Credentialing for a new group practice
Credentialing a New Group Practice, in the Right Order
Medtransic credentials new group practices in behavioral health and medicine, so the group and every clinician are in network with each insurer. We get the group its organization NPI, enroll the group and each clinician in Medicare with benefits reassigned to the group, keep every CAQH profile attested, and apply to each commercial payer the way that payer takes groups. Each clinician's applications cost $150 per application, per provider; the group's own applications are priced separately, so ask us for that price. In our experience it usually takes 60 to 90 days with each payer. You can follow every application in your client portal.
- Clinician applications
- $150
- per application, per provider
- Typical time
- 60-90 days
- with each payer, in our experience
- Medicare backdating
- 30 days
- at most, so file before the first visit
- Contract
- None
- no long-term contract
What a new group sets up, in order
Illustrative- Each payer
Commercial payers
Group contract where offered, individual elsewhere
- Each clinician
CAQH profiles
Attested every 120 days
- Each clinician
Reassignment to the group
On the CMS-855I or in PECOS
- Group and clinicians
Medicare enrollment
CMS-855B for the group, CMS-855I per clinician
- Group
Organization NPI
Type 2, for the group itself
Where a new group loses its first months of revenue
Most of these come from doing the right steps in the wrong order.
Seeing patients before the group is enrolled
Medicare billing starts on the later of the filing date or the date you first saw patients at the new location. It allows billing back at most 30 days, so visits before that are unpaid.
Reassigning a clinician to a group Medicare does not know yet
A clinician can only reassign benefits to a group that is enrolled, or enrolling at the same time. The reassignment cannot start earlier than either enrollment.
Looking for a form that no longer exists
CMS merged the CMS-855R into the CMS-855I in 2023. Reassignment now goes on the CMS-855I or in PECOS, and old forms are sent back.
Expecting a group contract you are too small for
Optum offers group contracts only to groups of at least 5 credentialed clinicians with central intake and billing. Evernorth treats 4 or more clinicians as a clinic; smaller practices apply as individuals.
A CAQH profile that expires quietly
Each clinician must re-attest every 120 days, or 180 in Illinois. Miss it and the profile shows as expired to every payer reading it.
Who handles what when you open a group
Medtransic runs
- The group's organization NPI application in NPPES
- Medicare group enrollment on the CMS-855B or in PECOS
- Each clinician's Medicare enrollment and reassignment to the group
- CAQH profiles for every clinician, kept attested
- Commercial applications, filed the way each payer takes groups
- Every application, its stage and the documents we need, in your client portal
Your practice keeps
- Forming the business and getting its tax ID
- Signing as the group's authorized official
- Each clinician's license and malpractice cover
- Choosing which payers the group joins
Group Contract or Individual Credentialing?
The payer decides, not the practice. These are the published rules for the largest behavioral health networks as of October 2026.
Optum (UnitedHealthcare behavioral health)
Optum handles behavioral health credentialing for UnitedHealthcare. Without an Optum group agreement, each clinician applies as an individual; group contracts need at least 5 clinicians, central intake and billing, and claims under the practice tax ID.
Evernorth (Cigna behavioral health)
A clinic is 4 or more independently licensed clinicians sharing a tax ID, location and staff, and applies with a clinic form. Smaller groups, and clinicians joining an existing practice, apply as individuals.
Aetna
Aetna takes a separate individual application for each clinician in a group, not one group application. It reviews network need first, then reads each clinician's CAQH profile.
UnitedHealthcare medical
For medical groups already on a UnitedHealthcare group contract, approved clinicians are added to the group contract and tax ID. UnitedHealthcare asks for the request no more than 30 days before the start date.
How we credential a new group, step by step
The order matters: each step needs the one before it.
- 1
Organization NPI
We apply for the group's Type 2 NPI once you have your tax ID. Each clinician keeps the Type 1 NPI they already have.
- 2
Medicare group enrollment
We enroll the group on the CMS-855B or in PECOS, signed by your authorized official, and answer the contractor's questions within its 30 days.
- 3
Clinicians enrolled and reassigned
We file each clinician's CMS-855I with the reassignment to the group, at the same time as the group where we can.
- 4
CAQH and commercial payers
We build or update each CAQH profile, authorize the payers, and apply as a group or as individuals, as each payer requires.
- 5
Tracked in your client portal
Each application shows its stage in your client portal, with any document we still need from you.
Only your authorized official can sign the group's first Medicare application. We prepare it and tell you exactly what to sign.
