The running example
Throughout this tutorial we follow Bluebird Dental, a fictional launch:- Sam Calloway, a non-dentist founder with an operations background, wants to build a dental group.
- Dr. Maya Okafor, DDS, a general dentist, will be the dentist-owner of the professional entity and will practice there.
- They are launching in one state, with one location, and plan to grow the way dental groups actually grow: by acquiring existing practices. See Acquire a dental practice when you get there.
The five stages
The eleven steps
1
Pick your state and entity types
Which state you launch in determines your entity form, your CPOD exposure, your fee structure options, and whether the DSO itself must register. Go →
2
Find your friendly dentist
The single highest-consequence hire in the structure. Go →
3
Form the PC
Dental purpose clause, dentist-only ownership, board certificates, EIN. Go →
4
Form the DSO
For Bluebird’s selected structure, a support company that will hold the permitted nonclinical assets and employ the permitted nonclinical team; leases, equipment, and workforce allocation remain state-specific. Go →
5
Sign the agreement stack
Five documents, in a specific order. Go →
6
Get NPIs and set up CAQH
Type 1 for the dentist, Type 2 for the PC, and the profile every payer will pull from. Go →
7
Open bank accounts
Route receipts to the account authorized for the enrolled billing provider and permitted by state law, payer terms, and the banking arrangement. Go →
8
Enroll with your first payer
One payer, end to end, including the EFT and ERA enrollments everyone forgets. Go →
9
Pick your billing stack
PMS, clearinghouse, and who operates them. Go →
10
Submit your first claim
A real visit becomes an 837D, and acknowledgments come back. Go →
11
Read your first 835 and get paid
The remittance arrives, the EFT lands, and you post it. Go →
Timeline: what actually takes how long
Use these ranges only as planning assumptions and replace them with current written estimates for the chosen state, board, bank, and payer. Payer authorization is often on the critical path.
For Bluebird’s model, a likely critical path is: form the professional entity → obtain required identifiers and location facts → submit each payer’s accepted application → cure deficiencies → receive and verify effective dates. Other work should run in parallel where its prerequisites allow.
What it costs
Ranges for a single-state, single-location launch. These are directional, not quotes.
The number that surprises founders is counsel. Resist the temptation to use a generalist corporate lawyer or a template. An MSA that doesn’t survive a CPOD challenge in your state is worth less than no MSA, because it documents the problem. See Hire healthcare counsel.
What can be parallelized
Run these three tracks simultaneously from week one:- Legal track, state selection, entity formation, agreement drafting, and any role-specific dental filings.
- Payer track, identifiers and credentialing data, then each application or transaction process as soon as its actual prerequisites are met.
- Operations track, banking, PMS selection, clearinghouse, staffing, lease.
A note on doing this in the wrong order
An expensive mistake is seeing insured or program patients without a written billing and beneficiary-liability plan for the pending period. A submitted application is not an effective date, and verbal assurances do not establish claim or patient-billing treatment. Obtain payer- or program-specific direction for the actual provider, location, product, and date of service. If you must open before credentialing finishes, understand your options, and their compliance limits, first: see Handle credentialing delays and gaps.Next
Step 1: Pick your state and entity types
Where you launch determines almost everything downstream.