How a Telehealth Startup Missed Its Launch Date by 13 Months — Then Rivon Rebuilt Their Credentialing From Scratch
Telehealth may be digital, but the rules governing telehealth licensing and credentialing are anything but modern. The rise of virtual care during the pandemic created an expectation that scaling across multiple states should be fast, standardized, and predictable. But for one rapidly scaling telehealth startup—let’s call them ClearHealth Virtual—that assumption nearly cost them their entire business.
ClearHealth was well-funded, backed by recognized investors, and on track to launch a national mental health and primary-care hybrid model. They had the team, the technology, and the demand. What they didn’t have was a credentialing strategy capable of navigating the intersection of telemedicine, state-specific licensing, payer-specific rules, and compliance multivariables that even seasoned administrators struggle with.
This is the story of how ClearHealth attempted a DIY licensing and credentialing rollout, how that attempt created 13 months of financial bleeding, and how Rivon Health ultimately rebuilt their entire operational foundation so they could launch in a matter of 4 months.
The Setup: 60 Providers, 22 States, and a Launch Date Set in Stone
ClearHealth had a straightforward goal:
Launch across 22 states in Q1 with 60 licensed clinicians.
To investors, it sounded reasonable.
To their internal team, it sounded ambitious but doable.
To anyone experienced in multi-state telehealth credentialing… it sounded like a compliance minefield.
ClearHealth’s team consisted of:
A director of operations with hospital experience
Two credentialing coordinators
A contract HR consultant
Several clinicians eager to start treating patients
None of them had experience with interstate telehealth licensing compacts, payer panel rules for virtual-only groups, or hybrid credentialing models where clinicians live in one state and treat patients in another.
This lack of expertise set the stage for the mistakes that followed.
Mistake #1: Assuming Telehealth Licensing Is Universal
ClearHealth believed a single license (or a compact license) would cover broad territory.
Reality was far more complicated:
The Interstate Medical Licensure Compact doesn’t operate the same in every state
APRN compacts and PT compacts have different rules and timelines
Behavioral health licensing varies dramatically by state
Some states require an in-state collaborating physician
Some require a physical practice location
Some require telemedicine-specific disclosures
Some require in-state malpractice riders
ClearHealth applied for licenses without understanding these rules, causing:
Applications to be returned
Missing documents
Incorrect attestation language
Mismatched collaborating physician information
Improper license routing
A process they estimated would take 2–4 weeks per provider turned into 6–12 months in several states.
Mistake #2: Applying to Insurance Panels Without Understanding Telehealth Restrictions
This was the costliest mistake.
ClearHealth applied to major commercial payers assuming:
Panels were open
Virtual-only groups were eligible
Out-of-state clinicians could be credentialed
Group contracts could be backdated
Medicaid enrollment was uniform
None of these were true.
Many commercial payers either:
Do not accept telehealth-only groups
Require a physical office address in the state
Require clinicians to live in-state
Require specific taxonomy codes for virtual care
Require separate contracting for mental health and primary care
As a result:
37 provider applications were rejected outright
12 were closed due to missing documents
6 were pended for months because the group contract was incorrect
Medicaid applications in 4 states were deemed invalid due to address issues
What ClearHealth expected to take 60–90 days quickly ballooned into a projected 14–16 month timeline, with 13 months already lost.
Mistake #3: Not Accounting for Telehealth Enrollment Variances in Medicaid
Virtual Medicaid rules are notoriously inconsistent.
Some states require:
An in-state address
A supervising MD
A facility license
A state-specific telehealth attestation
Proof of in-state malpractice
ClearHealth had assumed Medicaid was easier than commercial. It wasn’t.
Two states outright denied their group because ClearHealth didn’t maintain a physical location.
Three more denied them because provider addresses didn’t match HR paperwork.
Another state pended them indefinitely because they lacked a supervising physician registered with the state board.
These delays alone cost the company nearly $160,000 in projected Medicaid revenue in the first quarter.
Mistake #4: Overlooking Payer Taxonomy Codes
A small detail created catastrophic delays.
