Starting a new medical practice? Start credentialing first.
Opening a practice involves much more than finding a location. Before insurance companies will pay your claims, each provider must be credentialed and enrolled with every payer. This process is slow, paperwork heavy and unforgiving of small mistakes, and delays mean weeks or months without payment.
Credentialing commonly takes two to four months, and sometimes longer, so most new practices should begin three to six months before the planned opening date. The steps below show how it works. Well Bill MB LLC can handle every one of them for you.
Step-by-step: how to start
- Set up your businessForm your legal entity (LLC, PLLC or PC, depending on your state), get your EIN, open a business bank account and secure your business license and malpractice insurance.
- Get your NPI numbersEvery provider needs an individual NPI (Type 1). Your practice also needs an organizational NPI (Type 2) if it bills as a group or entity. Both are issued through NPPES.
- Gather licenses and documentsState medical license, DEA registration and state controlled substance registration if needed, board certifications, CV with work history, malpractice face sheet, and a W-9.
- Complete your CAQH profileMost commercial payers pull your information from CAQH. Fill in every section, upload documents, authorize payers and attest. Keep it current, since re-attestation is required regularly.
- Enroll with MedicareSubmit your Medicare enrollment through PECOS or the CMS-855 forms. Group practices also set up reassignment of benefits for each provider.
- Enroll with MedicaidEach state has its own Medicaid provider enrollment process, forms and timelines. Apply to the state program and any managed care plans.
- Apply to commercial payersApply to each insurance network you want to join, such as Aetna, Cigna, UnitedHealthcare and Blue Cross Blue Shield plans. Follow up often, because applications can stall.
- Set up billing systemsChoose your EHR and practice management software, connect a clearinghouse, enroll for electronic remittance (ERA) and electronic funds transfer (EFT), and load your fee schedule.
- Confirm effective datesDo not rely on approval emails. Confirm each payer effective date and participation status in writing before billing claims.
- Start seeing patients and bill cleanWith enrollment active, submit clean claims, verify eligibility before visits and track payments from day one.
Common credentialing mistakes that delay payment
Seeing patients too early
Treating patients before enrollment is active can lead to unpaid or out-of-network claims.
Incomplete or outdated CAQH
Missing sections, expired documents or a missed attestation will stop an application.
Mismatched information
Names, addresses and tax IDs must match exactly across licenses, NPI records and applications.
No follow-up
Payers rarely chase you. Weekly follow-up keeps applications moving.
Ignoring re-credentialing
Commercial payers typically re-credential every two to three years, and Medicare revalidates on a set cycle.
Wrong billing setup
Missing ERA, EFT or clearinghouse enrollment delays payment even after approval.
How Well Bill MB helps new practices
- Complete credentialing and payer enrollment, start to finish
- CAQH setup, attestation and ongoing maintenance
- Medicare, Medicaid and commercial applications
- Payer contracting and fee schedule review
- Billing system, clearinghouse and ERA/EFT setup
- Weekly status updates so you always know where things stand
- Medical billing and RCM once you open
- Flexible pricing that fits a new practice budget
Frequently asked questions
How long does credentialing take?
Commonly two to four months, and sometimes longer depending on the payer and state. Start as early as possible.
Can I bill before I am credentialed?
It is risky. Claims may be denied or paid at out-of-network rates. Confirm your effective date with each payer first.
Do I need to do credentialing for every provider?
Yes. Each provider is credentialed with each payer, and group practices also need group enrollment.
What does credentialing cost?
It depends on the number of providers and payers. We are flexible and will quote based on your needs and budget.
Can you handle billing after credentialing?
Yes. We can manage your complete medical billing and revenue cycle once you open.
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