When clinicians start a group practice, they often assume the hard part is getting the group "in network." That is half of it. Payers think in two layers: a contract with the group as a business, and credentialing of each individual who will see patients under that contract. Both have to be in place, and linked correctly, before claims pay the way you expect.
This guide explains how the two layers fit, what the group needs before it applies, and how to bring clinicians on without gaps. It complements our credentialing and contracting guide, which explains those two approvals in general.
Group contracts and individual credentialing
The group contract is an agreement between the payer and your practice entity. It identifies the group by its legal name, tax ID and group (Type 2) NPI, sets the fee schedule and terms, and lists the locations where the group provides care.
Individual credentialing is the payer's review of each clinician: license, education, training, malpractice history and so on. Once a clinician is credentialed, the payer links them to the group so that services they render can be billed under the group's contract.
A group contract with no credentialed clinicians cannot generate paid claims. A credentialed clinician who is not linked to the group's contract may be paid out of network, or not at all.
What the group needs before it applies
- A legal entity and tax ID, with ownership and authorized signers clearly documented.
- A group (Type 2) NPI in NPPES with the right taxonomy and practice address.
- Business licenses and facility requirements that apply to your specialty and location.
- Malpractice coverage for the entity and each clinician, as payers require.
- Practice locations that are ready to be listed, and in some cases inspected.
- A bank account in the group's name for payments.
- A payer plan that lists which networks you need first, based on your patients. Our guide to choosing payers can help.
What each clinician needs
- An individual (Type 1) NPI with current information.
- Active licenses, and DEA registration where relevant.
- A complete and attested CAQH profile with the group's information and locations. See our CAQH setup guide.
- Any existing payer participation documented, so it can be moved or linked rather than duplicated.
Medicare works the same way
Medicare follows a similar pattern. The group enrolls on a CMS-855B, and each clinician enrolls on an 855I and reassigns benefits to the group. Physician and non-physician practitioner groups do not pay the Medicare application fee. Our 855A vs 855B vs 855I guide covers how those forms fit together.
Adding clinicians to an existing group
Once the group is contracted, each new hire still needs to be credentialed and linked. Texas has a law that helps here. Under the Texas Insurance Code, certain physicians and other providers joining an established group that already contracts with a health plan may qualify for expedited credentialing, which can allow the plan to treat them as in-network while their full credentialing is completed. Eligibility depends on the plan type, the provider type and the details of the arrangement, so confirm it payer by payer.
Whatever the payer, a few habits prevent most problems: start applications as soon as a start date is known, keep the roster of who is linked to which payer up to date, and do not schedule patients for a payer until the clinician's linkage is confirmed.
Common problems for new groups
- Applying for the group contract before the entity, tax ID or group NPI details are final.
- Clinicians credentialed individually but never linked to the group.
- Locations listed differently on the contract, CAQH and NPPES.
- Old individual contracts left active and sending payments to the wrong place.
- No central roster, so nobody knows which clinician is active with which payer.
Why a roster matters from day one
A group's roster is the list of clinicians each payer believes are part of your practice. It sounds simple, but it drifts easily. A clinician leaves and is never removed. A new hire is credentialed but not linked. A location closes but stays on file. Each of these causes claims problems or directory errors later.
Keeping one internal roster, updated whenever someone joins or leaves, and comparing it with what each payer shows, is one of the most useful habits a new group can build. Many payers also ask groups to confirm or update their roster periodically for provider directory accuracy.
Texas Medicaid for groups
In Texas, groups that want to serve Medicaid clients need TMHP enrollment for the group and its performing providers, and then contracts with the Medicaid managed care plans that serve their area. That second step works much like commercial group contracting. Our Texas Medicaid and managed care guide explains the sequence.
How Maverick can help with group practice credentialing
- We plan the structure first. We confirm the entity, NPIs, locations and payer list before anything is filed, so the group contract and each clinician's credentialing line up.
- A complete and accurate file. We gather, check and line up your documents and data before anything is submitted, so the application agrees with itself and with the other records a reviewer will check.
- Prompt submission. Once your file is complete, we submit it. It does not sit in a queue on our side.
- Regular follow-up. We follow up with the payer or agency and handle requests for more information on your behalf.
- Keeping you updated. You always know where each application stands and what, if anything, we need from you.
Our Maverick Launch: Group package is built for this: your group and every clinician set up, filed and linked to your group's own contracts, with a roster tracker for new hires. Once you are up and running, Autopilot keeps recredentialing and changes on track, and Rate Check reviews the contracts you already hold. See our group enrollment and contracting service.
What we do not control is how long a payer, board or state agency takes to review your file. Those decisions belong to them, and we will never promise a date on their behalf.
Sources: NPPES (nppes.cms.hhs.gov) on Type 1 and Type 2 NPIs; CMS-855B and CMS-855I enrollment applications and Medicare application fee page (CMS.gov); Texas Insurance Code Chapter 1452, Subchapters C and D (expedited credentialing); Texas Department of Insurance guidance. Verified October 2026.