Billing & Credentialing Cranberry Twp. (Pittsburgh)
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  • Credentialing
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    • Behavioral Health
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  • Articles (Page 2)

Articles

Amazon’s Healthcare Revolution: Transforming Patient Care

September 23, 2025 / admin / Amazon, Amazon Care, Amazon Healthcare, Amazon One Medical, Articles, Healthcare Disruption, Healthcare Revolution, Healthcare Transformation, One Medical, Patient-Centered Care, PillPack, Virtual Care Normalization
Amazon Healthcare One Medical

Few companies have reshaped consumer expectations quite like Amazon. What began as a modest online bookstore has transformed into a global powerhouse that touches virtually every aspect of American life. Now, this tech giant is setting its sights on one of the most traditional and regulated industries: healthcare. The implications of Amazon’s healthcare expansion are […]

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Amazon, Amazon Care, Amazon Healthcare, Amazon One Medical, Healthcare Disruption, Healthcare Revolution, Healthcare Transformation, One Medical, Patient-Centered Care, PillPack, Virtual Care Normalization

How RPA Can Save Your Medical Billing

September 22, 2025 / admin / Articles, Automated Billing, Automation, Billing Automation, Manual Billing, RCM, RCM AI, Reimbursement, Revenue Cycle Management, Revenue Cycle Management AI, Robotic Process Automation, RPA, RPA Adoption
robotic-process-automation-RPA-example-code

Medical billing has become the backbone of healthcare revenue, yet it remains one of the most challenging aspects of running a medical practice. Between changing regulations, insurance requirements, and the constant pressure to reduce claim denials, billing departments are stretched thin while managing increasingly demanding workloads. The statistics paint a sobering picture: the average medical […]

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Automated Billing, Automation, Billing Analytics, Billing Automation, Manual Billing, RCM, Reimbursement, Revenue Cycle, Revenue Cycle Management, Robotic Process Automation, RPA, RPA Adoption

Getting Charge Capture Right

September 21, 2025 / admin / Articles, Charge Capture, Charge Capture Challenges, Charge Capture Strategy, EHR, EMR, Missed Charges, Optimized Charge Capture, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization, Revenue Leakage
Group of Ethnically Diverse Medical Doctors Discussing Charge Capture

Healthcare practices today face mounting pressure to maximize every revenue opportunity while maintaining exceptional patient care. Among all the operational challenges that demand attention, charge capture stands out as both the most critical and most frequently mishandled aspect of practice management. When done correctly, it transforms your revenue cycle from a constant source of stress […]

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Charge Capture, Charge Capture Challenges, Charge Capture Strategy, EHR, EMR, Missed Charges, Optimized Charge Capture, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization, Revenue Leakage

Value-Based Care Billing: Preparing for the Transition

September 20, 2025 / admin / Articles, RCM, Value Based Care, Value Based System, Value-Based, Value-Based Care, Value-Based Care Adoption, Value-Based Care Integration, Value-Based Care Models, Value-Based Models, Value-Based Reimbursement
Caucasian Red-Headed Male Medical Doctor

The healthcare industry stands at a pivotal moment. After decades of fee-for-service models that prioritized volume over outcomes, we’re witnessing a fundamental shift toward value-based care arrangements that reward quality, efficiency, and patient satisfaction. This transformation is reshaping the entire financial foundation of medical practices. For healthcare providers, this transition represents both tremendous opportunity and […]

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RCM, Value Based Care, Value Based System, Value-Based, Value-Based Care Adoption, Value-Based Care Integration, Value-Based Care Models, Value-Based Models, Value-based Reimbursement

What is Prior Authorization?

September 19, 2025 / admin / Articles, Diagnostic Imaging, Pre-Approval, Pre-Authorization, Pre-Authorization Process, Prior Authorization, Prior Authorization Process, Prior Authorizations, Services Requiring Prior Authorization
Female Mulatto Doctor Prior Authorization

Prior authorization is a fundamental healthcare process that requires healthcare providers to obtain approval from insurance companies or healthcare organizations before delivering specific medical services, treatments, or procedures to patients. This approval mechanism serves as a crucial gatekeeping function that ensures medical services are medically necessary, cost-effective, and appropriate for the patient’s condition before they […]

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Articles, Diagnostic Imaging, Pre-Approval, Pre-Authorization, Pre-Authorization Process, Prior Authorization, Prior Authorization Process, Prior Authorizations, Services Requiring Prior Authorization

What Comes First: Credentialing or Contracting?

