BCBS credentialing by state works differently every time, so if you’ve credentialed with Blue Cross Blue Shield in one state and assumed the next state would go the same way, you’re about to find out how wrong that assumption can be. BCBS runs as a collection of independently owned and operated licensees, each running its […]
Blue Cross Blue Shield, CAQH, Credentialing, Credentialing by State, DataSpring, NCQA, Recredentialing
The ghost provider problem starts with a lapsed CAQH profile. Your highest-volume nurse practitioner has been seeing patients for months, claims have been going out on time, and then the denials start. First a few, then a flood. Your billing team works the rejections, calls the payer, digs through EOBs and eventually someone traces the […]
CAQH, Claim Denials, Credentialing, DataSpring, Ghost Provider
Anthem credentialing decides whether you can see patients on Anthem plans and get paid for it, so it pays to get the application right the first time. Anthem runs Medicare Advantage, Medicaid managed care, and commercial plans, which makes it a major payer for most practices that take insurance. This guide covers the full credentialing […]
Anthem BCBS Credentialing, DataSpring, DataSpring / CAQH, Medical Credentialing, NPI
Kaiser Permanente credentialing and provider enrollment work differently from the big commercial payers, because Kaiser runs the health plan, the hospitals, and the medical groups under one roof. The rules also change by region, and in some regions Kaiser is not taking new applications at all, so the first job is to find out which […]
CAQH ProView, DataSpring, Kaiser Permanente Credentialing, Kaiser Permanente Recredentialing
Every credentialing delay traces back to one of a small number of root causes, even though it rarely feels that way when you’re the one chasing down a missing license copy. A physician can’t bill a payer’s network rate until credentialing clears, so every error in the process has a direct dollar cost attached to […]
CAQH ProView, Credentialing Compliance, Credentialing Workflow, DataSpring, Primary Source Verification, Provider Enrollment
UnitedHealthcare credentialing now runs through a tool called Onboard Pro, and most of the advice floating around the internet still describes an older process. UnitedHealthcare’s current instructions start there, move through credentialing, and then trigger contracting on their own. That changes what you should prepare, and in what order. This guide walks through the steps, […]
CAQH, DataSpring, Recredentialing, UnitedHealth Credentialing
Payer enrollment and credentialing are two separate steps whenever you bring new providers into a medical practice, and mixing them up delays billing. Bringing on a physician, nurse practitioner, or physician assistant opens doors to serving more patients and expanding your services. But there’s a catch that trips up even experienced practice managers, getting these […]
CAQH, DataSpring, Medical Credentialing, Payer Enrollment, Primary Source Verification