Leaving Your Employer for Your Own Practice: What Happens to Your Insurance Enrollments
Short answer: your NPI, your CAQH (DataSpring) profile and your Medicare enrollment belong to you. Your contracts with commercial plans usually belong to your employer's tax ID. So leaving means three things: update what is yours, end the links to the old group on your last day, and get your new practice contracted, ideally before you leave.
- 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
What Stays and What Changes
| Item | Who it belongs to | What to do |
|---|---|---|
| Individual NPI (Type 1) | Stays yours for life | Update your practice address in NPPES within 30 days of the change. |
| CAQH (DataSpring) profile | Stays yours | Add the new practice location, end the old one on your last day, re-attest and authorize the plans you are joining. |
| Medicare enrollment | Stays yours | Your reassignment to the old group ends. Your new practice enrolls as a group and you reassign to it. |
| Medicaid enrollment | Usually stays yours | Your link to the old group ends and the new practice is added, with its own enrollment where the state requires one. |
| Commercial plan contracts | Usually belong to your employer's tax ID | Plans typically keep your credentialing on file, but your new practice needs its own contract, or the new tax ID added, before you can bill under it. |
| Malpractice coverage | Usually ends when you leave | Get your own policy naming the new practice. If the old policy was claims-made, ask about tail coverage. |
The Order That Avoids a Gap in Billing
- Set Up the Practice (3 to 4 months before you leave). Form the entity, get the EIN, the group (Type 2) NPI and a practice address, and line up your own malpractice policy. Every application uses these.
- Update CAQH and Apply to Plans (3 to 4 months before). Add the new location to CAQH (DataSpring) with its start date, then apply to the commercial plans you want. They take the longest, and most can contract before your first day.
- Agree on the End Date (When you give notice). Agree with your employer that your reassignment and group links end on your last day, not before, so their claims for your visits still pay.
- Medicare for the New Practice (Your first days). Enroll the practice in PECOS and reassign your benefits to it. Medicare allows up to 30 days of retroactive billing, so file within your first month.
- Medicaid and Managed Care (Alongside). Add the new practice with your state Medicaid program, then with each Medicaid managed care plan you want to keep.
The most common mistake is waiting until after the last day to start. Commercial plans often take 60 to 120 days from a complete application, so a late start means months of seeing patients you cannot bill in network. Setting up the practice itself? See credentialing for a new practice.
What We Do for You
- Get the group NPI and set up the practice with each payer.
- Update your NPPES and CAQH (DataSpring) records so every application matches.
- File the Medicare enrollment and reassignment in PECOS, and the commercial and Medicaid applications.
- Follow up with every plan until it confirms your effective date, with a live status page.
Frequently Asked Questions
I was enrolled through my former employer. Can my enrollment move to my practice?
Partly. What is tied to you moves with you: your NPI, your CAQH (DataSpring) profile and your Medicare enrollment. What is tied to the employer's tax ID does not: the group contracts with commercial plans and your Medicare reassignment to their group. Your new practice gets its own contracts and you reassign to it.
Do I need a new NPI when I leave my job?
No. Your individual NPI is yours for life. You update its practice address in NPPES. If your new practice is an LLC or PC with its own EIN, the practice gets its own group (Type 2) NPI.
Will I lose my Medicare enrollment when I leave?
No. Your individual enrollment stays active; only the reassignment to the old group ends. Do set up billing somewhere soon, because CMS can deactivate an enrollment that submits no claims for 12 months in a row (42 CFR 424.540(a)(1)).
Do I have to be credentialed again with every insurance plan?
Usually not from scratch. Plans credential you as a clinician and keep that on file, but contracts are tied to a tax ID. Your new practice needs its own contract with each plan, or the new tax ID added to an existing one. Some plans handle it as a short form and others as a full new application.
Can I see my patients from my first day?
With every plan that has contracted with your new practice by then, yes. That is why the commercial applications go in three to four months before you leave. For Medicare, you can bill up to 30 days before your filing date (42 CFR 424.521(a)). For a plan still pending, patients can pay out of pocket or wait until the effective date.
Can I keep working part time for my employer?
Yes. Keep your links to their group and add your own practice. With Medicare, you hold two reassignments, one to each group.
Who ends the reassignment with my old employer?
Either you or the group can end it in PECOS. Agree on your last day as the end date so neither side has claims denied.
What does PECS charge for this?
Group NPI $100, group onboarding $500, CAQH (DataSpring) update $250, Medicare $500 and each commercial plan $200. With 4 commercial plans, the total is $2,150. Enrollments are billed half at the start and half at submission, with no monthly fee or contract.
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