September 18, 2025 / admin / Articles, Contract Negotiation, Contracting, Credentialing, Credentialing and Contracting, Credentialing Challenges, Credentialing Documentation, Credentialing Software, Credentialing Technology, Payer Contracting
Twin White Male Medical Doctors Looking at Each Other

Healthcare providers entering the world of insurance partnerships face a chicken-and-egg dilemma that can make even seasoned professionals scratch their heads. Should you get credentialed first, or should you secure contracts before diving into the credentialing process? The answer isn’t as straightforward as you might think, and knowing the nuances can save you months of […]

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Contract Negotiation, Contracting, Credentialing, Credentialing and Contracting, credentialing challenges, Credentialing Documentation, Credentialing Software, Credentialing Technology, Payer Contracting

How AI Saves Your Medical Practice (Money)

September 17, 2025 / admin / AI, AI in Healthcare, AI Models, AI Telehealth, AI Use Cases, AI-driven RCM, Articles, Artificial Intelligence, Contracting AI, Healthcare AI, Medical Coding AI, Medical Credentialing AI, RCM AI, Revenue Cycle Management AI
Artificial Intelligence Robot Thinking

Healthcare costs continue to climb, and medical practices face mounting pressure to deliver quality care while maintaining profitability. The financial strain on physicians and practice administrators has reached a tipping point, with many struggling to balance patient needs against operational expenses. Enter artificial intelligence, a technology that’s transforming how medical practices operate and, more importantly, […]

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AI Diagnostic Models, AI in Healthcare, AI Models, AI Telehealth, AI Use Cases, AI-driven RCM, Artificial Intelligence, Billing AI, Contracting AI, Credentialing AI, Data Management, Healthcare, Healthcare AI, Healthcare Use Cases, Medical Coding AI, Medical Credentialing AI, Medical Use Cases, RCM AI, Revenue Cycle Management, Revenue Cycle Management AI

Payer Contract Optimization Strategies

September 16, 2025 / admin / Articles, Healthcare Rate Negotiations, Medical Rate Negotiations, Payer Relationships, Rate Negotiations, Value Based Care, Value-Based, Value-Based Care, Value-Based Care Adoption, Value-Based Care Integration, Value-Based Models
Payer Contracting Negotiation

Managing payer contracts effectively can make the difference between a thriving practice and one that struggles financially. Healthcare organizations face mounting pressure to maximize revenue while delivering quality care, and optimizing payer contracts sits at the heart of this challenge. Smart contract optimization is about creating sustainable partnerships that benefit both providers and payers while […]

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Healthcare Rate Negotiations, Medical Rate Negotiations, Payer Relationships, Rate Negotiations, Value Based Care, Value-Based, Value-Based Care Adoption, Value-Based Care Integration, Value-Based Models

Claims Management 101: Your Guide to Efficient Billing

September 15, 2025 / admin / Articles, Billing, Claim Data, Claim Denial Prevention, Claim Denials, Claim Rejection, Claim Rejection Rate, Claim Scrubbing, Claim Status, Claim Transmission, Claims Management, Claims Management Challenges, Medical Billing
Claims Management 101

Medical billing has become a battlefield where providers fight daily for fair reimbursement. Recent industry data reveals a troubling trend: 77% of healthcare organizations express moderate to extreme concern about payers refusing to reimburse services. This growing anxiety stems from constantly shifting payer policies, stricter prior authorization requirements, and an increasingly intricate web of billing […]

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Billing, Claim Data, Claim Denial Prevention, Claim Denials, Claim Rejection, Claim Rejection Rate, Claim Scrubbing, Claim Status, Claim Transmission, Claims Management, Claims Management Challenges, Medical Billing

The Value of Rate Negotiations

September 14, 2025 / admin / Articles, Competitive Positioning, Healthcare Rate Negotiations, Inadequate Rates, Medical Rate Negotiations, Patient Care Benefits, Proactive Rate Negotiations, Rate Negotiations, Revenue Enhancement, Speak Up
Healthcare Rate Negotiations (Megaphone)

