Credentialing a Therapy Group Practice
Enrollments are billed 50% at the start and 50% at submission; everything else 100% at the start.
- 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
A therapy group is credentialed in two layers: the practice enrolls as a billing entity under its own Tax ID and Type 2 NPI, and each clinician enrolls individually and is linked to it. Physical, occupational and speech therapy groups and behavioral health groups follow the same outline. What costs groups time and money is doing the steps out of order. This guide gives the order, then each payer type.
Order of Operations: Avoid Paying Twice
Set up the entity completely before the first payer application goes out. Every application asks for the legal name, Tax ID and group NPI, and changing any of them later means amending each payer record or starting again.
- Form the entity. Your state may require a professional corporation or professional LLC for licensed clinicians; confirm with your state board or attorney.
- Get the EIN from the IRS and keep the confirmation letter. The legal name on it is the name every payer will match.
- Get the group's Type 2 NPI in NPPES, with a taxonomy that matches the services the group bills and the same practice address you will use everywhere else.
- Open the bank account and prepare the W-9 in the entity's name for electronic payment enrollment.
- Then file: CAQH (DataSpring) for each clinician, Medicare, Medicaid, and the commercial plans, in the same week where possible.
Group Enrollment Versus Individual Enrollment
Group enrollment means the practice holds the payer contract and is paid under its Tax ID, while each clinician is credentialed and listed under it. Individual enrollment means the clinician contracts under their own name and SSN. A group is more setup up front and much less later, because a new hire joins an existing contract instead of negotiating a new one. Decide before filing; converting from individual to group afterward means amendments with every payer.
Medicare: One 855B for the Group, One 855I per Clinician
The group enrolls once on CMS-855B. Each clinician files one CMS-855I, which since 2023 also carries the reassignment of benefits to the group: CMS merged the old CMS-855R into the 855I and no longer uses the 855R for reassignment. In PECOS, reassignments are added or ended in the Reassignment topic. Both the clinician and the group must be enrolled, or enrolling at the same time, for a reassignment to take effect, and adding a clinician does not change the group's PTAN.
Two Medicare details matter for therapy groups. Physical therapists enrolling as individuals or as group practices are in Medicare's moderate screening category, which brings an unannounced site visit. And Medicare allows billing for up to 30 days before the effective date only when the practitioner met every requirement, including licensure, during that period, so a late filing costs real visits.
CAQH (DataSpring) for Every Clinician
Each clinician needs their own CAQH (DataSpring) profile, listing the group's practice location and Tax ID exactly as they appear on the W-9, attested within the last 120 days, and authorized for each plan. Evernorth, for example, requires the W-9 to match the Tax ID on its application. One clinician's stale attestation can hold up that clinician's link to every plan.
Medicaid: State Enrollment, Then the Plans
Federal rules require Medicaid managed care network providers to be enrolled with the state, so state enrollment comes first. States differ on structure: some enroll the group as the payee and list clinicians as rendering providers, some enroll each clinician and the group separately, and some limit which therapy specialties bill fee-for-service at all. Confirm your state's model before filing, then credential with each managed care plan.
Commercial Plans and Rosters
Commercial plans contract with the group and then credential or roster each clinician under it. After the first contract, most plans add clinicians through a roster update or an individual application linked to the group's Tax ID. Therapy and behavioral groups often deal with a separate company for part of the work: UnitedHealthcare routes outpatient therapy to Optum Physical Health and behavioral health to Optum Behavioral Health, and Evernorth treats four or more independently licensed providers sharing a Tax ID, location and administrative staff as a clinic with its own Clinic Information Form. Carelon adds clinicians who join an existing group to the group's agreement after credentialing. See our behavioral health carve-out guide and the PT, OT and speech guide for which plans route where.
Adding a Clinician Later
For a new hire, the work is a CAQH (DataSpring) profile with the group's location, a CMS-855I with reassignment, Medicaid as your state requires, and a roster addition or application with each plan. Start on the day the offer is signed. Sessions billed before the link is effective usually deny, and most commercial plans will not backdate to cover them.
What PECS Does for Groups
PECS handles group onboarding (Tax ID and Type 2 NPI linkage, group payer records and rosters), each clinician's CAQH (DataSpring) profile, Medicare, Medicaid and every plan, at the flat amounts on our pricing page. Typical timelines are on credentialing timelines by state and payer.
Frequently Asked Questions
Does a therapy group need its own NPI?
Yes. A group practice that bills under its own Tax ID needs a Type 2 (organization) NPI from NPPES, in addition to the Type 1 NPI each clinician already holds. The group NPI, the EIN and the legal name on the IRS letter should match exactly on every application, because a mismatch between IRS records and an application is a common reason for rejection.
Is a separate CMS-855R still needed to reassign a clinician to the group?
No. CMS merged the CMS-855R into the CMS-855I in 2023. A clinician joining a group now files one CMS-855I that covers both the clinician’s own enrollment and the reassignment of benefits to the group, and in PECOS reassignments are handled in the Reassignment topic. The group itself enrolls once on CMS-855B.
In what order should a new group practice set things up?
Form the entity, get the EIN, get the group’s Type 2 NPI, open the bank account in the entity’s name, and only then file with payers. Filing under an individual’s SSN before the entity exists means every payer record has to be amended or redone later, which is the most common way practices pay for the same enrollment twice.
How do I add a new clinician to a group that is already credentialed?
The clinician needs a CAQH (DataSpring) profile listing the group’s location, a CMS-855I with reassignment for Medicare, Medicaid enrollment as the state requires, and an application or roster addition with each commercial plan. Most plans will not pay for the clinician’s sessions until the link to the group is effective, so start the day the offer is signed.
Do behavioral health groups credential differently from therapy groups?
Partly. Many plans route behavioral health to a separate company. Evernorth, which runs Cigna’s behavioral network, treats four or more independently licensed providers sharing a Tax ID, location and administrative staff as a clinic with its own Clinic Information Form, and Carelon adds clinicians to an existing group’s agreement after it credentials them.
Sources: CMS: consolidated CMS-855I and 855R · CMS MFT and MHC FAQ (reassignment) · 42 CFR 424.518 (screening levels) · 42 CFR 424.521 (retrospective billing) · 42 CFR 438.602 (Medicaid managed care enrollment) · Evernorth: join the network · Carelon: join our network.
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By the PECS credentialing team. Updated October 2026.