# Plan credentialing and payer enrollment for a new provider

A timeline and checklist for licensing, hospital privileges, CAQH, and payer enrollment so a new clinician can see and bill patients from day one.

- Topic: HR & Hiring
- Framework: Few-Shot
- Level: Advanced
- Tags: Sales, Plan, Fill-in Template
- Source: https://www.thinkwithprompt.com/prompts/plan-credentialing-and-payer-enrollment-for-a-new-provider

## Prompt

```text
Help me plan credentialing and payer enrollment for a new provider joining our practice.

**Provider type:** [e.g. MD, DO, NP, PA, LCSW, PT]
**Start date:** [DATE]
**State(s) of practice:** [STATES - and whether they are already licensed there]
**Practice structure:** [group NPI, tax ID, locations, telehealth across state lines]
**Payers we bill:** [Medicare, Medicaid/MCOs, commercial plans - LIST]
**Hospital or facility privileges needed:** [YES/NO and which]
**What is already done:** [e.g. CAQH profile exists, DEA registered at old address]

Give me:
1. A document checklist to collect from the provider (license, DEA and state controlled substance registration, board certification, malpractice coverage and claims history, CV with no unexplained gaps, NPI, CAQH access, references).
2. A sequenced plan: state license and DEA updates, NPI and reassignment, CAQH attestation, Medicare enrollment (PECOS), Medicaid, each commercial payer, and hospital privileges. Show dependencies and the order to file.
3. A timeline table: Step | Owner | Typical lead time | Target submit date | Status, working backward from the start date. Mark lead times as [CONFIRM WITH PAYER] since they vary by payer and state.
4. Rules for scheduling before enrollment is final: which payers allow retroactive billing and which do not, flagged as [CONFIRM], and how to avoid booking patients the provider cannot yet bill for.
5. A recredentialing and expiration tracker for licenses, DEA, board certification, and malpractice.

Do not suggest billing under another provider's number as a workaround; incident-to and supervision rules are specific and should be confirmed with our compliance lead.
```

## What to fill in

- e.g. MD, DO, NP, PA, LCSW, PT
- DATE
- STATES - and whether they are already licensed there
- group NPI, tax ID, locations, telehealth across state lines
- Medicare, Medicaid/MCOs, commercial plans - LIST
- YES/NO and which
- e.g. CAQH profile exists, DEA registered at old address
- CONFIRM WITH PAYER
- CONFIRM

Free to copy and use. From ThinkWithPrompt (https://www.thinkwithprompt.com/), a library of 2,663 curated AI prompts.