How to post an 835 ERA: group codes, the reason codes worth a write-off and the ones worth an appeal, and why unapplied cash builds when posting lags.
ERA 835 Posting: Write-Offs, Rework, and Appeals Read More »
Define initial denial rate, denial write-off rate, appeal rate, overturn rate, days to appeal and denial A/R aging, and which way each should move.
Denial Management KPIs: Six Numbers Your Team Can Move Read More »
Medicare, Medicaid and commercial credentialing timelines with the rules behind them, the four events that restart the clock, and how to sequence enrollment.
How Long Does Credentialing Take? Real Payer Timelines Read More »
A behavioral health carve out sends eligibility, prior authorization and claims to a different company. Here is how to route them correctly the first time.
Behavioral Health Carve Out: Who Really Pays the Claim Read More »
Diagnosis linking on a claim is the field payers read to decide medical necessity. Here is how Item 24E and 837P SV107 work and what to fix first.
Diagnosis Linking Claim Errors That Trigger Denials Read More »
The clean claim rate moves before days in A/R does. Here is the HFMA formula, the reject codes behind a low rate, and a target you can defend.
Clean Claim Rate: The Number That Predicts Your A/R Read More »
Why coordination of benefits denials arrive months late, what the reason codes mean, and how to work an open Medicare Secondary Payer case.
Coordination of Benefits Denial: Two Payers, One Claim Read More »
Build the expirables register: what to track, the renewal windows that matter, who owns each document, and the twice-a-year payer file check.
Credentialing Expirables: Track Licenses, DEA, Boards Read More »
Payer reviewers read behavioral health assessment documentation for named instruments, dated scores and a plan that supports the units billed.
Behavioral Health Assessment Documentation: Payer Review Read More »
Most coders hear about an error months after the claim leaves. Build a monthly loop that returns denial reasons to coding, ranked by denied dollars.
Coding Denial Feedback: Build a Monthly Coder Loop Read More »
