfect associate for your practice is a massive win. But before they can pick up a handpiece and start generating revenue, you have to survive the ultimate administrative gauntlet: insurance credentialing. It’s the hidden bottleneck that can leave a talented and eager provider sitting idle and your schedule in limbo for months.

Credentialing is the thorough process that dental plans use to verify providers’ qualifications, licenses, and legitimacy before adding them to their networks. It’s essential for maintaining a healthy revenue cycle, but if you don’t know the rules, it can easily derail your practice.

To see how this plays out in real life, let’s look at a common scenario that can happen when credentialing goes wrong.

The “Hurry Up and Bill” Scenario

Dr. Brady just hired a fantastic new dentist, Dr. Clara, to help handle the busy summer schedule. Eager to get her “drilling,” Dr. Brady schedules her to treat PPO patients on day one. When the office manager asks about her pending credentialing status, Dr. Brady waves a hand and says, “Just submit her claims under my NPI for now. We’ll switch it over once she’s officially credentialed.”

This is a major compliance violation. It is strictly against your insurance contracts to submit a claim under a provider who did not physically perform the treatment. Doing this can trigger audits, payment recoupments, or even accusations of fraud.

The credentialing process typically takes anywhere from 30 to 120 days. During this time, an approved panel reviews everything from dental school verifications to background checks through the National Practitioner Data Bank (NPBD) for any history of adverse malpractice or regulatory sanctions. There are no shortcuts.

Keep a credentialing checklist to streamline your process.

Whether you are onboarding a new doctor or navigating the re-credentialing process (which happens roughly every two to five years), having your paperwork organized is the only way to prevent delays or outright rejections.

Make sure you have documents ready to go, such as:

• a signed application and contract,
• a triennial state dental license and/or verification of licensure,
• their education and training history,
• board certification from any specialty board (if applicable)
• their identification numbers (e.g., NPI),
• a valid and unrestricted DEA certificate or DEA waiver,
• verification of applicable certificates (e.g., Basic life support), 
• a copy of your anesthesia license (if applicable),
• work history details including dates,
• verification of insurance coverage (e.g., malpractice), and
• a W-9 for tax identification number (TIN).

Start the credentialing process the moment a contract is signed. If the new doctor is already credentialed with the payor at a different office, ask the payor for an Add Location form instead of submitting a brand-new application. This can drastically speed up the process. Additionally, if you are bringing in a temporary doctor due to an illness or extended absence, call the payor first. Some state Medicaid programs and PPO plans have specific provisions that allow temporary billing under the owner doctor’s NPI, or they may grant expedited temporary credentials. Just be sure to get any such agreement from the payor in writing.

Treat credentialing like the priority that it is.

Deciding whether to credential with a payor requires careful strategy. Keep in mind that if you choose to remain out-of-network, some payors will refuse to pay the practice directly — completely ignoring how the assignment of benefits is marked on the claim form.

While credentialing usually isn’t a favorite administrative task at the office, treating it as a priority protects the doctor’s license and the office’s cash flow. Keep your records up to date, start the paperwork early, and know your plan types up front to ensure your practice gets paid for the hard work it does.

Ready for a deeper dive? Check out our chapter on Credentialing in our Dental Administration with Confidence publication

Source:

Practice Booster (2026). Dental Administration with Confidence (pp. 212-214). 2025 eAssist Publishing, LLC.