Why Healthcare Organizations Can’t Afford to Stay Silent Healthcare organizations across the country face an uncomfortable reality: many are accepting reimbursement rates that barely cover their costs, while others unknowingly leave significant revenue on the table by failing to negotiate effectively with insurance payers. The value of strategic rate negotiations extends far beyond simple revenue […]

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Competitive Positioning, Healthcare Rate Negotiations, Inadequate Rates, Medical Rate Negotiations, Patient Care Benefits, Proactive Rate Negotiations, Rate Negotiations, Revenue Enhancement, Speak Up

Which States Participate in Multi-State Licensing Models?

September 13, 2025 / admin / Articles, IMLC, Interstate Medical Licensure Compact, Medical Licensure Compacts, Multi-State Credentialing, Multi-State Licensing, Multi-State Licensing Compacts, Multi-State Movement, OTLC, PTLC, REPLICA, Telehealth, Telemedicine
Multi-State Licensing Models Map

Healthcare licensing has traditionally been a state-by-state affair, creating barriers for providers who want to practice across state lines and patients seeking care from specialists located in different states. Multi-state licensing models have emerged as a solution to streamline this process, allowing qualified healthcare professionals to obtain licenses in multiple states through coordinated agreements and mutual […]

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IMLC, Interstate Medical Licensure Compact, Medical Licensure Compacts, Multi-State Credentialing, Multi-State Licensing, Multi-State Licensing Compacts, Multi-State Movement, OTLC, PTLC, REPLICA, Telehealth, Telemedicine

Which CPT Codes are Used in General Surgery Billing?

September 12, 2025 / admin / 19120, 19301, 19303, 19307, 19350, 43235, 43239, 43247, 43248, 44140, 44145, 44160, 44950, 44960, 44970, 47562, 47563, 47600, 47605, 47610, 49000, 49020, 49505, 49507, 49520, 49521, 49560, 49561, 49565, 49566, Articles, CPT Codes, General Surgery, General Surgery Billing
White Female Surgeon at the Operating Table

General surgery practices rely on accurate CPT (Current Procedural Terminology) coding to ensure proper reimbursement and maintain compliance with healthcare billing standards. Knowledge of the most commonly used codes in general surgery billing is essential for medical coders, practice administrators, and healthcare providers working in this specialty. CPT Code Categories in General Surgery The CPT […]

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19120, 19301, 19303, 19307, 19350, 43235, 43239, 43247, 43248, 44140, 44145, 44160, 44950, 44960, 44970, 47562, 47563, 47600, 47605, 47610, 49000, 49020, 49505, 49507, 49520, 49521, 49560, 49561, 49565, 49566, CPT codes, General Surgery, General Surgery Billing

Strategic Payer Negotiations: A Data-Driven Approach

September 11, 2025 / admin / Articles, Contract Negotiations, Data-Driven, Data-Driven Negotiations, Data-Driven Payer Negotiations, Payer Negotiations, Scott Ellsworth, Strategic Payer Negotiations, Value-Based Care, Value-Based Care Models

Healthcare providers today face mounting pressures from multiple directions. Administrative burdens continue to pile up, denial rates are climbing, and reimbursement rates lag behind inflation. Yet many hospitals and health systems approach payer negotiations with the same old playbook, leaving significant money on the table and accepting contract terms that don’t serve their organization’s best […]

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Contract Negotiations, Data-Driven, Data-Driven Negotiations, Data-Driven Payer Negotiations, Payer Negotiations, Scott Ellsworth, Strategic Payer Negotiations, Value Based Care, Value-Based Care Models

Building Profitable Relationships Through Payer Contracting

September 10, 2025 / admin / Articles, Payer Contract, Payer Contract Management, Payer Contract Negotiation, Payer Contract Re-Negotiation, Payer Contracting, Payer Contracts, Payor Contract Management, Payor Contracting, Reimbursement, Reimbursement Rates
Payer Contract Management in Healthcare

