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This page is the map. Each step links to a full recipe. Read it once before doing anything, because the expensive mistakes come from doing steps in the wrong order.

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The critical path

Payer credentialing takes 90 to 180 days, and you can’t start it until you have an entity, an NPI, and usually an address. Everything else can compress. Credentialing can’t. Practices that open before it completes either see patients they can’t bill for, or sit idle paying rent.

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Step 1: Form the entity

Most states require a professional entity (PC or PLLC) owned by a licensee, because of corporate practice of medicine doctrine. Entity form and tax election are decisions for a healthcare attorney and a CPA. Re-forming later means re-credentialing, so get it right once. → Choose your legal entity · Why: CPOM

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Step 2: Get the identifiers

In order: EIN from the IRS, then a Type 2 (organizational) NPI from NPPES, then a CAQH profile, then PECOS if you’ll see Medicare patients. Your individual Type 1 NPI identifies you on claims; the Type 2 identifies the billing entity. → Get credentialed

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Step 3: Get the money

Practice lending is a friendly market: defaults are rare, so lenders compete for you. Options are SBA 7(a), bank practice-finance divisions, and specialty lenders. Fund the build-out, equipment, and at least 6 months of working capital to cover the credentialing gap. → Get a practice loan · Startup costs

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Step 4: Open the bank accounts

Same week the EIN arrives. Every later step points at these accounts: loan disbursement, payer EFT enrollments, payroll. Changing accounts later means re-enrolling with every payer, so the account you pick for payer deposits is a long-term decision. → Setting up your banking

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Step 5: Sign the lease and build out

Negotiate the healthcare-specific terms: tenant improvement allowance, exclusivity, and assignment rights (these matter when you sell). Have the healthcare attorney read the lease.

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Step 6: Choose the EHR

A ten-year decision disguised as a subscription. Vendors demo the clinical side; practices bleed on the billing side. Evaluate on claims quality, 835 ingestion, and data export. → Choose your EHR

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Step 7: Contract with payers, enroll EFT/ERA

Credentialing gets you approved. Contracting gets you rates. EFT/ERA enrollment gets money and remittance data flowing electronically. Payers must offer ACH EFT when you request it (45 C.F.R. § 162.1602). Enroll both during onboarding, not later. → Enroll in EFT and ERA · Payer directory

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Step 8: Test, then open

Before opening day, run a test claim through the full cycle for each top payer: submit, receive the 835, watch the deposit land, reconcile the two. Broken billing configuration discovered in week three costs a month of silent failures. → The claim lifecycle