Compliance & Credentialing resources
What to watch for in credentialing, enrollment, and eligibility verification -- the front-end work that determines whether claims ever get paid.
Ambetter Provider Credentialing: How to Join by State
Ambetter has no national credentialing application — enrollment routes through state Centene plans. The state-to-plan map, CAQH rules, and published timelines.
Read the Guide arrow_forwardCAQH 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_forwardCigna Provider Credentialing: How to Join the Network
How Cigna credentialing actually starts, the CAQH status it checks, the Evernorth behavioral pause in effect now, and the dental path. Sourced to Cigna.
Read the Guide arrow_forwardCMS-588 EFT Authorization: The Signer Rule and Everything Else
CMS-588 authorizes Medicare EFT — it is not enrollment. The same AO/DO on your CMS-855 must sign it. When you need one, bank-document rules, PECOS vs mail.
Read the Guide arrow_forwardCMS-855B: How an Organization Enrolls in Medicare
Form CMS-855B enrolls clinics and group practices in Medicare. Who files it vs 855A/855I, why physician groups skip the $750 fee, and what MACs reject.
Read the Guide arrow_forwardCMS-855I: What the Form Itself Requires, Section by Section
CMS-855I enrolls physicians and NPPs in Medicare and now carries every reassignment. Form selector vs 855B/855O, walkthrough, MAC timeframes, fee rules.
Read the Guide arrow_forwardCMS-855R Discontinued: How Medicare Reassignment Works Now
CMS discontinued the CMS-855R on October 31, 2023. All reassignment actions now run through CMS-855I or PECOS. The post-2023 workflow, quoted from CMS.
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 Audits: 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_forwardMedicare PTAN: What It Is, Who Issues It, and How to Find Yours
A PTAN is the Medicare-only number your MAC issues at enrollment approval. PTAN vs NPI vs MBI, recovering a lost PTAN, and the deactivation rules.
Read the Guide arrow_forwardMedicare Revalidation: The Operational Playbook CMS Doesn't Publish in One Place
Find your Medicare revalidation due date, revalidate in PECOS, avoid deactivation. The 5-year cycle, 7-month rule, and $750 CY2026 fee — all CMS-cited.
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 or 855B — 855R discontinued), reassignment via the 855I, revalidation, and effective 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.
Read the Guide arrow_forwardType 2 NPI: Which Entities Need One and How NPPES Assigns It
Sole proprietor, single-member LLC, S-corp or group — the CMS-sourced entity table, the CP-575 legal-name match, and the free NPPES application, quoted.
Read the Guide arrow_forwardGet a Free Billing Audit
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