Healthcare providers today face an increasingly challenging landscape when it comes to securing favorable contracts with insurance payers. The art of payer contracting goes far beyond simply negotiating rates, it’s about creating mutually beneficial partnerships that drive sustainable revenue growth while maintaining quality patient care. When done right, these relationships become the foundation of a […]

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Payer Contract, Payer Contract Management, Payer Contract Negotiation, Payer Contract Re-Negotiation, Payer Contracting, Payer Contracts, Payor Contract Management, Payor Contracting, Reimbursement, Reimbursement Rates

The 9-Step Medical Credentialing Process

September 9, 2025 / admin / 9-Step Credentialing, Articles, Credentialing, Credentialing Process, Credentialing Services, Credentialing Steps, Credentialing Verification, Medical Credentialing Process, New Provider Credentialing, Recredentialing
White male medical doctor signing credentialing document

Medical credentialing stands as one of the most complete and rigorous examples of professional credentialing in any industry. This systematic process ensures that healthcare providers possess the necessary qualifications, training, and competencies to deliver safe, effective patient care. Knowing the essentials of medical credentialing provides valuable insight into how credentialing works, why it matters, and […]

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Background Checks, Board Certification Verification, Credentialing, Credentialing Monitoring, credentialing process, Credentialing Services, Credentialing Steps, Credentialing Verification, Educational Verification, Licensing Verification, Medical Credentialing Process, New Provider Credentialing, Peer Review, Professional Reference, Recredentialing

What Payers Don’t Want You to Know About Credentialing

September 8, 2025 / admin / Articles, Credentialing, Credentialing Challenges, Credentialing Delays, Credentialing Denials, Credentialing Documentation, Credentialing Technology, Denied Credentialing, Medical Credentialing, Recredentialing
Black Male Payer Contracting Expert

Healthcare providers entering the world of insurance credentialing often find themselves in a tangled, difficult process that seems designed to frustrate rather than facilitate. While insurance companies present credentialing as a necessary quality assurance measure, the reality is far more complex. Behind the official explanations and standardized forms lies a strategic system that serves the […]

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Credentialing, Credentialing AI, Credentialing Applications, credentialing challenges, Credentialing Delays, Credentialing Denials, Credentialing Documentation, Credentialing Technology, Medical Credentialing, Recredentialing

How Artificial Intelligence (AI) is Reshaping Life Sciences

September 7, 2025 / admin / AI, AI in Healthcare, AlphaFold, Articles, Artificial Intelligence, Biological Research, Clinical Operations, Clinical Trial Design, Compound Screening, DeepMind, Google DeepMind, Lead Optimization, Target Identification
Life Science Lab Doctor Using Microscope AI

The intersection of artificial intelligence and life sciences represents one of the most transformative technological convergences of our time. From accelerating drug discovery to personalizing treatment plans, AI is fundamentally changing how researchers approach biological questions and how healthcare providers deliver care. This technological revolution is not merely augmenting existing processes but creating entirely new […]

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AI, AI in Healthcare, AlphaFold, Artificial Intelligence, Biological Research, Clinical Operations, Clinical Trial Design, Compound Screening, DeepMind, Google DeepMind, Lead Optimization, Target Identification

10 Credentialing KPIs Every Healthcare Provider Should Know

September 6, 2025 / admin / Articles, Credentialing, Credentialing Applications, Credentialing Criteria, Credentialing Cycle Time, Credentialing KPIs, Credentialing Metrics, Credentialing ROI, Medical Credentialing, Medical Credentialing KPIs, Recredentialing
White Male Doctor w/ Black Female Administrator

Provider credentialing serves as the foundation for patient safety, regulatory compliance, and revenue generation. The credentialing process verifies that healthcare providers possess the necessary qualifications, training, and experience to deliver safe, quality care. However, this critical function often operates behind the scenes, making it challenging for healthcare organizations to optimize their credentialing operations without proper […]

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Credentialing, Credentialing Applications, Credentialing Criteria, Credentialing Cycle Time, Credentialing KPIs, Credentialing Metrics, Credentialing ROI, Medical Credentialing, Medical Credentialing KPIs, Medical KPIs, Recredentialing

How is AI Being Used in Healthcare?

