On paper, credentialing looks like a way to save money. A practice manager, office admin, or clinician owner handles the forms, makes the calls, and you avoid paying a service fee. Once you put numbers to the time involved, that story changes.
This is a simple way to think about the cost of doing it yourself versus paying for help.
Start with the real hourly cost of your team
In most small practices, the people who end up doing credentialing are:
- The practice manager or operations lead
- An office administrator who already has a full plate
- A clinician owner, often in behavioral health or a small group, who splits time between clients and admin
You can estimate the cost of that time in two ways:
- For managers and admins, use their fully loaded hourly rate, which is often in the 30 to 50 dollars per hour range in many markets once you include benefits and taxes.
- For clinicians, use collected revenue per clinical hour, which for many behavioral health and therapy visits can land around $80 to $150 per session depending on setting and payer mix.
Whatever your numbers are, those are the values you are actually putting into credentialing work.
How much time does one enrollment really take
A single clean enrollment for one provider with one payor usually involves:
- Researching what that specific payor and product requires
- Gathering and checking provider data and documents
- Completing the application in the right portal or format
- Responding to questions or requests for more information
- Following up when the file goes quiet in the portal or on the phone
- Confirming approval, effective date, and directory listing
For someone who does not live in credentialing every day, it is easy for that to add up to 6 to 10 hours of scattered work per enrollment over a couple of months. If we pick a middle ground of 8 hours per enrollment, that is a realistic working assumption.
Example 1: practice manager time
Imagine a small practice with a practice manager whose fully loaded cost is $45 per hour.
If that manager spends 8 hours per enrollment and you want one provider enrolled with 6 payors:
- 8 hours per payor times 6 payors equals 48 hours of manager time
- 48 hours times $45 per hour equals $2,160 of internal cost for that one provider
If you are adding two providers this year, that number doubles to $4,320 of manager time spent on credentialing work alone.
That is time they are not using to improve scheduling, work claims backlogs, or manage staff. It is real money and real opportunity cost.
Example 2: behavioral health group owner
Now consider a behavioral health group owner who still sees clients and also handles credentialing. Say you collect an average of $120 per session and typically see 5 clients per clinical day.
If you pull back just one day per month from client care to work on credentialing:
- 5 sessions times $120 equals $600 of revenue per day
- Over 6 months of a launch or expansion, that is $3,600 of clinical revenue traded for admin work
If you add a second provider and repeat the pattern, that number doubles. That does not include any lost revenue from delayed effective dates if things slip.
Multiply by the number of payors and providers
Most practices do not stop at one plan.
If you have:
- 2 new providers this year
- 6 payors you want to be in network with
- 8 hours of work per enrollment
That is 2 providers times 6 payors times 8 hours, or 96 hours of credentialing time.
Even at a modest $40 per hour, that is $3,840 of internal labor. At $50 per hour, it is $4,800. If a clinician owner is doing a good part of that work instead of seeing clients, the effective cost is even higher.
Compare that to the cost of a service
Credentialing partners usually price:
- Per enrollment,
- Per provider for a set of payors, or
- As an ongoing monthly service for maintenance and new work.
Whatever the exact model, the all in cost to have a specialist handle one provider’s core enrollments is usually less than the several thousand dollars of manager and clinician time in the examples above, especially once you scale to more than one provider.
Even if you cut the assumptions in half, it is still easy to see thousands of dollars of effective internal cost for doing it yourself.
The cost of delays is even bigger
The math above only counts your time and your team’s time. It does not count the revenue lost when a provider starts seeing patients before enrollments are truly active.
As a simple example:
- One therapist or NP sees 6 patients a day
- At an average collected amount of $100 per visit
- Generates about $600 per day, or $12,000 over four weeks
If avoidable credentialing mistakes or slow follow up push your effective date out by one extra month, that is roughly $12,000 of potential revenue at risk for that provider. That can easily be more than what it would have cost to have the work handled correctly and early.
The break even point for your practice
You do not need perfect numbers to see whether this trade makes sense. You just need to sketch the basics:
- Hourly cost of your manager or admin: $[ ]
- Hours spent per enrollment: [ ] hours
- Number of payors per provider: [ ]
- Number of providers to credential this year: [ ]
- Rough collected revenue per clinical day for a new clinician: $[ ]
Then ask:
- How many hours of internal time am I buying when we “do it ourselves”
- How much potential clinical revenue am I pushing out if there are delays
- How does that compare to the all in cost of a credentialing partner
If the service cost is lower than the time and revenue you are already spending, or if it prevents even one month of avoidable delay for a new clinician, the math is on the side of handing it off.
At pie, we like putting real numbers to these decisions. If you want to sketch out this calculation for your own practice with your own numbers, we are glad to walk through it with you.
