Best Medical Billing

Medical billing articles

Denial resolution, payer policy, coding references and revenue cycle operations.

151 articles · page 1 of 8

  • PR-204 Denial Code: Causes, Fixes, and Patient Billing

    When a claim comes back with PR-204, the payer is telling you the service simply isn't a purchased benefit on the patient's policy. Here is exactly how to verify the exclusion, check your ABNs, and transfer the balance without losing the patient's trust.

    October 18, 20269 min read

  • EmblemHealth Timely Filing Limits & 2026 Billing Guide

    Managing EmblemHealth claims requires tracking multiple submission windows across commercial, Medicare, and Medicaid lines of business. Here are the 2026 filing limits, EDI requirements, and appeal strategies to keep your New York practice paid.

    October 18, 202610 min read

  • Fidelis Care Timely Filing Limit & Billing Rules (2026 Guide)

    New York billers know Fidelis Care plays by its own rulebook. Master their 90-day timely filing limits, Centene-backed portals, and appeal deadlines to keep your cash flow moving in 2026.

    October 17, 20269 min read

  • Specialty Drug Prior Authorizations: 2026 Workflow and Appeal Strategies

    A single denied specialty drug claim can wipe out a practice's monthly margin. Learn how to navigate 2026's aggressive step therapy mandates, buy-and-bill rules, and CMS's new electronic prior auth API requirements.

    October 16, 20269 min read

  • MetroPlus Prior Authorization & Billing Guide (2026)

    MetroPlus dominates the NYC Medicaid managed care space. If your practice operates in the five boroughs, you need a precise strategy for their tight filing limits, rigid NYRx pharmacy rules, and portal-driven prior authorizations.

    October 16, 20268 min read

  • 2026 Guide to Workers' Compensation Timely Filing Limits

    Workers' comp billing is a 50-state patchwork of deadlines, third-party administrators, and state board regulations. Missing a deadline by one day means losing total reimbursement. Here is how to track, submit, and appeal workers' comp claims in 2026 without eating massive write-offs.

    October 15, 20268 min read

  • Medicare Provider Enrollment Guide: Forms, PECOS & 2026 Rules

    A single typo on your CMS-855 can stall your Medicare enrollment for 60 days. Learn exactly how to push your PECOS application through MAC scrutiny, properly link providers to your group, and secure your PTAN faster in 2026.

    October 14, 20268 min read

  • Elevance Health Timely Filing Limits and Billing Guide (2026)

    Elevance Health operates Anthem and Wellpoint plans across 14 states, making filing limits a moving target. Here is exactly how to submit claims, clear credentialing hurdles, and beat timely filing denials in 2026.

    October 14, 20268 min read

  • Medical Practice Financial Management: The 2026 Blueprint

    Running a profitable clinic in 2026 requires more than excellent clinical care. From navigating Medicare fee cuts to managing high-deductible patient balances and commercial payer contracts, this guide covers the exact financial mechanics you need to keep your doors open and your margins healthy.

    October 13, 202613 min read

  • Bypassing Closed Network Rejections: 2026 Credentialing Guide

    Getting a credentialing rejection because a payer's network is "closed" stops practice cash flow in its tracks. Here is how medical billers and practice owners can legally bypass geographic lockouts in 2026 using niche appeals, Single Case Agreements, and delegated credentialing networks.

    October 13, 20269 min read

  • Highmark Timely Filing Limits and Billing Guidelines for 2026

    Highmark enforces a strict 365-day timely filing window for most commercial claims. Missing the nuances of their Medicare Advantage plans, out-of-network limits, or BlueCard routing will cost you. Here is how to get paid in 2026.

    October 12, 20268 min read

  • Fixing Coordination of Benefits Denials: 2026 Payer Rules

    Stop writing off claims because patients ignore letters from their insurance companies. Here is the exact workflow to clear COB denials, determine primary payers using NAIC rules, and protect your timely filing windows.

    October 11, 20269 min read

  • Fidelis Care Prior Authorization and Billing Guide 2026

    Navigating New York's largest managed care plan requires knowing which portals to use for authorizations, how Centene's systems tie into Fidelis, and strict deadlines for Medicaid appeals. Here is exactly how to get your Fidelis Care claims paid this year.

    October 11, 20269 min read

  • The Biller's Guide to Corrected Claims (Without Hitting Duplicate Denials)

    Submitting a corrected claim without the right frequency code guarantees a duplicate denial. Here is exactly how to map your EDI files, avoid clearinghouse traps, and navigate 2026 payer rules to keep your cash flowing.

    October 11, 20269 min read

  • Oscar Health Prior Authorization and Billing Guide (2026)

    Oscar Health pitches itself as a tech-forward payer, but underneath the app, it runs on strict EPO networks and aggressive utilization management. Here is how to handle their prior authorizations, claim submissions, and appeals in 2026.

    October 11, 20269 min read

  • The 2026 Guide to the Payer Enrollment Process

    Getting a provider clinically credentialed is only half the battle. If they aren't properly enrolled and linked to your practice's tax ID across every payer, claims will hit hard denials. Here is the exact blueprint for handling payer enrollment in 2026.

    October 9, 20269 min read

  • Cigna Prior Authorization Requirements & Billing Guide (2026)

    Handling Cigna claims requires navigating a massive list of delegated prior authorizations, primarily via eviCore. We break down the October 2026 rules for precertification, timely filing, and winning peer-to-peer reviews to keep your AR moving.

    October 8, 20267 min read

  • Primary Source Verification: The 2026 Guide to Provider Credentialing

    Stop relying on photocopies of medical licenses. Primary source verification is the only way to satisfy NCQA standards, enroll providers with Medicare, and protect your practice's revenue from devastating OIG clawbacks.

    October 8, 20269 min read

  • Locum Tenens Credentialing: 2026 Rules for Substitute Physicians

    Hiring a substitute physician keeps your clinic doors open, but getting them properly enrolled determines if you actually get paid. Here is how to handle Medicare’s 60-day fee-for-service rule and wildly inconsistent commercial payer requirements in 2026.

    October 8, 20269 min read

  • The Complete Guide to Medical Claim Denials and Appeals in 2026

    A zero-dollar remit hurts, but writing off the claim hurts worse. Learn how to diagnose root causes, write winning appeals, and stop medical billing denials before they happen using proven 2026 strategies.

    October 8, 202614 min read