Insurance Credentialing for Group Practices
Credentialing a group practice is a different challenge than credentialing a solo provider. You have a group NPI to enroll, individual providers to roster under the group, ongoing changes as providers join and leave, and a need for all of it to stay current so your billing is never interrupted.
Most credentialing services are built around solo providers. TheraProfessional works with group practices specifically, and we understand the additional complexity that comes with managing credentialing at the practice level.
What Is Different About Group Practice Credentialing
A solo provider has one NPI and credentials as an individual. A group practice has a Type 2 NPI for the practice entity itself, and each provider has their own Type 1 individual NPI. For insurance billing, both the individual provider and the group entity often need to be enrolled with each payer.
This means there are more applications, more enrollments, and more moving parts than solo credentialing. It also means that when something goes wrong, it can affect billing for multiple providers at once.
Group NPI Enrollment
Most commercial payers and Medicare require that your group NPI be enrolled as a billing entity separately from the individual provider enrollments. Until the group NPI is enrolled, you may not be able to bill under the group entity even if your individual providers are fully credentialed.
We handle group NPI enrollment with each payer as part of our group practice credentialing service.
Rostering New Providers
Every time a new provider joins your practice, they need to be credentialed individually and then rostered under your group with each payer. This is a separate process from the new provider's individual credentialing and needs to happen before they can bill under your group NPI.
Failing to complete this step, or completing it too slowly, results in claims denials and delayed reimbursement for new providers from their first day of billing.
We manage new provider roster additions for our group practice clients as an ongoing service, so the process is initiated as soon as a new hire is confirmed rather than after they have already started seeing clients.
Medicare PECOS Enrollment for Groups
Medicare credentialing for group practices involves enrolling both the group entity and each individual provider through PECOS, and then completing reassignment of each individual provider's billing rights to the group entity. All three steps need to be in place before the group can bill Medicare for that provider's services.
Medicare PECOS enrollment and reassignment is one of the most common areas where group practices experience billing delays. We handle each step in the correct sequence and track each component separately.
Managing Provider Departures
When a provider leaves your practice, their roster status with each payer needs to be updated. Failing to remove a departed provider from your group roster can create billing and compliance issues. We handle provider departures and terminations as part of ongoing credentialing management for group practice clients.
Keeping Credentialing Current
Active credentialing is not a one-time task. Licenses renew, malpractice policies renew, CAQH attestation expires every 120 days, and payers periodically require re-credentialing of paneled providers. For a group practice with multiple providers, keeping all of this current is a significant ongoing administrative responsibility.
Our maintenance retainer for group practices covers ongoing credentialing monitoring, attestation management, document updates, and coordination with payers for re-credentialing cycles.
Pricing for Group Practices
Individual provider credentialing for group practice clients is priced at $275 per payer when credentialing four or more payers at once. Group NPI enrollment is $125 per payer. Maintenance retainer pricing for group practices is available on request and is based on the size of your provider roster.
We are transparent about what is included and what is not before any agreement is signed.
Who We Work With
We work with group practices of all sizes, from two-provider partnerships to multi-site clinics. Our group practice clients include LCSWs, LMFTs, LPCs, psychologists, and PMHNPs. We are experienced with the credentialing requirements across a wide range of commercial payers, Medicare, and Medicaid programs.
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