How Long Until a New Practice Gets Paid by Insurance?

First Coast Service Options, the Medicare Administrative Contractor for Florida, publishes CMS's processing standards for CMS-855 applications. An initial enrollment filed online through PECOS with no site visit, no development request and no fingerprinting is processed 95% of the time within 15 calendar days and 100% within 50. If a site visit, development or fingerprinting is involved, it is 95% within 50 days and 100% within 85. Paper applications run 95% within 30 days and 100% within 65 with no site visit, and longer with one. File online.

Your effective date is not the approval date. Under 42 CFR 424.520(d) it is the later of the date you filed the application that was eventually approved, or the date you first furnished services at the new location. That is why a complete application filed on day one is worth so much: the clock for billable dates starts at filing, not at approval. Our PECOS explainer and Medicare enrollment page walk through the application itself.

Approval gives you a PTAN. It does not let you send a claim or receive a dollar. First Coast's EDI enrollment page says to allow two weeks for the form, and that one form covers both claim submission (837) and electronic remittance (835), because ERA is a requirement of EDI enrollment there. The electronic funds transfer agreement, CMS-588, is its own step, CMS requires it, and First Coast says complete applications are usually processed within 45 to 60 days. On a brand-new practice the EFT lane is often the longest one in the whole Medicare process, which surprises people.

AHCA publishes a processing standard of 60 days or less from a complete application, with 21 days to correct deficiencies before a denial, and the Level 2 background screening typically takes 7 to 10 business days. The effective date rule is in section 409.907(9)(a), Florida Statutes: "The enrollment effective date is the date the agency receives the provider application." Managed-care plans then on-board you under the AHCA contract, which requires plans to fully enroll contracted providers within 60 days. That is a contract term, not a statute; I looked for a Florida statute that puts a deadline on Medicaid or commercial credentialing and there is none. Two 2026 bills that would have created one both died in committee on March 13, 2026. Our Medicaid enrollment page covers the application.

UnitedHealthcare's credentialing FAQ (October 14, 2026) says credentialing generally takes up to 14 calendar days once it has a complete application, while its join-our-network page says up to 45 calendar days or more. Plan on the longer one. The same FAQ then says to allow up to 60 days for the contract to be loaded after credentialing is approved and the signed contract is received, and that this is what prevents claims from denying or paying at the out-of-network level. Cigna says credentialing typically takes 45 to 60 days, then about 10 business days to update its directories and claim systems. Florida Blue's provider manual promises a written decision within 30 business days after committee review. Aetna and Humana publish no overall figure.

In my experience, once the approval is in hand, United, BCBS, Aetna and Medicare behave about the same from there to the first payment: roughly two weeks. The differences between payers show up before approval, not after it.

Once a payer has approved you, your clearinghouse has to be told it may send that payer your claims and receive that payer's remittances. Claim.MD's quick start guide says you must be credentialed with a payer before completing its enrollments, that some payers require enrollment before you can submit electronic claims at all, and that ERA enrollments generally process between 3 and 30 days. Florida Blue's 835 enrollment form says your first electronic remittance is created the week following completion of enrollment, provided a payment has gone out. In our work this step takes a few days per payer when the logins and the NPI and tax ID all line up, and it is the step a biller can start the same day the approval letter arrives.

Two things worth knowing. You can often be paid before the ERA is connected; the money arrives as a paper check or as an EFT with no electronic remittance behind it, and the posting is slower until the 835 catches up. And none of this starts until someone has the payer portal and clearinghouse logins in hand, which brings me to the delays.

Medicare does not pay a clean electronic claim before day 14. The CMS MLN fact sheet (March 2026) says to wait at least 14 days for electronic claims and 29 days for paper before checking status, and that contractors owe interest if a clean claim is not paid within 30 calendar days. In Florida, section 627.6131 for insurers and section 641.3155 for HMOs require an electronic clean claim to be paid, denied or contested within 20 days of receipt and a paper claim within 40, with 12 percent simple interest on overdue payments. Those are legal outside limits, not averages. A clean first claim sent the day the connection goes live is usually paid inside them, which is where my "about two weeks" comes from.

Credentialing happens inside portals: CAQH, PECOS and the CMS Identity and Access system behind it, Availity, each payer's provider site, the state Medicaid portal. If the doctor set up CAQH in residency with a school email, or a former office manager was the Availity administrator and left, every step waits on a password reset, an identity re-verification or a mailed form before any application can be filed or checked. We now ask for every login on day one, before anything else, and we go through the full list on our what we need to start credentialing page with the practice before a single form goes out.

Doctors move. They change cell numbers and email addresses. The record in PECOS or NPPES does not move with them unless someone updates it, so verification letters, callbacks and confirmation emails go to an old address, an old number and an old inbox, and the application sits in a pending status that nobody knows about. CAQH also expires on its own schedule; UnitedHealthcare's FAQ reminds providers to re-attest every 120 days to keep the application current. Before we submit anything we go over all of the practice's information, field by field, against what every registry currently shows. Our free NPI readiness check is the first pass at that.

One practice lost months this way. Availity needed to confirm with the practice that we were authorized to represent them before it would give us access. The call went to the office, nobody answered it, nobody returned it, and nothing moved until we found out why. Availity's own help pages describe identity verification for a first-time administrator, online or by a mailed form, and the administrator is the only person who can let anyone else into the organization, so if the practice does not respond, the biller cannot work around it. When a payer or a portal reaches out to the practice during credentialing, that contact is the critical path. Pick up.

First Coast Service Options, the Medicare contractor for Florida, publishes CMS processing standards: a clean online PECOS application with no site visit is processed 95% of the time within 15 calendar days and 100% within 50. With a site visit, development or fingerprinting it is 95% within 50 days and 100% within 85. Paper applications run longer.

Enrollment approval alone does not produce a payment. You still need EDI enrollment to send claims (First Coast says allow two weeks; the same form covers ERA) and a CMS-588 EFT agreement to receive money (First Coast says 45 to 60 days). Clean electronic claims then sit on a 14-day payment floor. In my experience the first payment lands about two weeks after everything is connected.

For Medicare you can bill from your effective date, and 42 CFR 424.521 lets you bill retrospectively for up to 30 days before it. For commercial plans the answer is the effective date on the signed contract, and UnitedHealthcare says to allow up to 60 days after approval for the contract to load before claims pay in network. Clearinghouse and ERA enrollment then takes a few days to a few weeks per payer.

Payer review time is only part of it. In our work the delays we see most are on the practice side: nobody has the logins to CAQH, PECOS, I&A or Availity, and the phone number, address or email on file in PECOS or NPPES is years old, so verification letters, calls and emails go nowhere. Fix those before the first application goes out.

Medicare: yes, within the 30-day retrospective window in 42 CFR 424.521 once approved. Commercial plans: generally no in-network payment before the contract effective date. Humana says members seen before the network effective date are generally paid at the out-of-network level, Cigna's Medicare Advantage manual says such claims are denied, and UnitedHealthcare says claims can deny or pay out of network until the contract is loaded. Get the payer's policy in writing before you see its members.