> ## Documentation Index > Fetch the complete documentation index at: https://dso.getlemma.com/llms.txt > Use this file to discover all available pages before exploring further. # Overview: the road from idea to paid claim > The full map of launching a DSO-PC dental group (entity, people, paper, payers, pipes) with realistic timelines, costs, and what can run in parallel. Getting from "I have an idea" to a correctly paid first claim requires entity, licensure, contracting, enrollment, banking, and transaction work that can run on different clocks. This tutorial uses an illustrative **three-to-nine-month planning model**; it is not a filing-office, bank, or payer service-level commitment. ## 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. Their initial growth plan is to acquire existing practices. See [Acquire a dental practice](/guides/growth/acquire-a-dental-practice) when you get there. Each step applies the topic to Bluebird's illustrative launch. ## The five stages ```mermaid theme={null} graph LR A[1. Entity
PC + DSO] --> B[2. People
Friendly dentist] B --> C[3. Paper
Agreement stack] C --> D[4. Payers
NPI, CAQH, enrollment] D --> E[5. Pipes
Banking + billing] E --> F[First claim
→ First 835] ``` | Stage | Steps | What you end up with | | ---------- | ------- | --------------------------------------------------------------------------------------------------------- | | **Entity** | 1, 3, 4 | A PC and a DSO that legally exist, with EINs | | **People** | 2 | An active dentist-owner who has been properly vetted | | **Paper** | 5 | A management services agreement (MSA), transfer restrictions, employment agreements, a BAA, an IP license | | **Payers** | 6, 8 | NPIs, a CAQH profile, and at least one executed payer contract | | **Pipes** | 7, 9 | Bank accounts that respect the structure, and a billing stack that submits claims | ## The eleven steps Which state you launch in determines your entity form, your CPOD exposure, your fee structure options, and whether the DSO itself must register. [Go →](/start/zero-to-paid/pick-your-state-and-entity) Recruit and vet the dentist who will own and govern the professional entity. [Go →](/start/zero-to-paid/find-your-friendly-dentist) Dental purpose clause, dentist-only ownership, board certificates, EIN. [Go →](/start/zero-to-paid/form-the-pc) 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 →](/start/zero-to-paid/form-the-dso) Five documents, in a specific order. [Go →](/start/zero-to-paid/sign-the-agreement-stack) Type 1 for the dentist, Type 2 for the PC, and the CAQH profile used by participating payers. [Go →](/start/zero-to-paid/get-npis-and-caqh) Route receipts to the account authorized for the enrolled billing provider and permitted by state law, payer terms, and the banking arrangement. [Go →](/start/zero-to-paid/open-bank-accounts) Take one payer from contracting through provider linkage, EFT, and ERA setup. [Go →](/start/zero-to-paid/enroll-with-your-first-payer) PMS, clearinghouse, and who operates them. [Go →](/start/zero-to-paid/pick-billing-stack) A real visit becomes an 837D, and acknowledgments come back. [Go →](/start/zero-to-paid/submit-your-first-claim) The remittance arrives, the EFT lands, and you post it. [Go →](/start/zero-to-paid/read-your-first-835) ## Illustrative timeline 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. | Activity | Realistic duration | Can it run in parallel? | | -------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ----------------------------------------- | | Choosing state and entity form | 1–2 weeks | No | | Finding and vetting the friendly dentist | 2–8 weeks | Yes, alongside other early work | | Forming the PC | 1–6 weeks (board-certificate states are slower) | No | | Forming the DSO | 1–5 business days | Yes | | Drafting and signing the agreement stack | 3–8 weeks with counsel | Partially, starts after entities exist | | NPIs (Type 1 and Type 2) | Days to \~2 weeks via NPPES | Yes | | CAQH profile build and attestation | 1–3 weeks | Yes | | Bank account opening | Bluebird models minutes for a data-based Lemma application or 1–3 weeks for a manual bank process; actual review varies | Yes | | **Commercial dental payer credentialing** | **\~30–180 days per carrier**, and [Delta Dental](/reference/payers/profiles/delta-dental) is a federation of state member companies, so it is one queue per state, not one national contract | Yes, as each payer's prerequisites allow | | **Medicaid enrollment** | **Illustrative: \~60–180 days**; map the state's fee-for-service, dental carve-out, MCO/vendor, or mixed delivery model and every separately required enrollment, contract, credentialing, or affiliation step | Often | | Medicare enrollment | Often not required for routine general dentistry because Medicare excludes routine dental care by statute. Analyze covered pathways such as qualifying oral-surgery, sleep-appliance, or "inextricably linked" services. See [Medicare and dental](/reference/payers/profiles/medicare-and-dental) | Scope it to the services you plan to bill | | EDI / ERA / EFT enrollment per payer | 2–6 weeks after contract | Follows the contract | | Selecting and implementing the billing stack | 2–6 weeks | Yes | 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. **Start each payer process as soon as that payer accepts it and the required facts are fixed.** Some applications require a service location, ownership disclosures, licenses, a W-9, a contract or transaction form, or other prerequisites beyond an EIN and Type 2 NPI. ## What it costs Ranges for a single-state, single-location launch. These are directional, not quotes. | Item | Typical range | | --------------------------------------------------- | -------------------------------------------------------------------------------------- | | PC formation (filing + registered agent) | $200 – $1,500 | | DSO formation | $100 – $1,000 | | Healthcare regulatory counsel, full agreement stack | $10,000 – $40,000+ | | Fair market value study for the management fee | $5,000 – $25,000 (often deferred to first raise) | | Malpractice insurance (general dentist) | $3,000 – $8,000 / year; specialty, limits, claims history, and location affect pricing | | PMS (practice management system) | $300 – $800 / location / month | | Clearinghouse | Metered per transaction, or bundled into the PMS | | Credentialing (outsourced, per dentist per payer) | $150 – $400 | | Bookkeeping (two entities) | $500 – $2,500 / month | Healthcare regulatory counsel is a material launch cost. The MSA and related documents need state-specific dental review because a generic corporate form may assign ownership, fees, or control in a way the launch state restricts. See [Hire healthcare counsel](/guides/agreements/get-agreements-reviewed). ## What can be parallelized Run these three tracks simultaneously from week one: 1. **Legal track**, state selection, entity formation, agreement drafting, and any role-specific dental filings. 2. **Payer track**, identifiers and credentialing data, then each application or transaction process as soon as its actual prerequisites are met. 3. **Operations track**, banking, PMS selection, clearinghouse, staffing, lease. The dependencies are payer-specific. An organizational NPI requires an organization to exist, but an application may also require an EIN, service location, licenses, ownership disclosures, W-9, agreement, or transaction documents. Some payers accept EDI, ERA, or EFT setup only after contracting; others use a consolidated or earlier workflow. Record the prerequisite stated by each payer rather than hard-coding one sequence. ## Before treating patients during a pending enrollment 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, first review the available options and their compliance limits in [Handle credentialing delays and gaps](/guides/enrollment/handle-credentialing-delays). ## Next Identify the entity, ownership, fee, and filing rules for the launch state.