How to Start a Telehealth Practice: The Complete Checklist

Starting a telehealth practice involves dozens of steps across legal, compliance, technology, credentialing, and billing. Miss one and you either cannot see patients, cannot get paid, or both. This checklist organizes every step into a 90-day timeline so you know exactly what to do and when.

Before you begin

Two things determine your timeline more than anything else: your state's licensing requirements and insurance credentialing turnaround times. Credentialing takes 60-120 days, so it needs to start in week one. Everything else builds around that anchor.

This checklist assumes you already have an active clinical license. If you are still in the licensing process, start there first, then come back to this guide.

Phase 1: Business entity and registration

• Choose your entity type: LLC, PLLC, S-Corp, or sole proprietorship. Most solo telehealth providers start with an LLC or PLLC depending on state requirements. Some states require healthcare providers to form a PLLC (professional LLC) or PC (professional corporation).
• File with your state's Secretary of State. Processing time varies from same-day to 2-3 weeks depending on the state.
• Apply for an EIN (Employer Identification Number) through the IRS. This is free and instant online at irs.gov.
• Open a business bank account. Keep personal and business finances completely separate from day one.
• Apply for your NPI (National Provider Identifier) at nppes.cms.hhs.gov. You need a Type 1 (individual) NPI. If you plan to bill as a group, you will also need a Type 2 (organizational) NPI.
• Register for CAQH ProView at proview.caqh.org. Complete every section and attest your profile. This is the database most insurance companies pull from during credentialing.

Phase 2: Insurance credentialing

• Apply for Medicare through PECOS (pecos.cms.hhs.gov). This takes 60-90 days.
• Apply for Medicaid through your state's provider enrollment portal. Timeline varies by state (30-90 days).
• Submit applications to your top 3-5 commercial payers. Check which payers have open panels in your area.
• Submit all applications simultaneously. Do not wait for one to finish before starting the next.
• Set up a tracking system for every application: payer name, submission date, expected timeline, follow-up dates, and current status.
• Follow up with each payer every 2 weeks. Document every interaction.

Phase 2B: Malpractice insurance

• Get malpractice insurance before you see any patients. Most credentialing applications also require proof of coverage.
• Choose between occurrence-based and claims-made policies. Occurrence covers any incident that occurred during the policy period, regardless of when the claim is filed. Claims-made covers claims filed during the policy period.
• Get quotes from at least 3 carriers. Coverage levels of $1M per occurrence / $3M aggregate are standard for most telehealth providers.
• Verify your policy covers telehealth services across all states where you practice.

Phase 2C: HIPAA compliance

• Choose a HIPAA-compliant EHR system (SimplePractice, TherapyNotes, DrChrono, etc.)
• Choose a HIPAA-compliant telehealth platform. Confirm it offers end-to-end encryption and a signed BAA.
• Collect signed BAAs from every vendor that handles patient data
• Create your Notice of Privacy Practices
• Create your website privacy policy
• Complete your Security Risk Assessment (use the free HHS SRA Tool)
• Enable encryption on all devices, enable two-factor authentication on all systems

Phase 3: Tech stack and workflows

• Configure your EHR: set up appointment types, default billing codes, telehealth POS codes, and intake forms
• Set up your scheduling system (if separate from EHR)
• Create intake forms: demographics, insurance information, clinical intake, consent for treatment, telehealth consent, financial agreement, Notice of Privacy Practices acknowledgment
• Set up your billing workflow: claims submission process, eligibility verification, payment posting
• Configure automated appointment reminders
• Set up a professional email and phone system
• Build or launch your practice website with online scheduling

Phase 4: First patients

• Verify at least one insurance panel has approved your credentialing before scheduling insured patients
• Consider accepting cash-pay patients while remaining panels process
• Run a test appointment: walk through the full workflow from scheduling to claim submission
• See your first patients
• Submit your first claims within 24-48 hours of the visit
• Monitor claim status daily for the first two weeks to catch issues early

Phase 5: Growth and optimization

• Review your first round of ERA/EOB statements for payment accuracy
• Address any denied claims immediately. Log denial reasons.
• Follow up on remaining credentialing applications
• Begin marketing: Psychology Today profile, Google Business Profile, professional directories
• Set up a denial management process for ongoing claim issues
• Review your financial tracking: revenue per payer, average reimbursement, days in AR
• Evaluate whether to add more payers based on patient demand

Common mistakes that delay your launch

1. Waiting to start credentialing. This is the longest lead-time item. Submit applications in week 1-2, not after you have everything else set up.
2. Incomplete CAQH profile. Payers cannot process your application if CAQH is missing documents or has not been attested.
3. Choosing non-compliant tools. Switching your EHR or video platform mid-launch because it is not HIPAA-compliant wastes weeks.
4. Not tracking anything. Without a system to track credentialing status, follow-up dates, and task completion, things fall through the cracks.
5. Trying to figure it out from scratch. Every step in this checklist has been documented, systematized, and built into operational tools by people who have done it hundreds of times.