Who we help
Credentialing for a New Practice
Opening a private practice? The order you credential in decides when you get paid. Commercial plans can be done before you open, Medicare cannot, and a mismatch between your NPI, EIN and applications can cost months. We handle all of it, in the right order, and you see the status of every application.
- Flat PricesNo percentage of collections
- Half Now, Half at SubmissionFor every enrollment application
- Closed Network?Your choice of a refund or a credit
- Live Status TrackingCheck any application by reference number
The Order That Gets You Paid From Day One
- Entity and EIN (First). Form your LLC or PC with the state and get the EIN from the IRS. Every application uses this exact legal name and tax ID.
- Group (Type 2) NPI (Right after). Register the practice in NPPES with the legal name, EIN and practice address. A mismatch here is the most common reason applications come back.
- CAQH Profile and Malpractice (3 to 4 months out). Build or update CAQH with the new practice location and a malpractice certificate that names it. Commercial plans pull from CAQH.
- Commercial Plans (3 to 4 months out). Apply to Aetna, Blue Cross, Cigna, UnitedHealthcare and the others you want. Most can be credentialed and contracted before you open; you start billing once the effective date arrives.
- Medicare (At opening). File in PECOS once the location is open and staffed. The effective date is the later of filing or your first patient there, with up to 30 days of retroactive billing, so file within the first month.
- Medicaid and Managed Care (Alongside). Enroll with the state Medicaid program first, then each Medicaid managed care plan, since the plans require the state enrollment.
What We Do for You
- Set up the foundation: group NPI with the right taxonomy, CAQH profile and the practice linked as your billing group.
- Apply to the plans you choose three to four months before you open, and follow up until each one is approved.
- File Medicare at opening so you do not lose billable days, and Medicaid with its managed care plans if you want them.
- Show you where everything stands on a status page for every application.
Who This Is For
Therapists and counselors, psychologists, nurse practitioners, physical, occupational and speech therapists, chiropractors and physicians opening a solo or small group practice, including part-time practices started alongside another job. We work nationwide. Leaving an employer to do it? See what happens to your current enrollments.
Frequently Asked Questions
I am opening a private practice. What should I do first?
Form the entity and get the EIN, then the group NPI, then CAQH. With those in place, apply to commercial plans right away, since they take the longest, and file Medicare once you open. Medicaid managed care plans need the state Medicaid enrollment first, so start that early if you want those plans.
Can I get credentialed before my office opens?
With most commercial plans, yes. They need your practice address, NPI, CAQH and malpractice, not patients, and you can sign the contract before opening. A few plans and Medicare need the location open: Medicare sets the effective date at the later of filing or your first service there (42 CFR 424.520(d)), with up to 30 days of retroactive billing (42 CFR 424.521(a)).
How long does credentialing take for a new practice?
Commercial plans often take 60 to 120 days from a complete application, and some take longer. Medicare and Medicaid processing varies by contractor and state. That is why commercial applications should go in three to four months before opening.
Which should I do first, Medicaid or a commercial plan like Blue Cross?
Both, in parallel. They do not depend on each other. What does depend: Medicaid managed care plans need your state Medicaid enrollment first, and every payer needs your group NPI and CAQH, so those come before either.
Can I open a part-time practice while keeping my current job?
Yes. Your new practice gets its own EIN, group NPI and payer enrollments. Your enrollment through your employer stays in place; with Medicare, you add a second reassignment to your own group rather than replacing the first.
Do I need a group NPI if I am the only clinician?
If you bill under an LLC or PC with its own EIN, yes. The group NPI identifies the practice, and your individual NPI identifies you as the clinician who saw the patient.
What does PECS charge for a new practice?
Group NPI $100, new CAQH profile $500, group onboarding $500, Medicare enrollment $500, state Medicaid $500 per state and each commercial plan $200. Enrollments are billed half at engagement and half at submission. One clinician with the group NPI, CAQH, group onboarding, Medicare and 4 commercial plans is $2,400. Ongoing maintenance after approval is $100 per provider per quarter.
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Answers cover PECS services, prices and process. For legal, tax or clinical questions please consult a professional.
By the PECS credentialing team, updated October 30, 2026.