Practice setup and insurance credentialing, handled
From your Employer Identification Number to your first insurance payment, ClearRoute guides physicians, providers, behavioral health therapists and medical spas through every step of becoming ready to see patients and get paid.
Built for independent practices
Whether you are leaving a group to open your own office or adding insurance to a cash pay practice, the paperwork is the same: detailed, slow and unforgiving of mistakes. We carry it for you.
Physicians
Solo and small group medical practices opening their doors or joining new insurance networks.
Providers
Nurse practitioners, physician assistants, dentists, chiropractors and other licensed clinicians.
Behavioral health therapists
Licensed clinical social workers, licensed professional counselors, marriage and family therapists and psychologists in private practice.
Medical spas
Aesthetic and wellness practices setting up their business entity, provider identifiers and any insurance billable services.
From business entity to first payment
Choose the full route or only the steps you still need. Each stage builds on the one before it, and we track every application until it is complete.
Business foundation
Your practice needs a legal identity before anything else can be filed.
- Employer Identification Number application with the Internal Revenue Service
- Guidance on business structure and state registration
- Confirmation that your legal name and tax records match exactly
Provider identity
Insurers recognize you by your identifiers, so they must be set up correctly the first time.
- Individual National Provider Identifier for each clinician
- Organization National Provider Identifier for the practice
- Correct taxonomy codes for your specialty
Credentialing profile
Most commercial insurers pull your information from one shared profile.
- CAQH ProView profile creation or cleanup
- License, malpractice insurance, education and work history uploads
- Attestation and insurer authorizations
Insurance credentialing and payer enrollment
Applications to the networks your patients actually use.
- Commercial insurers such as Aetna, Cigna, UnitedHealthcare and Blue Cross Blue Shield plans
- Medicare and state Medicaid enrollment
- Application tracking and follow up until a decision is made
Getting paid
Once you are in network, payments should arrive directly and post cleanly.
- Electronic Funds Transfer enrollment for direct deposit
- Electronic Remittance Advice enrollment for payment details
- Clearinghouse connection guidance
Ongoing maintenance
Credentialing is not a one time event. Lapses can pause your payments.
- Quarterly CAQH ProView reattestation
- Recredentialing and license renewal reminders
- Updates when you move, add a location or add a provider
What you will need
Having these ready shortens the process considerably. We send a secure checklist at the start of every engagement and review each document before anything is submitted.
Insurer timelines vary and are outside anyone's direct control. What we control is accuracy, completeness and consistent follow up, which is what prevents most delays.
- Business formation documents
- Government issued photo identification
- State professional license for each provider
- Board certification, if applicable
- Malpractice insurance certificate
- Education and training history
- Five years of work history
- Practice address and contact details
- Bank letter or voided check for direct deposit
- Drug Enforcement Administration registration, if applicable
Practice setup pricing
Every practice is different, so pricing is based on the number of providers and insurers. You receive a fixed quote after your consultation.
Business and provider identity
- Employer Identification Number
- Individual and organization National Provider Identifiers
- CAQH ProView profile setup
Everything to open and bill insurance
- Everything in Foundation
- Credentialing with your selected insurers
- Electronic Funds Transfer and Electronic Remittance Advice enrollment
- Practice website with intake forms
Stay credentialed without the reminders
- Quarterly reattestation
- Recredentialing and renewal tracking
- Provider and location updates
The Internal Revenue Service does not charge for an Employer Identification Number, and there is no fee for a National Provider Identifier. ClearRoute fees cover preparation, submission and follow up. ClearRoute is not a law or accounting firm and does not provide legal or tax advice.