What is the Interstate Medical Licensure Compact and which states participate?

The IMLC is a physician licensure agreement enabling physicians licensed in one member state to obtain expedited licensure in other member states through a streamlined process. As of 2026, 40+ states participate. Processing time is 6–8 weeks per state — faster than individual state applications. The Compact does not replace state licensure; it accelerates it. Separate DEA registrations are still required in each state where controlled substances are prescribed.

What technology does a telehealth practice need on day one?

Core technology stack: a HIPAA-compliant telehealth platform (Doxy.me, Zoom for Healthcare, or integrated EHR telehealth) with BAA executed; an EHR with billing integration; and a practice management system for scheduling, eligibility verification, and claims submission. Every vendor handling PHI must sign a BAA before you see a single patient.

What is the Ryan Haight Act and how does it affect telehealth prescribing of controlled substances?

The Ryan Haight Act requires an in-person evaluation before prescribing controlled substances via telemedicine. Exceptions exist for patients in DEA-registered facilities, during declared emergencies, and potentially through a DEA Special Registration for telemedicine (a proposed pathway with evolving regulatory status). Telehealth prescribers of controlled substances should consult a healthcare attorney for current DEA guidance before prescribing Schedule II–V medications to new patients via telemedicine.

How to Start a Telehealth Practice from Scratch: Complete 2026 Guide

Starting a telehealth practice requires: multi-state medical licensing, insurance credentialing in every state where patients are located, HIPAA-compliant technology, malpractice insurance covering telehealth, and correct telehealth billing setup. Credentialing is the binding constraint — start it first.

Timeline to Launch

Months 5–6 before launch: Business formation, licensing applications, CAQH ProView, credential applications submitted to all payers simultaneously. Months 3–4: Technology selection, BAAs executed. Month 1: Marketing, schedule opens (verify payer effective dates before billing any insured patients).

Multi-State Licensing

Interstate Medical Licensure Compact (IMLC) accelerates licensure in 40+ states. Plan 3–6 months for multi-state licensing. DEA registration required in each state where controlled substances are prescribed.

Telehealth Credentialing

Same process as in-person credentialing, multiplied across every state where patients are located. ProEnrollment manages simultaneous multi-state telehealth credentialing. See our telehealth credentialing services. Most common mistake: starting credentialing too late. Free consultation.

Technology Stack

HIPAA-compliant telehealth platform (BAA required), EHR with telehealth integration, practice management system. See EHR vs EMR guide. Telehealth billing: modifier 95, POS 10 or 02. See CPT codes for telehealth.

The Legal Stack Before Your First Visit

A compliant telehealth practice needs, in order: entity formation appropriate to your state's corporate-practice-of-medicine rules (some states require professional entities, and multi-state operations may need friendly-PC structures), licenses in every state where patients will be located, malpractice coverage that explicitly includes telehealth across your state list, a HIPAA-compliant platform with a signed BAA, and payer enrollment in each patient state. Skipping the enrollment layer is the most common founder mistake — coverage mandates don't pay unenrolled providers.

The Revenue Model Decision

Insurance-based telehealth means credentialing in every patient state (Medicare PECOS once, Medicaid per state, commercial per state) — a 120–180 day build that creates a defensible moat once done. Cash-pay avoids credentialing but caps your addressable market and runs into superbill/out-of-network friction. Hybrid models start cash-pay while credentialing completes, then convert. For behavioral telehealth — the strongest telehealth category — Medicare's permanent home-originating-site rule and audio-only coverage make insurance participation especially valuable. Telehealth credentialing service | post-waiver rules | new practice setup.