September 5, 2025 / admin / AI Diagnostic Models, AI Models, AI Use Cases, Articles, Artificial Intelligence, Data Management, Healthcare, Healthcare AI, Healthcare Use Cases, Medical Use Cases
Artificial Intelligence Robot Thinking

The intersection of artificial intelligence and healthcare represents one of the most transformative developments in modern medicine. As AI technologies develop, they’re reshaping how medical professionals diagnose diseases, treat patients, and manage healthcare systems. From machine learning algorithms that can spot cancer cells in medical images to chatbots that provide 24/7 patient support, AI is […]

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AI Diagnostic Models, AI Models, AI Use Cases, Articles, Artificial Intelligence, Data Management, Healthcare, Healthcare AI, Healthcare Use Cases, KPIs, Medical, Medical Use Cases, Patient Care

10 Payer Contracting Use Cases

September 4, 2025 / admin / Articles, Payer Contract, Payer Contract Management, Payer Contract Negotiation, Payer Contract Re-Negotiation, Payer Contracting, Payer Contracts, Payor Contract Management, Payor Contracting, Reimbursement, Reimbursement Rates
Payer Contract Negotiations, with White Male Medical Doctor

Payer contracting can make or break a healthcare organization’s financial health. The difference between a well-negotiated contract and a mediocre one often means millions in revenue over the contract term. At Medwave, we’ve helped many thousands of healthcare providers optimize their payer relationships, and we’ve seen firsthand how the right approach transforms both revenue and […]

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Payer Contract, Payer Contract Management, Payer Contract Negotiation, Payer Contract Re-Negotiation, Payer Contracting, Payer Contracts, Payor Contract Management, Payor Contracting, Reimbursement, Reimbursement Rates

Struggling with Credentialing? Medwave Can Help!

September 2, 2025 / admin / Articles, Credentialing, Credentialing Applications, Credentialing Challenges, Credentialing Management, Credentialing On-Boarding, Credentialing Optimization, Credentialing Problems, Credentialing Process, Recredentialing
White Male Medical Doctor Needing Credentialing

Medical credentialing shouldn’t feel like running through a maze blindfolded, yet that’s exactly how many healthcare professionals describe the process. Whether you’re a seasoned physician looking to join a new practice, a fresh graduate eager to start your career, or a healthcare administrator drowning in paperwork, the credentialing process can be overwhelming, time-consuming, and frankly, […]

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Credentialing, Credentialing Applications, credentialing challenges, Credentialing Management, credentialing on-boarding, Credentialing Optimization, Credentialing Problems, credentialing process, Recredentialing

How to Restructure Payer Contracts

August 31, 2025 / admin / Articles, Contract Management, Payer Contract, Payer Contract Negotiation, Payer Contract Re-Negotiation, Payer Contracting, Payer Contracts, Payer Enrollment, Payer Negotiation, Payer Regulations, Payor Contract, Payor Contracting
Agreement to Negotiate Contracts in Healthcare

Healthcare providers often believe they have limited options when it comes to improving their payer contracting income. This assumption couldn’t be further from the truth. Contract negotiation and contract management represent powerful tools your healthcare organization can leverage to enhance current contracts and increase revenue substantially. The challenge lies in execution. Many physicians struggle to […]

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Payer Contract, Payer Contract Negotiation, Payer Contract Re-Negotiation, Payer Contracting, Payer Contracts, Payer Enrollment, Payer Negotiation, Payer Regulations, Payor Contract, Payor Contracting

Credentialing for New Graduates: From Residency to Practice

August 29, 2025 / admin / Articles, Credentialing, Credentialing Challenges, Credentialing Delays, Credentialing Difficulty, Credentialing Management, Credentialing Pitfalls, Credentialing Problems, Medical Credentialing, New Graduate Credentialing
White Female Medical Doctor Smiling

The transition from medical residency to independent practice represents one of the most significant milestones in a physician’s career. While newly minted doctors have spent years mastering clinical skills and medical knowledge, many find themselves unprepared for the tough administrative environment that awaits them in the real world of healthcare delivery. Among the most critical […]

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Credentialing, credentialing challenges, Credentialing Delays, Credentialing Difficulty, Credentialing Journey, Credentialing Management, Credentialing Pitfalls, Credentialing Problems, credentialing process, Medical Credentialing

