Case Study: New Practice From Zero to Credentialed
How Fast Can a New Practice Get Credentialed?
A new practice engaged ProEnrollment at entity formation rather than at opening. By starting credentialing on day one — NPI, CAQH, Medicare, Medicaid, and commercial payers submitted in parallel — the practice's effective dates landed near its open date instead of a quarter later.
The Problem: The Sequencing Trap
Most new practices sequence credentialing after buildout, hiring, and marketing — then discover their first quarter is cash-pay only because no payer has issued an effective date. For a physician projecting $30,000/month in insurance revenue, that sequencing mistake costs $60,000–$90,000 before the practice ever gets going.
The Action: Day-One Parallel Submission
We started the week the entity existed. Week 1: EIN, Type 1 and Type 2 NPI registration, malpractice bound with the new entity named. Weeks 1–2: CAQH profile built complete with the new practice address. Weeks 2–3: Medicare CMS-855I, 855B, and 855R filed together; state Medicaid submitted; all commercial applications out simultaneously. Weeks 3–16: weekly follow-up on every application, deficiency responses within days, effective dates confirmed in writing.
The Result: Billing on Schedule
Because credentialing ran parallel to buildout rather than after it, the practice's payer effective dates arrived in line with its opening — turning what is normally a lost first quarter into a billing quarter. The pre-submission audit meant applications cleared first-time rather than cycling through deficiency loops.
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