Expanding Clinical Care into New States

This guide covers both operational prerequisites and Healthie configuration required to safely and compliantly expand care into a new U.S. state.

Healthie settings alone do not grant clinical or billing authority - ensure all regulatory requirements are met before enabling client booking.

Preparation for Market Expansion

Every organization is unique. Consider these prerequisites before making state-specific changes in Healthie:

• Complete healthcare facility licensing for new state(s) 
• Confirm all providers hold active, unrestricted licenses and are authorized to practice via telehealth, (if applicable)
• Credential providers with state programs or payers, if applicable 
• Verify any state-specific clinical requirements or restrictions
• Ensure any integration partners for lab diagnostics, medication prescriptions, etc. operate in new states 

Contact Healthie support at hello@gethealthie.com if you need the State Licensure Booking (License-Aware Scheduling) setting enabled for your account.

Telehealth Modality & State Rules

Each state has telehealth-specific consent and modality nuances that differ from others. 

Before enabling booking in a new state, confirm:

• Whether synchronous video is required for initial visits
• Whether audio-only visits are permitted
• If telehealth-specific consent language is required

• If asynchronous care (messaging, forms) is restricted

  
  

Healthie considerations

• Confirm appointment types correctly reflect contact type
• Ensure intake forms include any state-specific consent language
• Align POS codes with telehealth modality (02 vs. 10)
• In the CMS-1500: Box 32, Facility:
  • Select the correct location for the appointment from the service facility drop-down menu.
  • To add a new location, select the facility in a claim form >  Edit Facility
  • For more detail, check out this resource

Add State Licensure Details for Providers

In order for the right providers to show as available to see patients in new states, you’ll need to add the new state license(s) to each provider who will be seeing patients in that state. 

Learn how to add state licensure details for providers here. 

Quick reference: 

Settings > Organization > Members > Select provider > [...] > Edit > Professional Information > [...] > Edit >  [select appropriate states]

Appointment Location vs. State Licenses

The Healthie calendar supports the ability to add both Appointment Locations and State Licenses. These two concepts are used in distinct ways to accomplish different objectives, and you may need to update both when expanding care into new states. 

• Appointment Locations are specific (typically physical) locations where specific appointments with an “In-Person” contact type will be conducted. 
• State Licenses allow you to track which providers are licensed to practice in which U.S. state (e.g. Provider “Jane Doe” is licensed in “NY”, “MA” and “CA”). The state licensure feature can be relevant no matter the contact type of the appointment and is commonly used by companies delivering virtual care in multiple states. You should consider adding state licenses if the type of care you deliver requires that a provider be licensed in the specific state.

Client Physical Location at Time of Care

For telehealth services, the client’s physical location at the time of the visit typically determines:

• Which provider may legally see them
• Which state license applies
• Which payer rules govern reimbursement

Operational recommendation

• Clearly collect and store client state of residence
• Train staff to confirm client location at time of booking or visit
• Use State Licensure Booking to prevent invalid client self-bookings

Add State-Specific Insurance Policies

If you plan to bill insurance in a new state(s), you’ll need to add the state-specific insurance plans to your accepted policies list. This makes it easier for clients and your team to select the correct insurance plan. 

If an insurer does not appear in the Healthie database of payers, you can optionally add an insurer as a custom policy. For further guidance on setting up your Healthie account to take insurance, click here. 

Once you’ve added your new insurance payers in the main organization settings, you can set individual provider payer policies.

Quick reference: 

Settings > Organization > Members > [select provider > [...] edit] > Accepted Policies > + Add Policy

Additional steps related to insurance billing to keep in mind:

• Clearinghouse enrollment may be required per state
• ERAs may need payer-specific setup per state

Update Forms & Templates 

Consider updating any intake forms or charting notes that mention states of operation for your organization.

You may want to consider updating or adding the following to your forms or intake flows:

• Telehealth consent
• State-specific disclosures
• Notice of privacy practices (if state-specific)

Client Intake & Eligibility Guardrails (Recommended)

To reduce downstream scheduling and billing issues, confirm that client intake workflows capture state eligibility early.

Operational recommendations:

• Require client state of residence during intake
• Surface state-based eligibility messaging if care is restricted
• Ensure intake data is visible to scheduling and billing teams

Healthie considerations

• Client onboarding can be used to electronically collect client location prior to booking
• State data should be reviewed before confirming appointments or submitting claims

Provider Roles, Permissions & Training

Before going live in a new state, confirm:

• Provider permissions reflect new state workflows
• Scheduling staff understand state-based restrictions
• Billing staff are trained on new payer rules
• Clinical templates are updated and approved

Healthie consideration:

Use role-based permissions to limit who can edit:

• Licensure details
• Insurance settings
• Claim facilities

Test Before Going Live (Recommended)

Before opening booking to patients:

• Book a test appointment for the new state
• Verify provider visibility behaves as expected
• Confirm correct POS code appears on claims
• Validate intake forms render correctly
• If billing insurance, submit or simulate a test claim for the new state prior to first patient visit