Opening your own practice
Getting paid takes more than credentialing: a clearinghouse, fee schedules, eligibility checks, payer deposits and a front desk that knows the workflow. We set it up in 2 to 4 weeks, track every payer enrollment weekly, and send held claims as each payer approves you.
Twenty minutes. If you're already set up well, we'll tell you that.
Write down the five insurance plans most of your patients will use. For each one, note whether you're already credentialed with it, and whether it backdates your effective date once you're approved. That short list decides when your first deposits land. It's also the first thing we'd build with you.
The plan depends on how much runway you have.
The best position to be in. We file your payer enrollments early, so most or all of them can be approved before your first patient.
Your payers still need your new practice and tax ID linked to your credentials. We handle those updates and set up your billing system. Setup usually takes 2 to 4 weeks; the payer updates run on each payer's timeline.
We file everything right away, set up the rest of your billing, and hold claims that can be paid so they go out as each enrollment is approved.
Which payers first, based on your expected patients, and a weekly status update with each payer's expected effective date.
Individual and group NPIs, taxonomy codes, your CAQH profile and Medicare enrollment.
Clearinghouse, EDI, electronic remittance (ERA) and direct deposit (EFT) enrollment, so payments land without paper checks.
Vendor introduction and training coordination, provider and clinic data, charge codes and fee schedules.
Eligibility checks, copays, prior authorizations and charge capture.
Uploaded, if you're bringing patients with you.
Processes set up for your staff from day one.
What payers actually do during the wait, and what we do about it.
Once approved, Medicare can pay for services up to 30 days before your application was filed, so filing early matters. Payment arrives only after approval.
Some payers backdate your effective date and many don't. We confirm each payer's policy, hold claims for dates that can be covered, and submit them as soon as your enrollment is approved, inside each payer's filing deadline.
For non-Medicare patients who agree to pay directly: clear cash rates, a superbill they can send to their own plan, and the Good Faith Estimate the law requires. Medicare patients are handled differently, and we walk through that with you.
Claims held, expected approval dates and a projected first deposit, updated weekly, so you can plan payroll and rent. These are estimates; payers set the actual dates.
Starting at $500 a month for a practice just starting out, billed from when you sign. It covers setup, enrollment tracking and your billing. Credentialing is billed per payer at a discounted rate, quoted up front for the payers we agree on. Once your collections grow, billing moves to our standard percentage of collections.
Opening with several providers, or expecting high volume from the start? Pricing for your size is set on the call.
Billing and system setup usually takes 2 to 4 weeks, depending on your clearinghouse and EHR. Credentialing runs on each payer's timeline, commonly 60 to 120 days and sometimes longer, which is why we start it as early as possible. No one can make a payer move faster; we keep your applications complete and followed up so they don't stall.
You can see patients, but insurance payers only pay once you're credentialed, and only for dates they cover. Some backdate, many don't, and Medicare has its own rules. We go through your payer list on the call and plan which patients to schedule when.
A US based lead biller with a support team. Claims go out within 24 to 48 hours of receipt, and a person calls the payer on denied or underpaid claims.