Medical Billing and Credentialing Blog
Practical guides to the parts of billing and credentialing that cost practices the most time: how each major payer actually runs its enrollment, what the forms are really asking, and where applications stall. Written for providers and practice managers.
Every guide below covers one payer end to end - who credentials you, what they need, how long it takes and what to do when it goes quiet.
BCBS Credentialing: Getting In Network with Blue Cross Blue Shield
Blue Cross Blue Shield is 33 independent companies, not one payer, so each state plan is its own application with its own timeline. What BlueCard does and does not do for you once you are in.
UnitedHealthcare and Optum Credentialing
UHC credentials medical providers; Optum credentials behavioral health. Getting that wrong at the start is the single most common reason a UHC application sits for months.
Medicare Credentialing and Provider Enrollment
PECOS, the CMS-855 forms, reassignment of benefits, and the retrospective billing window that lets you bill for care delivered before your approval came through.
Medicaid Credentialing and Provider Enrollment
The state programme first, then every managed care plan separately - and why providers who stop after the state enrollment find their claims denied by the plan.
Aetna Credentialing and Provider Enrollment
Aetna runs on CAQH and starts with a network need review, so an application can be declined before it is ever assessed on your credentials. How to read that decision.
Cigna Credentialing and Evernorth Behavioral Health
Medical goes to Cigna, behavioral health goes to Evernorth, and they are separate processes with separate contracts. Which one applies to you, and what happens if you do both.
Delta Dental Credentialing and Provider Application
Member companies by state, the PPO and Premier decision that sets your fee schedule for years, and how associate dentists are linked to a practice location.
Best Credentialing Services for Mental Health Providers
An honest comparison of the four routes - doing it yourself, a credentialing service, a billing company, or a panel aggregator - including when not to hire anybody.