Credentialing Workflow Optimization

August 25, 2025 / admin / Articles, Credentialing, Credentialing Accuracy, Credentialing Challenges, Credentialing Delays, Credentialing Difficulty, Credentialing Errors, Credentialing Workflow Optimization, Suboptimal Credentialing
Medical Credentialing Workflow

For many organizations, credentialing remains a cumbersome, time-consuming workflow filled with inefficiencies and bottlenecks. The undermentioned content explores the nuances of credentialing workflow optimization. We break down what it is, why it matters, and how organizations can transform their approach to this essential function. The Current Credentialing Terrain Credentialing, at its core, is the process […]

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Credentialing, Credentialing Accuracy, credentialing challenges, Credentialing Delays, Credentialing Difficulty, Credentialing Errors, Credentialing Workflow Optimization, Suboptimal Credentialing

Value-Based Care: What It Is and Why You Should Care

August 23, 2025 / admin / Articles, Value Based Care, Value Based System, Value-Based, Value-Based Care, Value-Based Care Adoption, Value-Based Care Models, Value-Based Models, Value-Based Pricing, Value-Based Reimbursement, VBC
Value-Based Care Models

Healthcare in America is undergoing a fundamental transformation. For decades, our medical system operated on a simple premise: the more services provided, the more money earned. This fee-for-service model incentivized volume over value, leading to escalating costs, fragmented care, and outcomes that often failed to match the enormous investment. Enter value-based care, a revolutionary approach […]

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Value Based Care, Value Based System, Value-Based, Value-Based Care Adoption, Value-Based Care Models, Value-Based Models, Value-Based Pricing, Value-based Reimbursement, VBC
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Recent Posts

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Practices Served

  • Behavioral Health
  • DME
  • Urgent Care
  • Speech Therapy
  • Geriatric Medicine
  • Skilled Nursing Facilities (SNF)
  • Substance Abuse
  • Genetic Testing
  • Pharmacogenetic (PGx)
  • Toxicology
  • Allergy Testing
  • Oncology
  • Pathology
  • OBGYN
  • Internal Medicine
  • Primary Care
  • Biologics and Specialty Drugs
  • Telestroke and Teleneurology
  • Digital Therapeutics (DTx)
  • Remote Patient Monitoring
  • Remote Therapeutic Monitoring
  • Home Infusion Therapy
  • Sleep Study Labs
  • Physical Therapy (PT)
  • Occupational Therapy
  • COVID-19 Testing

Practices Served

  • Behavioral Health
  • DME
  • Urgent Care
  • Speech Therapy
  • Geriatric Medicine
  • Skilled Nursing Facilities (SNF)
  • Substance Abuse
  • Genetic Testing
  • Pharmacogenetic (PGx)
  • Toxicology
  • Allergy Testing
  • Oncology
  • Pathology
  • OBGYN
  • Internal Medicine
  • Primary Care
  • Biologics and Specialty Drugs
  • Telestroke and Teleneurology
  • Digital Therapeutics (DTx)
  • Remote Patient Monitoring
  • Remote Therapeutic Monitoring
  • Home Infusion Therapy
  • Sleep Study Labs
  • Physical Therapy (PT)
  • Occupational Therapy
  • COVID-19 Testing

Recent Posts

  • CareSource Credentialing

    A Guide to Provider Credentialing with CareSource

  • Middle-Aged White Male Medical Doctor

    Credentialing Denials: The Ugly Truth

  • Behavioral Health Credentialing, Billing & Contracting Use Case

    Use Case: Behavioral Health Contracting

  • Group of Medical Doctors Discussing Charge Capture at Hospital

    10 Billing KPIs Every Healthcare Provider Should Know

  • Tax Status Dictates Contract Structure (Doctor Signing)

    Tax Status Dictates Contract Structure

  • Blonde Female Healthcare Provider / Owner

    New NCQA 2025 Rules and Their Impact

  • Black Male and Female Medical Doctors

    Payer Contracting: Unlock Your Revenue Potential

  • 12 Real World Healthcare Use Cases of AI / Artificial Intelligence

    How AI-Powered Healthcare Solutions Improve Patient Care & Satisfaction

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