Compliance & Credentialing resources
What to watch for in credentialing, enrollment, and eligibility verification -- the front-end work that determines whether claims ever get paid.
CAQH ProView Credentialing Guide (2026)
How CAQH ProView works, what providers must keep current, the 120-day attestation cycle, and the common credentialing failures that hold up payer enrollment.
Read the Guide arrow_forwardEPSDT Medicaid Billing for Children: The Federal Rules
Medicaid EPSDT billing for pediatric well-child visits: federal requirements, state periodicity schedules, the EP modifier, and visit-type documentation.
Read the Guide arrow_forwardGood Faith Estimate Requirements Under the No Surprises Act (2026)
Good Faith Estimates must reach uninsured/self-pay patients in 1-3 business days. Required elements, timing, the $400 PPDR threshold, and a sample GFE.
Read the Guide arrow_forwardHIPAA Compliance in Medical Billing: Complete 2026 Guide for Practices and Vendors
HIPAA compliance for medical billing: BAA checklist, three rules (Privacy, Security, Breach Notification), minimum necessary standard, and how to vet a vendor.
Read the Guide arrow_forwardMedical Billing Audit Checklist (2026): 47 Items to Review
47-item billing audit checklist: coding accuracy, documentation, denial trends, KPIs, compliance, and revenue leak detection — the first-engagement framework.
Read the Guide arrow_forwardMedical Coding Audit Services: A Buyer's Guide (2026)
What a coding audit is: prospective vs retrospective, random vs focused, OIG expectations, sample sizes, error-rate thresholds, and 2026 cost ranges.
Read the Guide arrow_forwardMedicare Incident-To Billing Rules (2026)
Medicare incident-to requirements: direct supervision, established patient, established plan of care, and the rules in 42 CFR 410.26 — with OIG audit risks.
Read the Guide arrow_forwardModifier 25: When to Use It (and When You Can't)
AMA CPT modifier 25 rules: when an E/M is significant and separately identifiable, the OIG audit triggers, audit-proof documentation, and common procedures.
Read the Guide arrow_forwardModifier 59 vs X-Modifiers (XE, XS, XP, XU): The 2026 Picture
How modifier 59 and the X modifiers (XE, XS, XP, XU) work, when CMS requires the X modifiers, and the NCCI edit logic that drives bundling reversals.
Read the Guide arrow_forwardPayer Credentialing Timeline and Cost (2026)
Credentialing timelines by payer (Medicare 30-60 days, commercial 90-180 days), the cost, typical effective dates, and steps that compress the process.
Read the Guide arrow_forwardPECOS Enrollment: Step-by-Step Guide for Providers (2026)
PECOS enrollment step by step: which 855 form to file (855I, 855B, 855R), revalidation every 5 years, reassignment, NPI linkage, and effective/retro dates.
Read the Guide arrow_forwardPlace of Service Codes: POS 11 vs POS 22 (and the Others That Matter)
POS 11 (office) vs POS 22 (on-campus outpatient hospital) and the reimbursement difference, plus POS 02/10 telehealth and patterns that produce POS denials.
Read the Guide arrow_forwardPOS 02 vs POS 10: Telehealth Place of Service Codes Explained (2026)
POS 10 is telehealth in the patient's home (higher non-facility rate); POS 02 is telehealth elsewhere (lower facility rate). Rate table, payer rules and fixes.
Read the Guide arrow_forwardPOS 13 in Medical Billing: Assisted Living Facility Code Explained (2026)
POS 13 = Assisted Living Facility, paid at the non-facility rate. Who bills it, E/M codes 99341-99350, POS 12/14/31/32/33 compared, and common denials.
Read the Guide arrow_forwardProvider Enrollment Checklist (2026): Every Document You Need
Provider enrollment checklist: 32 documents needed for Medicare, Medicaid, and commercial payer enrollment, organized by category with verification.
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