What does one lapsed provider actually cost?

Your numbers, my arithmetic. No email gate, nothing sent anywhere, and it runs entirely in your browser. The defaults come from published sources listed at the bottom, including a competitor's.

Before you use this, a warning about the numbers you will see elsewhere. Figures of $9,000 to $10,000 per provider per day are widely quoted for credentialing delays. Those are health-system revenue, including downstream facility income. A billing firm bills professional claims, which are an order of magnitude smaller. This calculator models the smaller, correct number, which is why its answers look less alarming than the ones in most vendor marketing, including some aimed at you.

Your numbers

Used only to work out what RosterSafe would cost you.

Professional collections, all payers, for that one provider. The $8,000 default is the figure used in a published worked example, not a benchmark. Your billing system knows the real one.

35%

A lapse is usually with one payer. The provider stays billable to the others, so only this slice is at risk. Set it to 100% only if every enrollment lapsed at once.

Be honest. If the answer is "when the denials show up", that is a billing cycle or more. This is the only number RosterSafe changes.

Commonly reported at 90 to 120 days, longer for commercial payers. No software shortens this, including mine.

0%

Defaulted to zero, and that is not pessimism. Aetna, Cigna and UnitedHealthcare do not reimburse services before the effective date, and those are hard denials with no appeal path. Medicare allows up to 30 days back. Some BCBS plans backdate by state. Raise this only if you know your payer does.

What that works out to

Days non-billable with that payer120

Claims denied over that window
$11,038
That payer's share of the provider's billings while the enrollment is inactive.
Comes back, late
$0
Recoverable on reprocessing where the payer backdates. Not lost, but months away, and your cash flow carries it meanwhile.
Does not come back
$11,038
Genuinely gone, at the recovery rate you set.

The part RosterSafe can actually change

Not the re-enrollment. That runs its course whatever software you own. What alerting changes is the 30 days before you notice, because the deadline is flagged before it passes rather than after the denials arrive.

Unrecovered claims attributable to noticing late$2,760

Set "days before you would notice" to 0 and watch that figure go to nothing. That is the honest before-and-after, and it is much smaller than the headline. Anyone selling you the whole number is selling you the payer's timeline as though it were theirs to fix.

Against what RosterSafe costs

At 20 providers, RosterSafe is $500 per month, or $6,000 per year, published on the pricing page.

A caveat I would rather say than have you find: this weighs a single lapse against a year of subscription. If nothing ever lapses, the subscription is a cost with no offsetting saving, and concluding that from this page is a perfectly reasonable outcome.

The arithmetic, in full

So you can check it rather than trust it.

  1. Days non-billable = days before you notice + days to re-enroll.
  2. Monthly amount at risk = monthly collections x that payer's share.
  3. Claims denied = monthly amount at risk x (days non-billable / 30.44).
  4. Comes back late = claims denied x your recovery rate.
  5. Does not come back = claims denied minus the above.
  6. Attributable to noticing late = the same calculation over the notice window alone, unrecovered share only.

Where this is deliberately simplified:

  • One provider, one payer. If several enrollments lapse together, run it once per payer and add them up.
  • Collections are treated as even across the month. Real billing is lumpy, and a provider on leave during the gap changes the answer.
  • Staff time is not counted. The hours spent re-enrolling and reworking denials are real, and leaving them out understates the cost rather than inflating it.
  • Timely filing is not modelled. Even where a payer backdates, claims often have to be resubmitted within 30 to 90 days of approval or they are void. Recovery you are counting on can still expire.
  • Exclusion-list findings are a different problem. Billing for an excluded provider is False Claims Act exposure, not a denial, and this calculator says nothing about it.

Sources

Researched and written by Charles C, who builds RosterSafe.

Every default above traces to one of these. Checked 7 August 2026. If a figure here is wrong, email [email protected] and I will correct it.

  1. CredyApp, "The Anatomy of a Credentialing Denial"Source of the default worked example: a provider at $8,000 monthly collections, one payer at 35% of volume, a 90-day gap, and roughly $8,400 unrecoverable. Also the clearest statement that commercial credentialing denials are hard denials with no appeal pathway. Note this is a competitor of ours, which is precisely why it is worth citing here.
  2. Physician Practice Specialists, retroactive Medicare billingMedicare permits billing up to 30 days before the enrollment effective date, and only where the application is subsequently approved
  3. Staffingly, which payers still grant retroactive effective datesAetna, Cigna and UnitedHealthcare do not reimburse before the effective date. Some BCBS plans backdate by state. Retro dates are shrinking and have to be checked per contract
  4. Verisys, credentialing timelinesThe 90 to 120 day re-enrollment range used as the default

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