Credentialing Guru

02/27/2026

Starting and growing your business. The details behind the work that can sink your or help you blossom.

I had a great conversation yesterday with a fellow who was leaving Blue Cross Blue Shield- internal network management - to open his own small business. I was thinking in my head "good for you-BCBS is a hot mess- can you give me a secret phone number ?" 😁

What is his new business ? A cookie business !!! YAY- I love cookies. He told me about his plan, his passion was he loved baking- His product and how he was going to do this and that. I thought he had a great idea- it's amazing how you can think out of the box about a COOKIE business. I won't give away his secrets but I sat there thinking how many people I knew that I could connect him with that could create sales for him.

He had his business message down pretty good and was ready with samples.

Think about your business...you may have enough ongoing business that you don't feel the need to craft a good business message. who are you and what do you do?

"I sell cookies" That is not good enough.

1. Name of your business.

2. Your service ( or product).

3. Why is your service or product different or better?

Here is the wild thing. Down the road, you can change this ! You get a new idea, you expand your services- something new to offer. Craft a new message.

Think about who your customers are now. Are you measuring that success? I don't mean "tracking your applications" How happy are your clients?

Take a few minutes and journal about whether your interactions and communications are attracting the interest of customers, contributing to securing that agreement and are your good results increasing profits.

I realized after talking to the cookie guy there was a revenue model that might work for me that I had not considered.

**** If any of you are in the Dallas-Fort worth North metro and want a good cookie guy- let me know. ☺️

If you are looking for help in your provider business let me know.

02/23/2026

Congratulations to the USA Hockey Team on bringing home Gold 🇺🇸🥇
We love sports in our family. While hockey isn’t our sport — we’re more of a track & field household with a bit of basketball mixed in — the mindset of high performers is universal. while I wasn't the athlete in the family. My role was support. Cheering, driving to games, cheering - arguing with refs, buying pole vault poles, shoes, shoes, shoes - that's what Mom's do. 😁
Sports have a way of teaching lessons that extend far beyond competition:
Discipline. Resilience. Goal orientation. Healthy competitiveness.

And perhaps most importantly — teamwork.

High performers understand something fundamental: You must love the game and give 100% to the effort.

Excellence is rarely about talent alone. It’s about consistency, commitment, and showing up fully — especially when it’s hard.

Thank you, USA Hockey, for the reminder. I'm proud of you. Congrats on an incredible achievement.

01/26/2026

Waiting on credentialing? Your patients still need care.

If your in-network application has been submitted and is still pending (and yes — 90+ days is common), that doesn’t mean treatment has to stop or be delayed.

When a patient needs medically necessary care before your network effective date, your billing team can request a Single Case Agreement (SCA) with the payer.

An SCA allows you to:
✔️ Treat a specific patient
✔️ Get paid at agreed-upon rates
✔️ While your credentialing is still in process

It’s temporary, case-specific, and designed to protect continuity of care — not replace network participation.

If you’re pending INN and a patient needs services now, ask:
👉 “Can we request a Single Case Agreement?”

Care doesn’t wait — and with the right process, neither should your practice.

if you need more info on how to manage a single case agreement see our library of resources

Credentialing delays are normal — but patient care can’t wait. This Single Case Agreement (SCA) Resource Bundle was created for providers and practice owners who are pending in-network and need a clear, compliant way to treat patients and get paid in the meantime. Inside, you’ll find plain-lan...

01/13/2026

Life is not for the faint of heart.

It will knock the breath out of you, sometimes before breakfast. It hands out losses and disappointments with a casual shrug, as if to say, Yes, this too. You don’t get a warning. You don’t get a manual. You just get up, again and again, and do the best you can with what’s left in your hands. And somehow—miraculously—there are moments of astonishing beauty tucked right in the middle of the mess. Which makes the joy feel sharper, truer, earned.

The struggle is real, and it’s not just the big catastrophes. It’s the daily grind, the quiet griefs, the hopes that wobble, the plans that don’t pan out. These are the things that sand us down and shape us. They don’t make us perfect, but they make us honest. And they teach us how sweet the good moments are when they finally show up.

Most of the things we say to ourselves—the little phrases, the mantras, the steady reassurances—aren’t about being brave in public. They’re about survival. They’re how we talk ourselves through the day. How we stay upright. How we remind ourselves that we’re still here, still trying, still allowed to hope.

Now - get to work and call that payer.

If you need help setting up a new practice or taking on credentialing on your own-let us know. happy to help.

12/26/2025

HAPPY DAY AFTER CHRISTMAS - HERE WE GO 2026

January is the best time to clean up insurance credentialing before payer backlogs hit.

We are offering a January Credentialing Jumpstart for behavioral health providers who want to get positioned for payer panel in-network status without the overwhelm.

who want to start the year positioned for in-network success.

✔ CAQH audit, review, re-attesting & cleanup

✔ Medicare and Medicaid application

✔ Roster cleanup & provider adds

✔ Submission to 1–2 commercial payers

✔ Fee schedule review or contract rate increase request

✔ A Single Flat-Fee, done-for-you sprint

Limited January availability.

Comment “Jumpstart” or message me if you’d like details.

Perfect for small group practice or single providers. For OBOT or MAT looking for accreditation help: send me a message.

07/02/2025

Recovery Made Possible—Even From Miles Away 🌄 From our collaborative partner IPILL.

Meet Jake—he lives in a small rural town, hours from the nearest clinic. But he's committed to staying in recovery and following his medication-assisted treatment plan.

Before, Jake had to drive to the clinic every single day just to get his medication. It was exhausting, costly, and sometimes impossible with work and weather. But now, thanks to the FDA-approved iPill dispenser, Jake can receive his medication securely at home—with oversight from his provider—and stay on track.

