HealthcareManagement

Provider Credentialing

Provider Credentialing Process: A Guide for Practices

For practice managers, healthcare providers, and owners, efficient provider credentialing is the backbone of a healthy revenue cycle. Credentialing with payers—whether commercial giants like UnitedHealthcare, BlueCross BlueShield, Humana, and Aetna or government programs like Medicare and Medicaid—is essential for timely reimbursements. However, the process is often complex, time-consuming, and fraught with challenges. Understanding the Credentialing […]

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Reason Code N77

Preventing Reason Code N77 Denials: A Guide for Healthcare Practices

Understanding Reason Code N77 and Its Impact In the complex landscape of healthcare claims, denials can significantly disrupt revenue cycles for practice managers, healthcare providers, and practice owners. One prevalent denial reason is Reason Code N77, which signifies a missing, incomplete, or invalid designated provider number. Understanding the root causes and implementing effective strategies to

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Denial Code 198

Denial Code 198: Essential Strategies for Healthcare Providers

Denial Code 198 presents a persistent challenge for healthcare providers, practice managers, and owners. This code indicates that a claim has been denied or reduced due to missing or inadequate precertification, authorization, or notification for a provided service. Precertification—also known as prior authorization or pre-approval—is a process required by many insurance companies before certain medical

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Navigating Denial Code B15: Maximize Reimbursement.

Healthcare providers often face the daunting challenge of insurance claim denials, with denial code B15 being one of the most perplexing. This denial arises when a qualifying service is missing or does not meet payer requirements, causing delays in reimbursement. To maintain healthy revenue cycles and reduce administrative hassles, understanding and proactively addressing B15 denials

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The M80 Myth: Debunking Healthcare Billing Misconceptions.

M80 denials are a frequent challenge in healthcare billing, signaling that a service wasn’t covered because it overlapped with a previously processed service. These denials can disrupt cash flow and increase administrative workloads for healthcare providers. This guide explores the causes of M80 denials and effective strategies to overcome them. What Triggers M80 Denials?Common reasons

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N59 Denials: Your Roadmap to Precise Claim Submissions

Struggling with N59 denials? These denials, urging providers to review payer manuals for further clarification, often highlight underlying errors in billing processes. Left unresolved, they can disrupt cash flow and hinder effective revenue cycle management. Let’s uncover the causes, strategies, and steps to optimize claim submissions and prevent denials. Top Causes of N59 Denials Actionable

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N362 Denial: Identify Causes and Optimize Revenue.

​N362 denial codes, which signify excessive days or units of service, can be a persistent challenge for healthcare practices, impacting revenue cycles and patient care. This comprehensive guide explores the most common reasons for these denials and actionable strategies to prevent them, ensuring smooth claim processing for your practice. Common Causes of N362 Denials Proactive

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Navigating Medicaid Contract Delays: Impact on Provider Credentialing.

Texas recently announced a delay in awarding new Medicaid contracts until June 2025, a decision affecting nearly 1.8 million beneficiaries across the state. This pause, initiated after a court injunction, allows lawmakers to review criteria impacting health plans, including three nonprofit hospital-affiliated plans. While the focus is on managed care restructuring, the ripple effects extend

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Navigate CO9 Denials: Prevention and Resolution Strategies.

CO9 denials, which result from inconsistencies between diagnosis codes and procedures, are a frequent challenge in healthcare billing. For healthcare providers, practice managers, and owners, these denials can disrupt revenue flow. This guide explains the causes, prevention strategies, and steps to resolve CO9 denials effectively. Common Causes of CO9 Denials Strategies to Prevent CO9 Denials

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