So, you're diving into the wild world of dental insurance credentialing. Maybe you’ve just bought a practice and feel like the king or queen of the castle—or maybe you’re joining a new office as an associate, trying to keep your schedule from looking like the Mojave Desert.

Either way, welcome to credentialing, where forms multiply like rabbits, insurance plans move slower than molasses, and you’ll need equal parts organization, patience, and caffeine.

This article is your no-fluff, all-facts, slightly-funny survival guide to dental credentialing—whether you're taking over a practice or jumping into one.

What Exactly Is Credentialing?

Credentialing is the process of getting recognized by an insurance plan as an in-network provider, allowing you to bill that plan and receive contracted rates. It involves:

• Submitting your licensure and DEA information

• Completing long, redundant applications

• Waiting…and waiting…and then waiting some more

In-network status makes you more accessible to patients who don’t want to pay out-of-network fees. But it also locks you into the plan’s negotiated rates, which can sometimes be a double-edged scaler.

Scenario 1: You Bought the Practice — Now What?

Congratulations! You bought a practice. You probably also inherited the seller’s dental chairs, their patient base, and their insurance contracts—but not in the way you think.

Important truth bomb:
You cannot take over another dentist’s contracts.
Credentialing is tied to the individual dentist, not the practice. So even if the seller was in-network with 12 plans, you, as the new owner, are out-of-network until credentialed under your own name and tax ID.

Tips for Buyers:

1. Start the credentialing process BEFORE you take over.
   Most plans let you submit paperwork 30–60 days in advance of your official start date.

2. Use a dual credentialing strategy.
   Credential yourself under both the old Tax ID (if available during transition) and your new one. This can keep cash flow going during the ownership switch.

3. Beware the “Effective Date” trap.
   Many plans won’t backdate your effective date to your practice purchase date. That means any work you do before being approved is out-of-network—even if you submitted forms early.

4. Watch for umbrella networks.
   One application (e.g., with Connection Dental or Zelis) might link you to multiple plans. Be intentional about what plans you want, because automatic participation can sneak up on you.

Scenario 2: You’re Joining as an Associate

As an associate, your experience with credentialing can be smoother—or just as frustrating, depending on how well your new office handles it.

You’ll still need to credential under your own name and NPI, but under the practice’s Tax ID and group NPI. This means you don’t carry the full burden of credentialing admin, but you should still be proactive.

Tips for Associates:

1. Start early, like pre-start-date early.
   Credentialing takes 60–120 days, depending on the insurance plan. The sooner you apply, the sooner you’re seeing patients in-network.

2. Clarify who’s submitting the applications.
   Is the office manager doing it? Are you hiring a credentialing service? Ask. (And don’t assume.)

3. Track your effective dates.
   Just because you’ve applied doesn’t mean you’re active. Keep a spreadsheet of who you’ve applied to and when you get approved.

4. Understand the fee schedule game.
   Some plans assign lower fee schedules to new associates. Don’t be afraid to negotiate or ask to be tied to the practice owner’s existing contract, if allowed.

Common Pitfalls That’ll Sink Your Credentialing

Credentialing seems like it should be a “submit and done” kind of task, but it’s more like a slow-motion obstacle course. Here are the top traps to avoid:

1. Missing information

• Expired license? No DEA number yet? Application denied.

• NPI mismatch between Type 1 and Type 2? Denied again.

2. Wrong address or Tax ID

• One tiny typo and your credentialing can get connected to the wrong office.

3. Failure to follow up

• “Set it and forget it” will leave you uncredentialed forever. Most plans won’t contact you if something’s missing. You have to chase them down.

4. Using group contracts improperly

• You can’t bill under another doctor’s credentials just because you work in the same office. That’s considered fraud in most states and may result in clawbacks or worse.

5. Not checking for auto-renewals or terminations

• Plans sometimes require re-credentialing every 2-3 years. Miss the deadline and you’re booted out of network without even knowing it.

How Long Does Credentialing Take?

• Average Time: 60–90 days

• Some plans (like Aetna or Cigna): as quick as 30 days

• Others (looking at you, MetLife): may take 120+ days

• Medicaid or state-funded plans: variable and often longer due to regulatory layers

Hot tip: If you want to avoid a dry spell in patient flow, start at least 3 months ahead of your first day. Seriously.

What to Have Ready Before You Start

Prepare a “credentialing packet” with:

• Dental license

• DEA certificate

• Malpractice insurance certificate

• Current CV/resume

• NPI Type 1 (individual) and NPI Type 2 (group)

• State and federal tax ID documents

• Previous work history with no unexplained gaps

• Disciplinary action explanations (if applicable)

If you’re missing any of these, you’ll be stuck in the dreaded “pending review” purgatory.

Should You DIY or Hire It Out?

Credentialing can be DIY’d—but unless you have plenty of free time and a high tolerance for paperwork and phone tag, it may not be worth it.

Hiring a credentialing service (like Veritas Dental Resources, ahem!) can:

• Shorten delays

• Prevent errors

• Follow up on your behalf

• Help you decide which plans to credential with (and which to avoid)

Cost ranges from $150 to $500 per plan, depending on service level. But honestly, losing even a week of in-network status can cost you more than that in uncollected revenue.

Final Words: Play the Long Game

Credentialing is not glamorous—but it’s foundational. Getting it right helps you:

• Fill your schedule

• Bill clean claims

• Avoid patient confusion

• Maximize insurance collections

Whether you’re the proud new owner or the fresh-faced associate, credentialing done right means you can focus on dentistry—not paperwork.

Quick Recap

• Credentialing ≠ transferable – even if you buy a practice.

• Associates must credential under their own name and NPI.

• Start at least 60–90 days ahead of seeing patients.

• Common pitfalls include missing data, lack of follow-up, and billing under the wrong provider.

• Hiring a credentialing service can save time, money, and headaches.

• Be proactive. Be organized. And never assume insurance plans will do the right thing without a nudge (or twelve).

Benjamin Tuinei

Founder - Veritas Dental Resources, LLC
Phone: 888-808-4513

Services:
PPO Fee Negotiators | PPO Fee Negotiating | Insurance Fee Negotiating
Insurance Credentialing | Insurance Verifications

Websites:
www.VeritasDentalResources.com | www.VerusDental.com