Field notes
Notes on enrollment, coverage and billing, each with its sources.
Each draws on published payer and CMS rules and on HRI's behavioral-health billing work.
iEnrollment and panels
For a practice that is opening, or a clinician who is joining one.
Getting each payer to set a date.
- What "credentialed" means, and why nothing pays before the effective dateEnrollmentCredentialing, enrollment and the effective date are three approvals, and a claim waits on the last of them.
- The CAQH profile mistakes that stall an applicationCAQHThe profile gaps that hold a file in a payer's queue, and how to close them before you file.
- What a payer checks before it reads your CAQH profileChecklistEight checks per provider you can tick off on the page, with nothing to sign up for.
- CAQH Provider Data Portal: set up, attest, keep it currentCAQH
- Enrollment snapshot: what the public record shows for an NPIToolEnter one NPI to read its NPPES record, Medicare enrollment and any revalidation date, with what to check next.
- Medicare enrollment for a new practice: the order of operationsMedicareThe practice goes in first, then each clinician, then the link that routes their payments to the practice.
- Enrolling a new practice in Medicare (PECOS)Medicare
- Medicare revalidation: the cycle and your due dateMedicare
- NPPES and your NPI: when to update itNPI
- Enrolling with Medi-Cal as a practiceMedicaid
- Enrolling with Florida Medicaid as a practiceMedicaid
- Enrolling with New York Medicaid as a practiceMedicaid
- Enrolling with Texas Medicaid as a practiceMedicaid
- Closed panels: single-case agreements, network adequacy and group contractsPanelsWhat a practice can still do after a payer says its network is full.
- Who should run your enrollment: your staff, a filing service or a firm that also billsEnrollmentThe three options set side by side on what happens after the forms go in.
iiService lines and coverage
Knowing what a new service will pay before you buy for it.
- Adding a service line: the five questions every payer asksService linesThe questions a payer puts to a new service before it pays for one, and where the answers come from.
- Hyperhidrosis and other services that look cosmetic and are coveredCoverageTreatments sold in aesthetic settings that payers treat as medical care when the record supports it.
- Dentists and medical insurance: sleep-apnea appliances, TMJ and the supplier ruleDentalWhen a dental office can bill a medical plan, and the supplier enrollment that has to come first.
- Prior authorization: the weekly load, and how enrollment choices change itAuthorizationWhy the payers you join decide how much of the week goes to asking permission.
iiiPrices and fees
How the work is priced.
Talk to HRI Med
Ask the question a note did not answer.
Tell us which payers you bill today and which you still need. Leave patient information out of the request.
Name the note you were reading.