✅ No daily clinic trips
✅ Safe, tamper-resistant dispenser
✅ Increased privacy and dignity
✅ Better consistency in treatment

The iPill dispenser is giving patients like Jake a real chance at long-term recovery—no matter where they live.

Recovery shouldn’t depend on your ZIP code. Learn more about how iPill is changing lives: www.ipilldispenser.com

Improving Opioid Treatment at Home. The iPill dispenser safely and securely delivers medication assisted therapy (MOUD) through its patent-protected device. iPill is a secure medication dispenser that helps remove barriers to Suboxone OUD therapy by offering safe, effective, at-home treatment.

06/21/2025

As a contractor handling behavioral health credentialing and payer enrollment, you often join big organizations with messy, broken processes.

It’s tempting to jump in, point out flaws and want to fix everything, but here’s a better approach:

Keep it positive, build relationships, and focus on your work. Take off your hard hat and put away your fix-it tools.

Stay Positive: A good vibe goes a long way. Even if the system’s a mess, bring energy and a can-do attitude. don't complain or gossip.

Connect with People: Chat with admins, clinicians, and staff. Listen, learn, and build trust—it’s your biggest asset.

Communicate Clearly: Fragmented systems breed confusion. Be upfront, share updates, and keep everyone on the same page.

Do Your Job Well: Complete your tasks—credentialing and enrollment. Show your value through results, not by tackling their chaos.

Share Ideas Later: As trust grows, you’ll get chances to suggest better processes. Don’t force it; let those convos happen naturally.

By staying positive, connecting with people, and delivering solid work, you’ll become a go-to partner. The system fixes? That’s a bonus, not your mission.



ipilldispenser.com credentialingguru.com

06/13/2025

an ongoing challenge for recovery professionals is how do I help my outpatient client stay current with his OPT or MAT program? How can I help y remote clients who can't come into the office.

The answer is a system that bridges that service gap. An FDA approved medication dispenser. Specifically designed for the SUD provider.

It will generate revenue and there are many options for funding if you are a non profit provider.

Check it out and if you have questions about it email me nancy@ipillrcm.com

Improving Opioid Treatment at Home. The iPill dispenser safely and securely delivers medication assisted therapy (MOUD) through its patent-protected device. iPill is a secure medication dispenser that helps remove barriers to Suboxone OUD therapy by offering safe, effective, at-home treatment.

05/29/2025

Life is good. Be gooder

05/26/2025

IF YOU WANT TO SUCCEED AND BE PROFITABLE IN YOUR BUSINESS. YOU HAVE TO DEVELOPE CONFIDENCE IN YOUR ASSERTIVENESS. BE ASSERTIVE. THAT DOESN'T MEAN YOU ARE 'MEAN'- IT MEANS YOU ARE CONFIDENT IN YOUR SPACE. DON'T BE AFFRAID TO LEARN.

BE ADAPTABLE AND CURIOUS ABOUT YOUR INDUSTRY- STRIVE TO UNDERSTAND THE NICHES, NUANCES AND EVEN THE UNEXPLAINABLE BAD PROCESS'S SO YOU CAN SOLVE PROBLEMS AND HAVE PRODUCTIVE RESULTS.

STOP THE NEGATIVE SELF TALK: "I'M NOT GOOD AT THIS"

DAILY PRODUCTIVE ACTIONS IS ALWAYS BETTER THAN THE WHINEY BOOOBY THOUGHTS YOU HAVE ABOUT YOURSELF.

IF YOU FORGOT TO SUBMIT A PACKAGE, OWN IT AND GET IT DONE. IF YOU PUT SOMETHING ASIDE BECAUSE YOU HAD NO IDEA WHAT TO DO ABOUT IT- DIG IT OUT AND SOLVE THE PROBLEM. FIND A MENTOR WHO CAN ASSIST YOU. YOU CAN DO HARD THINGS. LEAN INTO IT.

05/25/2025

When you are onboarding a new facility provider client- there may be conversations about the necessity of the medical director/main provider to be credentialed and to have certain identifiers. Yes - you will get push back. Because of how facilities bill for reimbursement, there is a belief that they do not have to credential the individual provider - or collect that information that would be needed for credentialing.

this is an error.

while typically, RTC bills on UB04 Facility Billing so the bill should be billed under the facility + add the medical director onto the claim. The medical director does not have to be credentialed just the facility,

but....

to be on the roster, those licenses and identifiers have to be provided to the payer as part of the roster. This ensures that down the road after the contract is signed, when the payer verifies those primary sources ( primary source verifications) they will sese your provider is legit and practicing within their licensed scope of practice and how they have presented their information via an NPI number and a CAQH number.

As part of the billing process, Aetna, Humana and Magellan will always ask for the 'roster' vs Optum when you are in 'prepayment review'.

and sometimes just to make this worse.... facilities will bill a rev code of 0944 or 0945 and then a HCPC/CPT code for add on services after the bundled rev code of like 1001 for mental health rtc. Then it is true that those codes will deny unless the Medical Director ( Doctor) is credentialed and that separate code is listed in their contract.

Specific to CAQH. This is a platform for payers to use to verify provider information. If you have an MD who is not regularly re-attesting or adding new locations to their CAQH account, payers can and do reject claims because that provider would then be deemed "out of network" or even un-credentialed.

Be clear about your needs when you take on a new provider client.

05/13/2025

Me: Here is the voided check and signed eft. (uploaded in portal)

Medicaid: It has to be original

Me: it is an original, scanned and uploaded

Medicaid: it has to be an original voided check taped to the eft.

Me: It is an original voided check taped to the eft, scanned and uploaded in the portal ( with all the other documents)

Medicaid: I can send the pony express messenger to pick it up from you and courier back to me along the western trail. That will only take another 6 months.