Modernizing credentialing to expand children’s access to dental care

Dental credentialing, the process that verifies providers before they can treat patients, plays an essential role in safeguarding patient care. Verifying licensure, training, and compliance ensures that children and families receive treatment from qualified professionals. 

But when the process is slow, the consequences extend beyond paperwork. For children in underserved communities, delays in credentialing can mean missed opportunities for care during the limited windows when school-based programs operate. 

Every year, children in low-income communities miss more than 34 million hours of school¹ because of preventable dental problems. Expanding access requires many solutions, including workforce development, strong school partnerships, and community engagement. 

It also requires modernizing the administrative systems that determine how quickly qualified providers can begin serving patients. 

From different vantage points, we have seen how credentialing timelines can unintentionally slow access, but thoughtful modernization of credentialing processes can help bring care to children faster—without compromising quality or oversight. 

The problem is structural, not personnel 

Dental credentialing exists for a good reason. Insurance companies need to verify that providers are licensed, qualified, and compliant before they can bill for services. Nobody is arguing against that. 

The issue is how it's done. The process is still largely manual. Applications are completed by hand, submitted by fax or email, reviewed by humans checking boxes against spreadsheets. When an application has an error, and the vast majority do, the entire process restarts. A single missing document can add weeks. 

For a large dental group expanding into new markets, this means hiring more administrative staff not to deliver care, but to push paper. For a school-based program trying to reach more underserved communities, it means qualified dentists sitting idle while children go without treatment. 

The 2025 CAQH Index quantified the scale of the problem: $21 billion in potential savings if the healthcare industry eliminated manual administrative workflows.² Dental is disproportionately affected. The same index shows dental still lags medical in electronic transaction adoption. And recent state laws requiring insurers to spend at least 83% of premiums on patient care are making the status quo unsustainable.³

This is not a clinical problem. It is an administrative design problem. 

The real cost of slow credentialing 

Most dental leaders know credentialing is painful. Few appreciate how directly it hits both access and revenue. 

On the access side, slow credentialing compresses the window in which school-based and community programs can actually operate. If a dentist cannot be approved before a district's scheduled visit dates, those chairs stay empty and those kids wait another year. 

On the business side, each new provider typically needs to be credentialed with five to 10 insurance companies. Every missing document, inconsistent format, or duplicated data entry triggers extra back-and-forth and pushes out the start date for billable care. If you multiply that across a 50 or 200 provider organization, you are looking at a real drag on revenue. 

Recruiting a dentist is only half the battle. Until that provider is credentialed with key plans, the schedule cannot be filled at the mix you modeled and production targets slip. 

The moral math 

There is a dimension to this the industry should not ignore. 

When credentialing drags, the first communities to feel it are the ones with the least margin for delay: low-income, rural, and Medicaid-heavy populations. In school-based programs, a slow approval is not just an operational headache. It is a missed chance to treat decay before it becomes an emergency, or to keep a child in class instead of in pain. 

As dental leaders, we have invested heavily in clinical innovation. The next frontier is the administrative infrastructure that controls who can deliver that care and when. States are passing dental loss ratio laws that cap administrative spending. The federal push toward interoperability is accelerating. The pressure to modernize is no longer theoretical. 

Fixing credentialing will never win a design award. But it is one of the fastest, most controllable ways to expand access and strengthen practice economics at the same time. 

The children who need care the most should not be the ones waiting the longest. The technology to fix this exists now. The question is whether the industry will adopt it fast enough. 

References: 

1. Oral health in schools. American Academy of Pediatrics. June 27, 2025. Updated https://www.aap.org/en/patient-care/school-health/oral-health-in-schools/  

2. The 2025 CAQH index. CAHQ. 2025. https://www.caqh.org/insights/caqh-index-report  

3. Dental medical loss ratios: Understanding the landscape in Massachusetts and beyond. National Academy for State Health Policy. October 13, 2023. https://nashp.org/dental-medical-loss-ratios-understanding-the-landscape-in-massachusetts-and-beyond/