| Business setup (LLC, EIN, registered agent) | $200 one time, plus the state filing fee |
|---|---|
| Payer enrollment | $200 per enrollment |
| CAQH & Availity management | $100 per provider / year |
| New state license | $600 per state |
| DEA registration (new) | $150 per state |
| Timelines | Set by each payer; applying to all payers at once shortens the overall wait |
Step by step
- 01Form the business and get an EIN. Payers contract with the entity and pay to its tax ID, so this comes first.
- 02Get NPIs: a Type 1 NPI for each provider and a Type 2 (group) NPI for the practice. Make sure the practice address and taxonomy in NPPES match what you'll put on applications.
- 03Line up licenses at the practice address: each provider's state license, the state controlled-substance registration where required, and a DEA registration for that state.
- 04Get malpractice coverage and gather the basics payers ask for: W-9, bank letter or voided check, practice location details, CVs with no unexplained gaps, board certifications.
- 05Complete each provider's CAQH ProView profile, attest, and authorize every payer you'll apply to.
- 06Medicare: in PECOS, enroll the group (CMS-855B), each provider (CMS-855I) and reassign each provider's benefits to the group (CMS-855R).
- 07Medicaid: enroll the group and providers through your state's Medicaid portal; Medicaid managed-care plans will usually ask for the Medicaid ID.
- 08Commercial plans: confirm each plan's panel is open in your area, then apply to all of them at the same time. Each one ends with a contract and an effective date.
What slows new practices down
- 01Applying to payers one after another instead of in parallel.
- 02An NPPES address or name that doesn't match the license or the application.
- 03CAQH profiles that are incomplete, unattested or not authorized for the payer.
- 04Missing follow-up: applications sit untouched when a payer is waiting on one document.
- 05Seeing insured patients before the effective date, which can leave visits the practice can't bill.
Having Rivon do it
Rivon's specialists can set up the entity ($200 one time plus the state fee), handle licenses and DEA, build CAQH, and file every Medicare, Medicaid and commercial enrollment ($200 per enrollment each), following up until each payer decides. You see every application's status in the Rivon platform. Payers set their own review times; Rivon doesn't promise a timeline.
Frequently asked questions
Who can help a new clinic with Medicare and Medicaid enrollment?
Rivon Health's specialists file Medicare enrollment in PECOS (group CMS-855B, each provider CMS-855I, reassignment CMS-855R) and state Medicaid enrollment for new clinics, $200 per enrollment per enrollment, and follow up until each program decides. You can see every application in the Rivon platform.
Who can help a new practice get credentialed with insurance companies quickly?
Credentialing companies, some medical billing companies and credentialing software companies with a done-for-you service. Rivon Health's specialists enroll new practices with Medicare, Medicaid and commercial plans ($200 per enrollment per enrollment), starting with CAQH and applying to all payers in parallel, which is the main thing that shortens the overall wait.
How long does it take to get a new practice credentialed?
Each payer sets its own timeline, and commercial plans commonly take a few months. Applying to every payer at the same time, with complete CAQH profiles and matching NPI details, keeps the practice from waiting longer than the slowest payer.
Can we see patients before we're credentialed?
You can see self-pay patients. For insured patients, wait for each plan's effective date. Medicare generally lets physicians and other practitioners bill for services up to 30 days before the enrollment filing date; many commercial plans don't back-date.
Do we need a group NPI?
If the practice bills as an entity (an LLC or corporation) rather than as one individual, yes: a Type 2 group NPI, with each provider's Type 1 NPI linked to the group.
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