Solo & Small Practice Credentialing

In a solo or two-clinician practice, "the credentialing person" is you, squeezed between patients, on hold with a payer, wondering whether the application from months ago is still moving. Every hour it takes is a clinical hour you do not bill, and every month it slips is a month of in-network revenue you do not collect.

We are the credentialing department you do not have to hire: panel strategy, clean applications, regular payer follow-up, and a straight answer whenever you ask where things stand.

Find your practice type

The rules that decide how your file moves are specific to your license, not your practice size. These pages go deeper on what each payer actually does with your license type:

• Nurse practitioners: independent panelability by payer, Texas delegation, and the incident-to trap.
• Therapists & counselors: license-level panelability and closed-panel appeals that actually work.
• Dentists: fee-schedule assignment and the network-leasing clause nobody reads.
• Chiropractors: the delegated specialty networks that hold your contract instead of the payer.
• Family medicine & primary care: the broad payer list, Medicare and Medicaid together, and attribution rules.

The launch order that wastes the least

For a new practice, credentialing is usually the longest lead-time item, longer than the lease, the EHR, or the website. You cannot bill a payer before your effective date, so the order of operations decides when revenue starts. The sequence that costs the least:

1. Entity, tax ID, and NPI structure first. Decide whether you bill as an individual or under a Type 2 organizational NPI, and make sure the IRS letter, bank account, and NPI records all match exactly.
2. CAQH before any application. Commercial payers pull your file from CAQH. An incomplete or unattested profile stops the review without a rejection letter.
3. Pick the panels, then file them together. Medicare, Medicaid where it fits your practice, and the commercial plans your patients actually carry, all filed in parallel rather than one at a time.
4. Texas Medicaid before the MCOs. TMHP enrollment has to close before any Medicaid managed care plan will credential you.
5. Open on private-pay or a hybrid model while panels close. Many practices see self-pay patients first and add insurance as each effective date is confirmed.

Start as early as you can. We do not promise payer processing times, because payers set their own pace and it varies. What we can promise is that your file will never be the reason it waits.

Which panels a small practice should join

Not all of them. The right list depends on your specialty, your market's employer mix, and each panel's rates and administrative hassle. A plan with a large membership in your county and a reasonable fee schedule is worth the application. A plan with few members near you, low rates, and heavy prior authorization often is not. Panel strategy is the first conversation we have, and sometimes the answer is fewer panels than you would guess.

When offers come back, read the contract before you sign. Fee schedules, lesser-of clauses, auto-renewal windows, and network-leasing language decide what the panel is actually worth. We review each offer with you and flag the terms that matter, and you make the call.

Where solo files stall

• Mismatched records. A practice name, address, or tax ID that reads one way on the IRS letter, another on NPPES, and a third on CAQH.
• Unexplained work-history gaps. Payers ask about gaps, and an unanswered question stops the file.
• Lapsed attestation. CAQH requires regular re-attestation, and a lapsed profile can quietly pause every pending application.
• Missing documents. Malpractice face sheets, DEA, board certification, and diplomas that take time to reissue.
• Silence. Applications that nobody follows up on are the ones that drift.

After you are in-network

Getting credentialed is the start, not the finish. A go-live check confirms you are loaded under the right tax ID and location, that EFT and ERA are set up, and that a first claim pays. Then the maintenance work begins: CAQH re-attestation, license and malpractice renewals, Medicare revalidation, and payer recredentialing. Missing any one of them can suspend payments, so we track them for you and file ahead of each deadline.

How we work a solo practice

We start with one short call about your license, location, specialty, and the patients you want to see. You get a written quote and a clear list of what we need from you. A named specialist then builds your CAQH profile, prepares and submits every application promptly once your file is complete, follows up regularly with every payer, and confirms each effective date in writing. Whenever you want to know where things stand, you ask and get a straight answer.