Starting a Medical Practice: Credentialing Checklist Before Day One

Practice Type Guide

The Credentialing Timeline Reality

You've signed a lease, ordered equipment, and hired staff. But can you actually see patients and get paid? The credentialing process can take up to six months, which is why you need to budget enough time when you set up your practice.

This checklist covers everything you need to credential before opening day—and the timeline for getting it done.

Master Timeline Overview

Section 1: Personal Physician Credentials

State Medical License

Each state has specific licensing rules and timelines, so review these conditions thoroughly and plan ahead. It takes around 2 months on average for the state medical board to process and approve an application.

Checklist:

• ☐ Verify current license is active and in good standing
• ☐ If relocating, apply for new state license 4-6 months ahead
• ☐ Complete any state-specific CME requirements
• ☐ Update address with medical board after move

DEA Registration

You must have your medical license before you submit your DEA registration, so plan accordingly. Your DEA number will stay with you throughout your entire career in medicine, though you will need to renew it every 3 years.

Checklist:

• ☐ Apply for DEA registration after state license is active
• ☐ Use new practice address on application
• ☐ Select appropriate schedules (typically II-V)
• ☐ Budget for $888 fee (3-year registration)
• ☐ Timeline: 4-6 weeks after application

State Controlled Substance Registration

Many states require a separate state-level controlled substance registration in addition to federal DEA.

Checklist:

• ☐ Research whether your state requires separate CDS registration
• ☐ Apply after DEA registration is issued
• ☐ Note state-specific requirements (some states link to PDMP)

Board Certification

While not always legally required for practice, board certification is practically essential for payer credentialing.

Checklist:

• ☐ Verify board certification is current
• ☐ Document MOC (Maintenance of Certification) status
• ☐ Have certificate and verification letter available

Section 2: NPI and CAQH

National Provider Identifier (NPI)

You need two NPI numbers: Type 1 (individual) and Type 2 (organization/practice).

Checklist:

• ☐ Verify existing Type 1 NPI or apply at NPPES
• ☐ Apply for Type 2 NPI for your practice entity
• ☐ Update Type 1 NPI with new practice address
• ☐ Timeline: Usually within 10 days

CAQH ProView Profile

CAQH ProView for credentialing is used by over 1.4 million providers and is required by most commercial payers.

Checklist:

• ☐ Create or update CAQH profile
• ☐ Upload all required documents (license, DEA, malpractice, etc.)
• ☐ Attest to accuracy quarterly
• ☐ Keep profile current—payers pull data automatically

Documents to Have Ready for CAQH

Section 3: Insurance and Payer Credentialing

Medicare Enrollment

Medicare enrollment happens through PECOS (Provider Enrollment, Chain, and Ownership System).

Checklist:

• ☐ Create PECOS account or access existing one
• ☐ Enroll practice entity (Type 2 NPI)
• ☐ Link individual providers to practice
• ☐ Submit all required documentation
• ☐ Timeline: 60-90 days typically

Medicaid Enrollment

Medicaid enrollment is state-specific and separate from Medicare.

Checklist:

• ☐ Research state Medicaid enrollment requirements
• ☐ Determine if managed Medicaid plans require separate enrollment
• ☐ Apply through state Medicaid portal
• ☐ Timeline: Varies by state (30-90 days)

Commercial Payer Credentialing

The first step is credentialing, where you get networked with health insurance companies. The insurers will want to know about your medical education and residency, as well as confirming that you're properly licensed and have appropriate malpractice insurance.

Checklist:

• ☐ Identify major commercial payers in your market
• ☐ Contact each payer about network participation
• ☐ Complete payer-specific applications (many use CAQH)
• ☐ Negotiate rates where possible
• ☐ Timeline: 60-120 days per payer

Priority Payers to Target

1. Medicare (non-negotiable for most practices)
2. Largest commercial payer in your market (often Blue Cross)
3. Second-largest commercial payer
4. Medicaid (if accepting)
5. Remaining major payers

Section 4: Business and Facility Credentials

Business Entity Formation

Decide on the legal structure of your practice (e.g., sole proprietorship, partnership, corporation, LLC).

Checklist:

• ☐ Consult attorney for business structure advice
• ☐ File formation documents with state
• ☐ Obtain EIN (Employer Identification Number) from IRS
• ☐ Register business name
• ☐ Open business bank accounts

Business Licenses and Permits

Starting your own medical practice typically involves obtaining different types of business permits and healthcare licenses. The specific requirements will vary depending on the size, specialty, and location of your practice.

