How to set up a new company for providers

Here are the general instructions I usually give to startup companies as the timeline process and how to begin:

First:

If you are trying to decide whether or not you want to set up a corporation, I would suggest you do it before you start this process rather than do it later. Most set up a single member LLC, but this again should be discussed with your accountant.

To set up a corporation:

1. Reserve your name first on the state of your choice's secretary of state website. Since I am located in Georgia, most of the following instructions will be for the sos.ga.gov website: a. https://ecorp.sos.ga.gov/

click online services

create user account

Login. Click reserve name (3 option down on left)

b. They will ask for 3 options for names to reserve. Should receive an email with confirmation once reserved. Once you receive the confirmation of which name has been selected, then proceed to step 2.

2. Obtain your tax id from irs.gov. Make sure both names match exactly, including any commas or other punctuation. For example, if you name reservation with the state is ABC 123 LLC then your business name with the IRS should be ABC 123 LLC as if LLC is part of the business name. Not specifically identifying that it's an LLC, just part of the name. a. https://www.irs.gov/businesses/small-businesses-self-employed/employer-id-numbers

Click blue box icon in middle of page " Apply for an EIN online"

b. MAKE SURE you save the confirmation page and letter the IRS gives you confirming your tax id/EIN. VERY IMPORTANT LETTER.

3. Return to the sos.ga.gov website to start your corporation paperwork online there.

a. Login to https://ecorp.sos.ga.gov/

b. On main page, click "Create or Register a Business"

c. Follow the steps from there thru the process. Remember if you are filling as an LLC, make sure you list yourself for any positions over and over that are required (secretary, board members, etc). You will need a copy of the letter emailed from the state previously for the name reservation to upload during this process as well as the name reservation number.

4. Work on your NPI. Make sure your individual NPI has your home address and contact info is current. Insurance companies look at this info if you’re out of network in particular to confirm your information.

a. If you do not have an individual NPI, go here and create a login: https://nppes.cms.hhs.gov/NPPES/Welcome.do

b. If you do have an individual NPI but do not have your login because someone else created it or forgot it, you must contact them: 800-465-3203

c. Create a group NPI from the business name you created above. Login to the nppes website and click create an organization NPI. I suggest you select multiple specialty group, then select your specialty as a sub category for the taxonomy.

d. NPIs are usually approved very quickly. Changes are usually seen that day or the next. You will receive an email confirmation for these as well.

5. Set up a business bank account.

a. Make sure the bank sees your IRS letter and list the name to be spelled exactly how the IRS is listed.

b. Order checks immediately. I suggest ordering the cheapest checks at this time to save money and select the quickest process possible. Medicare/Medicaid will not take starter checks, and are VERY particular how the name is listed on the checks. AGAIN, make sure the IRS name matches the first line on the checks exactly. No commas, no misspellings.

At this point, you are ready to apply to Medicare and or Medicaid. If applying to both, Medicare must be completed first before Medicaid is applied to. See separate instructions for these applications.

6. After submitting your Medicare or Medicaid application, I recommend you update your CAQH information online. CAQH is not as important for federal credentialing since Medicare/Medicaid does their own application background checks. However, UHC, BCBS, Aetna, CIGNA and most commercial insurance companies use CAQH still. https://proview.caqh.org/PR/Registration/ContactCAQH

a. If you do not know your caqh login but do know you have a number, contact CAQH at 888-599-1771 7AM-7PM M-F.

b. Make sure your new business is listed under practice locations. If you’re working with another company currently, it’s ok to leave that company primary.

c. Make sure you change your name to be the only credentialing contact in the system.

d. Make sure under the tab Authorize that you click change settings and check “Yes release my data to any organization that requests access. “

e. Make sure your state license and liability insurance information is current and upload any documents if needed.

7. Register for availity: https://www.availity.com/provider-portal-registration

a. Create a login for Availity. Availity allows you to check benefits, submit claims, check eobs, confirms data with companies such as BCBS, AG, Cigna, etc. It can take a few days to receive confirmation of your login, so it’s best to do this in the beginning so it’s ready to go when needed.

Sequence of application process:

Medicare (if wanting to see adults, if not start with Medicaid) – can take 2-3 months to complete

Medicaid – Can take 6 weeks to be approved.

CMOS: Amerigroup, Caresource, Peachstate, Wellcare – these can take 3 months. These can not be applied to until Medicaid is completed.

Commercial insurance companies can be requested once Medicaid is submitted. Most commercial insurance companies want to know your approved Medicare or Medicaid number to start the application. Usually by the time you have the first response from the commercial insurance company your Medicare/Medicaid number will be completed.