Start a Private-Insurance-Credentialed Practice

1. 1

   Know the two credentialing layers

   Payers credential the individual and the entity independently. A solo practitioner needs individual credentialing (primary source verification of education, board status, malpractice history) under their Type 1 NPI; a group or facility ALSO needs entity credentialing with a group tax ID, group NPI, and verification of every owner. Budget time for both if you are building a group.

2. 2

   Choose networks like a strategist

   Each commercial payer maintains its own process, rate schedule, and network adequacy standards. Research which insurers dominate your market's employers, whether panels are open or closed in your specialty, and what each pays for your core codes before applying anywhere.

3. 3

   Know your lane's special rules

   Behavioral health credentialing runs through separate managed behavioral health networks with meaningfully different requirements than medical credentialing; therapists (LCSW, LPC, LMFT, psychologists) should target those networks specifically. Locum and new group providers still need their own individual credentialing regardless of the group's status.

4. 4

   Submit complete and track relentlessly

   Incomplete applications are the top cause of months-long delays. Keep a master credentialing file (license, DEA if applicable, malpractice certificate, work history, references), use CAQH where payers require it, and follow up on every application on a schedule.

5. 5

   Negotiate rates instead of just signing

   Commercial contracts are negotiable in a way government rates are not, especially where a specialty is scarce. Never sign the first fee schedule without asking; a few points on your core codes compounds across every visit for years.

6. 6

   Run the revenue cycle like it is the business

   Verification of benefits, clean claims, denial follow-up, and credentialing renewals decide profitability. Whether you hire a biller, outsource, or learn it yourself, someone must own it from day one.

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