25 guides
Guides for practice owners
Plain-English guides to credentialing, insurance enrollment, licensing, compliance and running a practice, written for the people who manage practices.
Each guide is written and reviewed by our team, links to the rules it explains, and shows when it was last updated. Read how we write and review our guides.
Guides are general information, not legal advice. When you need help applying a rule to your practice, talk to an advisor.
New to running a practice?
Start here: three guides, in order
Open the practice, get your providers credentialed, then keep the practice compliant.
Step 1 · 7 min readStart a medical practiceHow to start a medical practice in Florida: ownership, the AHCA license or exemption, local permits, CLIA, DEA and payers, in the order you need them.Read the guide 
Step 2 · 7 min readCredentialing explainedMedical credentialing explained: what health plans verify, how long each plan says it takes, the documents you need, and how it differs from enrollment.Read the guide 
Step 3 · 8 min readHIPAA checklistA HIPAA compliance checklist for small practices: Privacy, Security and Breach Notification tasks, each with an owner, a deadline and its rule.Read the guide
3 guides
Credentialing and enrollment
How plans check your providers, how long it takes, and the numbers and records behind it.
- Guide
Credentialing explained
Medical credentialing explained: what health plans verify, how long each plan says it takes, the documents you need, and how it differs from enrollment.Read the guide 
GuidePTAN number
What a PTAN number is, how First Coast assigns one with your Medicare enrollment, how it differs from your NPI, and how to find yours.Read the guide
GuideVerify a Florida license
Florida healthcare license search: verify any DOH license free on MQA, read its status and discipline, and check other states and the NPDB.Read the guide
7 guides
Insurance companies
Plan by plan: where to apply, what each one asks for and the timelines it publishes.
Insurer guideAetna
Aetna provider enrollment step by step: the request for participation, CAQH (DataSpring), credentialing checks, the contract and your effective date.Read the guide
Insurer guideFlorida Blue and BCBS
Blue Cross Blue Shield credentialing in Florida: joining Florida Blue through Availity and CAQH, which networks are open, and Lucet for behavioral health.Read the guide
Insurer guideCigna and Evernorth
Cigna and Evernorth provider enrollment: the medical route by phone, the Evernorth Behavioral Health portal, and 45 to 60 and up to 90-day timelines.Read the guide
Insurer guideUnitedHealthcare and Optum
United Healthcare credentialing for Florida practices: Onboard Pro, DataSpring (CAQH), published timelines and Optum behavioral health networks.Read the guide
Insurer guideHumana
Humana provider enrollment in Florida: Medicare Advantage, Humana Healthy Horizons Medicaid and TRICARE, with a 30-day credentialing target.Read the guide
Insurer guideFlorida Medicaid plans
Molina Healthcare, Sunshine Health and Simply credentialing for Florida Medicaid: your Medicaid ID first, the SMMC 60-day rule and each plan's route.Read the guide
Insurer guideOther payers
Provider enrollment with Tricare, the Devoted Health plan, MultiPlan and other Florida payers: each one's first step, published timelines and rules.Read the guide
7 guides
Compliance
HIPAA, OSHA, exclusion checks, background screening, CLIA and accreditation.
- Guide
HIPAA checklist
A HIPAA compliance checklist for small practices: Privacy, Security and Breach Notification tasks, each with an owner, a deadline and its rule.Read the guide 
GuideHIPAA BAAs
HIPAA business associate agreements: who needs one, the ten terms HHS lists, subcontractors, breach notice duties and what OCR cases cost practices.Read the guide
GuideOIG exclusion checks
OIG and Medicaid exclusion list checks in Florida: the LEIE, SAM and AHCA searches, how often to run them, and what to do after a match.Read the guide
GuideOSHA for medical offices
OSHA for medical offices: the needle stick injury protocol, the bloodborne pathogens standard, sharps containers, the 300 Log and who enforces it.Read the guide
GuideJoint Commission
Joint Commission (JCAHO) accreditation for ambulatory and behavioral health programs: eligibility, standards, the survey cycle and where Florida uses it.Read the guide
GuideCLIA waiver
The CLIA Certificate of Waiver for Florida practices: who needs one, Form CMS-116, the $248 fee every two years, waived tests and what to report.Read the guide
GuideAHCA background screening
AHCA Level 2 background screening in Florida: who needs it, Clearinghouse fingerprints, results timing, disqualifying offenses, exemptions and cost.Read the guide
4 guides
Starting a practice
Opening a medical or mental health practice in Florida, management services organizations and NP autonomy.
- Guide
Start a medical practice
How to start a medical practice in Florida: ownership, the AHCA license or exemption, local permits, CLIA, DEA and payers, in the order you need them.Read the guide 
GuideStart a mental health practice
How to start a private mental health practice in Florida as an LCSW, LMFT or LMHC: license, entity, NPIs, the AHCA exemption and payer enrollment.Read the guide
GuideWhat is an MSO
What an MSO is in healthcare: what a management services organization may do, how it is paid, and what Medicare and Florida Medicaid ask you to report.Read the guide
GuideNP autonomy
A Florida NP's collaborating physician: the statute's supervising physician and protocol, the 3,000-hour autonomous APRN registration and its limits.Read the guide
4 guides
Running a practice
The numbers to watch, progress notes, ancillary services and scope of practice.
GuideHealthcare KPIs
Healthcare KPIs for medical practices: formulas for denials, A/R, collections and access, the public benchmarks that exist, and which are members-only.Read the guide
GuideProgress notes
Progress notes and SOAP charting that pass audits: what Medicare and Florida Medicaid require, SOAP, DAP and BIRP layouts, and the errors OIG found.Read the guide
GuideAncillary services
Ancillary services for a medical practice: labs, imaging and therapy lines, Stark's in-office exception, Florida's self-referral law and what each needs.Read the guide
GuideScope of practice
Scope of practice in Florida for MAs, LPNs, RNs, APRNs and PAs: what each statute allows, who supervises whom, and Medicare's incident-to rule.Read the guide
Talk to an advisor
You care for patients. Who’s taking care of the business?
Tell us where your practice is today. We will tell you what we would do first.