Best Medical Billing

Medical billing articles

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

31 articles · page 2 of 2

  • Fixing CO-15 Denials: Missing or Invalid Authorization Code

    A CO-15 denial means the payer thinks you failed to get prior authorization, or the authorization number submitted does not match the billed service. Learn how to track down the approval, update the EDI loops, and submit a corrected claim.

    August 28, 202610 min read

  • Healthfirst Prior Authorization and Billing Guide (2026)

    New York's massive not-for-profit health plan requires exact portal workflows to get paid. Here is how to handle Healthfirst's 2026 authorization rules, credentialing, and appeals.

    August 28, 20267 min read

  • OA-18 Denial Code: Duplicate Claim Resolution Guide

    An OA-18 denial means a payer’s system flagged your submission as an exact duplicate of a previously processed claim. Before you blindly resubmit, you need to know if it was an impatient biller, a clearinghouse glitch, or a missing modifier. Here is how to get that claim paid.

    August 28, 202610 min read

  • Claim Resubmission vs. Appeal: Stop Triggering Duplicate Denials

    Sending a corrected claim when you actually need a formal appeal is the fastest way to trigger a duplicate claim rejection. Here is how to choose the right denial management workflow to get paid in 2026.

    August 28, 20269 min read

  • WellCare Billing Rules & Timely Filing Guide (2026)

    WellCare operates under the massive Centene umbrella, which means provider billing rules are highly siloed by state and product type. Here is exactly how to manage their 2026 timely filing limits, submit EDI claims, and fight contract-specific denials.

    August 28, 20268 min read

  • Healthfirst Billing Guide: Timely Filing Limits & Claims (2026)

    Mastering Healthfirst claims requires knowing exactly how this massive New York payer handles initial submissions, corrected claims, and tight appeal windows. Learn the 2026 rules for getting paid on time.

    August 28, 20268 min read

  • Anthem Timely Filing Limits and Billing Rules for 2026

    Missing an Anthem deadline by a single day means writing off the entire claim. From strict 90-day commercial windows to credentialing delays, here is how billers are getting claims paid in 2026 without running out the clock.

    August 28, 20269 min read

  • OA-94 Denial Code: Processed in Excess of Charges

    An OA-94 adjustment occurs when a payer reimburses more than your billed charge. While getting paid extra sounds great, it suspends your ERA, forces manual ledger balancing, and exposes you to compliance risks if your chargemaster isn't updated.

    August 28, 202610 min read

  • 2026 Medicare Prior Authorization Guide

    CMS changed the game in 2026 with strict new turnaround times for Medicare Advantage prior authorizations. Here is exactly how to submit, track, and appeal Medicare auths this year without stalling your revenue cycle.

    August 28, 20269 min read

  • The Complete Guide to Prior Authorization in Medical Billing

    Prior authorization holds up care and chokes cash flow. But with new 2026 CMS rules enforcing faster payer decisions, practices have a window to overhaul their workflows. Here is exactly how to manage prior auths, win peer-to-peers, and drop your denial rate.

    August 28, 202611 min read

  • Medical Billing Claim Denial Management Basics: A Workflow Guide

    Effective claim denial management is the cornerstone of a healthy revenue cycle. Learn how US medical practices can systematically identify, appeal, and prevent denied claims to protect their bottom line, complete with actionable workflows, CARC/RARC analysis, and compliance timelines.

    August 27, 202610 min read