Starting a new practice: enrollment and billing checklist

Opening a practice involves a long list of tasks, and billing setup often gets left until late. That is risky, because payer enrollment can take months, and you cannot bill in network until it is done. Start enrollment and billing planning as early as you can.

Business and identifiers

1. Form the business entity and get a tax ID (EIN) from the IRS.
2. Open a business bank account for deposits.
3. Get an organizational (Type 2) NPI for the practice through NPPES.
4. Confirm each provider's individual (Type 1) NPI and update addresses and taxonomy.
5. Confirm state licenses, DEA registration where needed, and any state facility or business licenses.

Enrollment

1. Decide which payers matter most for your patients and location.
2. Set up or update CAQH ProView for each provider, authorize payers, and attest.
3. Enroll the practice and providers in Medicare through PECOS, including reassigning benefits to the group.
4. Enroll with your state Medicaid program and Medicaid managed care plans if you will accept Medicaid.
5. Apply to commercial payers and track each application.
6. Record effective dates for each provider and payer as approvals arrive.

Systems

1. Choose an EHR and practice management system that fit your specialty.
2. Set up a clearinghouse and complete electronic claim enrollment with each payer.
3. Enroll for electronic remittance (ERA) and electronic funds transfer (EFT) with each payer.
4. Load fee schedules, provider information, and payer details into the system.

Workflow

1. Decide who verifies eligibility and authorizations, and when.
2. Set a target for closing notes, and a daily process for charge entry.
3. Decide who works rejections, denials, and follow up.
4. Write a patient financial policy covering copays, deductibles, self pay, and payment plans.
5. Agree on the reports you want each month.

Before the first patient

• Check which payers are active and which are still pending.
• Decide how you will handle patients whose plans are not yet active.
• Run a test claim where possible to confirm setup.

Common mistakes when opening

• Applying to payers too late, so the practice opens with most enrollments pending.
• Forgetting ERA and EFT setup, so payments arrive slowly by paper.
• Using different addresses on NPPES, CAQH, and applications.
• No clear owner for denials and follow up from the first week.

Questions to settle before opening day

• Which payers will be active on day one, and which are still pending?
• How will we schedule patients whose plans are not yet active?
• Who checks eligibility, enters charges, and works denials in the first month?
• What will our first monthly report show?
• Who will answer patient billing questions, and what will they say about plans that are still pending?

Where Afiable helps

Afiable plans enrollment and billing workflows with new practices before the first claim: credentialing, payer enrollment, clearinghouse and ERA setup, and day one billing. Book a free audit and we will build your enrollment and billing plan with you.

This article is general information for practice owners and managers. Payer policies and regulations change, so confirm current rules with each payer before acting.