OIG Exclusion Screening: Whose Job Is It for Referrals?

Key Finding OIG exclusion screening is not just for your own staff. If you bill for a service...

NCQA Behavioral Health Accreditation: What Practices Face

TL;DR: NCQA behavioral health accreditation now scores the organizations that run your payer...

Best Credentialing Companies: How to Choose the Right One

TL;DR: The best credentialing companies keep a provider's DataSpring profile current between...

Outsource Credentialing or Not: The Honest Sizing Guide

TL;DR: The outsource credentialing decision turns on load, not price. Operators report one payer...

Aetna Credentialing Timelines and How to Sequence Them

TL;DR: Aetna credentialing routinely outruns every other payer on the list. Operators in AAPC's...

M115 Denial Code: Why Credentialed Providers Still Get Denied

TL;DR. The M115 denial code means a payer treats the provider as non-contracted. Often the real...

NCQA Credentialing Standards 2026: What Practices Must Know

TL;DR: The NCQA credentialing standards 2026 surveys enforce apply to files processed on or after ...

Billing Under Another Physician: What Actually Holds Up

Key Finding: Billing under another physician is legal, but only in narrow cases. Reciprocal billing...

Medicaid Credentialing: State-by-State Basics

TL;DR Medicaid credentialing is not one process. It is 50-plus separate state programs, each with...

Medicare Provider Enrollment: Payer-by-Payer Timelines

TL;DR: Medicare provider enrollment usually runs 45 to 90 days. Medicaid and commercial payers...