Checklist:

• ☐ State business license
• ☐ Local business license (city/county)
• ☐ Health department permits (if required)
• ☐ Occupancy permit for practice location
• ☐ Zoning verification

Facility-Specific Licenses

Depending on your location, you may need to obtain a permit or license from your state, county, or city health department. These permits ensure that your medical practice complies with local health and safety regulations.

If applicable:

• ☐ CLIA certificate (if performing lab tests)
• ☐ Radiology license (if performing imaging)
• ☐ State facility license (for certain specialties/procedures)
• ☐ Accreditation (AAAHC, etc. if performing procedures)

Section 5: Hospital Privileges (If Needed)

Hospital Credentialing

If you need admitting privileges or will perform procedures at a hospital:

Checklist:

• ☐ Identify hospitals where you need privileges
• ☐ Request applications from medical staff offices
• ☐ Gather required documentation (similar to CAQH)
• ☐ Complete peer reference requirements
• ☐ Prepare for possible interview
• ☐ Timeline: 60-120 days typically

Section 6: Insurance Requirements

Malpractice Insurance

Checklist:

• ☐ Obtain quotes from multiple carriers
• ☐ Verify coverage meets state minimums
• ☐ Verify coverage meets hospital requirements
• ☐ Verify coverage meets payer requirements
• ☐ Understand claims-made vs. occurrence policies
• ☐ Budget for tail coverage if claims-made

Other Insurance

• ☐ General liability insurance
• ☐ Property insurance
• ☐ Workers' compensation (if employing staff)
• ☐ Cyber liability insurance (for EHR/patient data)

Section 7: Compliance Requirements

HIPAA Compliance

Complete compliance with HIPAA, OSHA, and other relevant healthcare regulations is required before seeing patients.

Checklist:

• ☐ Develop privacy policies and procedures
• ☐ Create Notice of Privacy Practices
• ☐ Implement security safeguards
• ☐ Train staff on HIPAA requirements
• ☐ Designate privacy officer
• ☐ Execute Business Associate Agreements with vendors

OSHA Compliance

• ☐ Develop exposure control plan
• ☐ Ensure proper disposal procedures for sharps/biohazards
• ☐ Post required notices
• ☐ Document staff training

Document Collection Checklist

The most important physician credentialing checklist includes gathering all required documentation:

Educational

• ☐ Medical school diploma
• ☐ Medical school transcript
• ☐ Residency certificate(s)
• ☐ Fellowship certificate(s) if applicable
• ☐ Board certification certificate

Licensing

• ☐ State medical license (wallet card and wall certificate)
• ☐ DEA certificate
• ☐ State controlled substance registration

Professional History

• ☐ CV/resume with complete work history
• ☐ Explanation of any gaps in employment
• ☐ Professional references (3-5 typically)
• ☐ Hospital privilege documentation

Insurance and Legal

• ☐ Malpractice insurance certificate
• ☐ Claims history
• ☐ Any disciplinary history documentation

Personal

• ☐ Personal immunization records
• ☐ TB test documentation
• ☐ Health attestation
• ☐ Background check authorization

Final Pre-Opening Verification

One week before opening, verify:

• ☐ State license is active (check online verification)
• ☐ DEA registration is active
• ☐ Medicare enrollment is complete
• ☐ At least one major commercial payer is active
• ☐ Malpractice insurance is in effect
• ☐ EHR/billing system has correct NPI and credentials
• ☐ CAQH profile is attested and current

Conclusion

Credentialing is the hidden timeline in practice startup. You can find a location, buy equipment, and hire staff in weeks—but credentialing takes months. Start the credentialing process as soon as you've decided to open a practice, not after you've signed a lease.

The practices that open on time and bill from day one are those that treated credentialing as the critical path it is.

Key Takeaways

• Start 6 months before opening: Credentialing takes 3-6 months
• Complete CAQH first: Most payers pull from CAQH
• DEA requires license first: Sequence matters
• Medicare takes 60-90 days: Apply early
• Commercial payers vary: 60-120 days per payer
• Document everything: Have files ready before applications

References

[1]: DrChrono - How to Start a Medical Practice Checklist https://drchrono.com/blog/2025/10/how-to-start-a-medical-practice-your-essential-checklist/

[2]: Physician Practice Specialists - Medical Practice Startup Outline https://physicianpracticespecialists.com/practice-start-up/medical-practice-start-up-outline-2024/

[3]: Tebra - Licenses You Need to Start Your Own Medical Practice https://www.tebra.com/theintake/practice-growth/start-a-practice/licenses-you-need-to-start-your-own-medical-practice

[4]: Verisys - Healthcare Credentialing Documents Checklist https://verisys.com/blog/healthcare-credentialing-documents-checklist/