Medicare rules a new group should know
These come from CMS and federal rules as of October 2026.
| Rule | What it says | What it means for a new group |
|---|---|---|
| Billing start date | The later of the filing date or the first day of service at the new location. | File before you open. Billing back is limited to 30 days, and only when enrollment in advance was not possible. |
| Reassignment | Clinician and group must both be enrolled, or enrolling together. | File the group and its first clinicians together, so no one waits on the other. |
| Reporting changes | Ownership, authorized official and location changes within 30 days; other changes within 90. | Moving offices or adding an owner is a filing, not just a new lease. |
| Revalidation | Every 5 years for most groups; notice comes 90 to 120 days before. | Keep the notice address current, or the reminder goes nowhere. |
| Shared liability | The group and the clinician are jointly responsible for overpayments on reassigned claims. | Clinicians can see every claim billed under their name. |
Your client portal, included
Your EHR shows what you billed. Your portal shows what we are doing about it.
Your EHR or practice management system runs your practice, but it does not show you our work. The Medtransic HIPAA Compliant Portal does: every claim and its current stage, the denials we are working, your A/R by age, each payer application and its in-network date, and the documents we still need from you. It is the same record our team works from, and it comes with every client account.
- Did that claim get paid?
- Every claim with its stage and amount, the denials we're working, and your receivables by age.
- Where is my application with Aetna?
- Each payer application shows its stage, its history, and the date you can start seeing that payer's patients.
- What do you still need from me?
- One list of the documents we're waiting on. Upload once, and it reaches every payer that asked for it.
When a group setup is not what you need
- If you are adding one clinician to a group that is already enrolled and contracted, you need individual credentialing for that clinician, not a group setup. Our counselor, psychologist and PMHNP credentialing pages cover that.
- If your practice is private pay only and will join no panels, you do not need payer credentialing. When you want billing later, it is 4-8% of what we collect for you.
Questions owners ask about credentialing a new group
Does a group practice need its own NPI?
Yes. A group practice gets an organization (Type 2) NPI. Each clinician keeps their own individual (Type 1) NPI, which does not change when they join the group.
Is the CMS-855R still used for reassignment?
No. CMS merged it into the CMS-855I in 2023. Reassignment to a group now goes on the CMS-855I or in PECOS.
Can a new therapy group get a group contract with insurers?
Some payers offer one and some do not. Optum requires at least 5 credentialed clinicians, Evernorth treats 4 or more as a clinic, and Aetna credentials each clinician individually. We check each payer before we apply.
Can we bill Medicare for visits before the group was enrolled?
Only up to 30 days before the effective date, and only when circumstances prevented enrolling in advance. File before the first visit.
How long does group credentialing take, and what does it cost?
In our experience it usually takes 60 to 90 days with each payer. Each clinician's applications are $150 per application, per provider. The group's own applications, such as its Medicare enrollment and group contracts, are priced separately; ask us for that price. There is no long-term contract.
Keep reading
- Credentialing for therapists and behavioral health →
- Counselor credentialing (LCSW, LPC, LMFT) →
- Psychologist credentialing →
- PMHNP credentialing →
- Credentialing by insurer, for therapists →
- CAQH provider profile guide →
- Payer enrollment →
- TherapyNotes billing →
- The client portal →
+ − Sources: 14 checked 2026-10-15
- CMS, NPI: What You Need to Know (MLN booklet), checked 2026-10-15
- CMS, How to apply for an NPI, checked 2026-10-15
- CMS MLN, Medicare Provider Enrollment (MLN9658742), checked 2026-10-15
- CMS, Consolidated CMS-855I/CMS-855R enrollment applications, checked 2026-10-15
- CMS, Processing reassignment of benefits (Program Integrity Manual attachment), checked 2026-10-15
- eCFR, 42 CFR 424.520, effective date of billing privileges, checked 2026-10-15
- eCFR, 42 CFR 424.521, retrospective billing, checked 2026-10-15
- eCFR, 42 CFR 424.80, reassignment and joint liability, checked 2026-10-15
- DataSpring (formerly CAQH), Resources and Provider Data Portal FAQs, checked 2026-10-15
- Optum Provider Express, Group with individually credentialed providers, checked 2026-10-15
- Optum Provider Express, Our Network, checked 2026-10-15
- Evernorth, Join the behavioral health network, checked 2026-10-15
- Aetna, Request to join the Aetna network, checked 2026-10-15
- UnitedHealthcare, Credentialing and recredentialing FAQ, checked 2026-10-15
Book a free consultation
We look at a sample of your actual claims and show you, line by line, where money is going uncollected. No commitment follows it.