PRACTICE LAUNCH PLANNING WORKSHEET Grasshopper Practice Operations | Illustrative planning aid USE BOUNDARY This is not an intake form, contract, launch schedule, or legal, tax, accounting, financial, or clinical advice. Do not enter protected health information or client information. Exact requirements and sequence depend on the practice, advisers, platforms, and payers. PUBLISHED TERMS SNAPSHOT - Standard Practice Launch: $3,950 flat - Included payer scope: up to 5 selected payer panels; Medicaid counts as one - Additional payer: $295 each - Typical credentialing range: 90-150 days, payer-controlled and not guaranteed - Payment timing: $1,975 at signing; $1,975 at first commercial panel approval - Standard Launch credit: $1,000 when a 12-month Complete agreement signs at go-live - Complete starts at $995/month; the $750 transition fee is waived for Practice Launch graduates - Founding Launch pricing and the Complete credit do not stack 1. OPERATING TARGET Desired first session: ______________________________________________ Desired resignation / notice date: __________________________________ Cash-pay opening, if any: ___________________________________________ Insurance opening target: ___________________________________________ Planning principle: Do not make payer timing your resignation promise. Work backward using the full 90-150 days range, the time needed to provide complete inputs, and a cash-flow plan reviewed with your own CPA or financial adviser. Employment constraints: [ ] Notice terms reviewed [ ] Outside-work restrictions reviewed [ ] Target hours / caseload defined Adviser readiness: [ ] Attorney identified [ ] CPA identified [ ] Financial adviser identified, if used Practice model: [ ] Location / telehealth plan [ ] Insurance vs. cash-pay mix [ ] Solo practice ownership 2. PAYER SHORTLIST You select the panels. Grasshopper prepares, submits, and follows up. Each payer controls panel availability, acceptance, timing, contract terms, and effective dates. 1. Payer / program: __________________ Why it matters: ________________ Known status / question: __________________ 2. Payer / program: __________________ Why it matters: ________________ Known status / question: __________________ 3. Payer / program: __________________ Why it matters: ________________ Known status / question: __________________ 4. Payer / program: __________________ Why it matters: ________________ Known status / question: __________________ 5. Payer / program: __________________ Why it matters: ________________ Known status / question: __________________ Any payer substitution rule should be explicit in the signed launch plan. A closed panel cannot be overridden. 3. INPUT READINESS Identity, license, and history: [ ] Accurate legal and contact information [ ] Licensure and identifier information [ ] Work history and payer-requested history [ ] CAQH source information or access Practice and payer choices: [ ] Practice name and location facts [ ] Entity / EIN / NPI-2 status [ ] Selected payer list [ ] Timely signatures and attestations Systems and workflows: [ ] EHR choice; SimplePractice is the stated default [ ] Telehealth and intake preferences [ ] Consent and reminder decisions [ ] Fee schedule and superbill inputs Response plan: [ ] One point of contact [ ] Secure access path when needed [ ] Prompt response to payer requests [ ] No PHI in this worksheet "Complete inputs" means the accurate information, access, selections, signatures, and attestations required for the selected applications and systems build. Exact requirements vary by payer. 4. PARALLEL LAUNCH MODEL - Foundation: entity, EIN, and NPI-2 coordination - Payers: CAQH, selected applications, and weekly logged follow-up - Systems: EHR, telehealth, intake, consent, reminders, fee schedules, and superbills - Verify: go-live checklist and first claim per payer tracked through payment Illustrative sequence, not a guaranteed calendar. Selected applications are submitted within 14 days of complete inputs. 5. RESPONSIBILITY CHECK Entity and tax - You: choose and authorize - Grasshopper: coordinate administrative steps - Attorney / CPA: advise CAQH and payer panels - You: provide accurate inputs, select, review, and sign - Grasshopper: build, submit, and follow up weekly - Payer: controls status, timing, panel availability, and terms EHR and workflows - You: choose and approve business and clinical decisions - Grasshopper: configure the published systems scope - Counsel / platform: counsel advises; platform controls its product Go-live and claims - You: decide when to open, provide care, and document - Grasshopper: run the checklist and track the first claim per payer - Payer: adjudicates and reimburses Ownership - You own the practice, payer contracts, client relationships, and practice data - Grasshopper provides flat-fee administrative support and never takes a percentage of collections 6. CASH-FLOW QUESTIONS FOR YOUR CPA OR FINANCIAL ADVISER [ ] What reserve covers the payer review window? [ ] How will cash-pay and insurance openings differ? [ ] What expenses begin before reimbursement? [ ] What is the plan if approval or payment is delayed? 7. SYSTEM CHOICE NOTES Preferred EHR: _____________________________________________________ Telehealth platform: _______________________________________________ Phone / inbox: _____________________________________________________ Open question: _____________________________________________________ 8. DEFINITION OF DONE TO CONFIRM [ ] All selected panel applications submitted within 14 days of complete inputs. [ ] Weekly follow-up on every payer, logged where the client can see it, with a weekly status note. [ ] Systems pass the go-live checklist before the first session. [ ] First claim per payer tracked through payment. 9. FIT-CALL AGENDA Bring: [ ] Target dates and employment constraints [ ] Payer shortlist [ ] Entity and CAQH status [ ] EHR preference [ ] Adviser questions Resolve in writing: [ ] Exact inputs and start trigger [ ] Payer substitutions if a panel is closed [ ] Non-default EHR support limits [ ] Payment handling if no commercial panel approves [ ] First-claim tracking endpoint Illustrative only | No PHI https://grasshopperpractice.com/practice-launch