ClearHealth selected the wrong taxonomy codes for:
Group enrollment
Individual enrollment
Behavioral health specialties
Telehealth-specific service categories
This caused:
Claims to reject
Group contracts to pend
Providers to be denied participation
Entire Medicare enrollment packets to be sent back
Taxonomy errors are one of the top three reasons telehealth groups fail credentialing, and ClearHealth learned this the hard way.
Mistake #5: Underestimating How Long It Takes to Credential 60 Providers
Credentialing one provider can take 45–180 days.
Credentialing 60 providers simultaneously requires an army.
ClearHealth had:
No centralized system
No tracking dashboards
No automation
No document management workflows
No standardized intake process
Every payer asked for:
Something different
In a different format
With different attestations
With different supporting documents
ClearHealth’s team was overwhelmed.
They fell behind on deadlines.
They forgot follow-ups.
They double-submitted forms.
They emailed the wrong versions.
By month 13, ClearHealth was still not credentialed in even half of their target states.
The Breaking Point: $420,000 Burned Waiting for Approvals
By month 13, ClearHealth had burned over $420,000 in operating expenses, salaries, and overhead, without generating revenue. Investors were asking questions, the board was losing patience, and clinicians were considering leaving for other opportunities.
That’s when ClearHealth called Rivon Health.
How Rivon Health Saved the Launch
Rivon took a full audit of ClearHealth’s situation.
Within 10 days, they uncovered:
117 application errors
42 missing documents
28 incorrect taxonomy selections
19 state-specific compliance issues
11 Medicaid restrictions
6 supervisor mismatches
2 Medicare discrepancies
1 contracting error that would have blocked claims for an entire region
Then Rivon built a new plan from scratch.
Step 1: Restructuring the Licensing Strategy
Rivon mapped each provider to:
Best-fit compact eligibility
State-specific licensing timelines
Telehealth acceptable states vs. restricted states
States with supervising physician obligations
States requiring physical practice addresses
Re-filed applications
Corrected collaborating physician pairings
Provided state-specific disclosures
Submitted compact applications where eligible
Managed weekly board follow-ups
This alone reduced licensing timelines by ~50%.
Step 2: Rebuilding Payer Enrollment the Correct Way
Rivon constructed:
A telehealth-specific provider enrollment matrix
A payer-by-payer eligibility breakdown
A list of states requiring physical locations
A list of closed panels
A Medicaid eligibility filter
Then Rivon:
Re-submitted all 60 provider enrollments
Rebuilt group contracts
Handled appeals
Provided missing documentation
Corrected taxonomy code errors
Managed every payer communication
Within 7 months, ClearHealth was fully credentialed and contracted in all priority states.
Step 3: Implementing a System to Avoid Future Collapse
Rivon installed:
Credentialing dashboards
Document storage automation
Expiration tracking
Workflow systems
Renewal reminders
Compliance alerts
Monthly audits
ClearHealth went from chaos to enterprise-level organization in less than a quarter.
The Final Outcome
Original projected timeline: 14–16 months
DIY timeline: delayed by 13 months
Rivon’s corrected timeline: 4 months to launch
Financial results:
Revenue flow began immediately
Clinician utilization hit 80%
Investor confidence restored
Burn rate stabilized
Expansion resumed
ClearHealth’s CEO said:
“Rivon didn’t just fix our credentialing. They saved our business model.”
Conclusion: Telehealth Credentialing Is Its Own Specialty
Virtual care is the future, but the regulations governing telehealth are still stuck in the past. Telehealth startups cannot afford:
Missed deadlines
Incorrect enrollment
Misaligned licensing
Medicaid denials
Taxonomy errors
Multi-state compliance failures
ClearHealth’s story is not rare.
It’s the rule — unless you have experts who live in this world every day.
Rivon Health ensures:
Faster approvals
Higher acceptance rates
Streamlined workflows
State and payer compliance
Scalable systems
Predictable timelines
Telehealth moves fast.
Credentialing doesn’t.
Rivon bridges that gap.