Oak & Willow Billing LLC » Starting a Solo Medical Practice: Your Billing and Credentialing Setup Checklist

Starting your own practice is one of the most exciting things a provider can do — and one of the most administratively overwhelming. Between setting up your clinical operations, finding office space or a telehealth platform, hiring staff, and managing the business side, billing and credentialing often get pushed to the back of the list.

Don't let that happen. Billing and credentialing decisions made early will determine how quickly you can see insured patients and how smoothly your revenue cycle runs from day one. Here's what you need to set up, and in what order.

Phase 1: Before You Open the Doors

✅ Obtain your National Provider Identifier (NPI)

Your NPI is your unique provider identifier — you need it for everything. Apply at nppes.cms.hhs.gov. If you're starting a group practice, you'll need both an individual NPI (Type 1) and a group NPI (Type 2).

✅ Set up your CAQH ProView profile

Register at proview.caqh.org and complete your profile in full. Most commercial payers will pull from CAQH during credentialing, so having this ready before you apply saves weeks.

✅ Obtain or update your DEA registration (if applicable)

If you prescribe controlled substances, you need a DEA registration. Apply at deadiversion.usdoj.gov. This typically takes 2–4 weeks and some payers require it before credentialing.

✅ Secure professional malpractice insurance

You'll need this before most payers will credential you. Confirm your coverage dates and get the declarations page — you'll need it for your CAQH profile and credentialing applications.

✅ Obtain a Tax Identification Number (TIN) / EIN

If you're billing under a business entity (LLC, PLLC, PC), you'll need an EIN. Apply free at irs.gov. This is what you'll use for Medicare enrollment and most payer applications.

Phase 2: Start Credentialing Immediately

✅ Identify your target payers

Which insurance companies do your patients use? Start with the highest-volume plans in your area. Don't try to credential with everyone at once — prioritize the payers that will generate the most revenue early.

✅ Begin Medicare enrollment

If you'll accept Medicare, start this process as early as possible. Medicare enrollment can take 60–120 days. Complete your 855I (individual) or 855B (group) application via PECOS (pecos.cms.hhs.gov).

✅ Apply to commercial panels

Submit applications to your target commercial insurers. Complete applications = faster processing. Use your CAQH profile number on every application.

✅ Apply to Medicaid (if applicable)

Medicaid enrollment is state-specific and timeline varies widely. Start this early if you plan to see Medicaid patients.

Phase 3: Set Up Your Billing Infrastructure

✅ Choose an EHR/practice management system

Your clinical and billing data need to live together. Look for systems with integrated billing modules: Athena, SimplePractice, TherapyNotes, DrChrono, Practice Fusion, and others.

✅ Set up your billing workflow

Decide early: will you handle billing in-house or outsource it? Outsourcing typically costs less than in-house staff when you factor in salary, benefits, training, and turnover — and you get immediate expertise rather than learning on the job.

✅ Establish a patient financial policy

Create a clear written policy on copays, deductibles, patient balances, and payment plans. Collecting at the time of service dramatically improves your patient balance collection rate.

A Note on Timing

The biggest mistake new practices make is waiting too long to start credentialing. The process takes time even when everything goes right. If you want to see insured patients in Month 1, your credentialing applications need to go in 3–4 months before you open — or sooner for Medicare.

Oak & Willow Billing helps new practices navigate every step of this process. We set up your CAQH profile, prepare and submit your payer applications, and track everything through to approval. If you're planning to open a practice in the next 6 months, now is the time to start.

Schedule a free consultation at oakwillowbilling.com.