Credentialing Guru

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.

05/08/2025

Sometimes an application/contract takes so long- you forgot you applied !!

This request to join the Cigna BH network was submitted in Dec. 23, 2024. Full package completed/contract signed in Feb.

oh wait- what am I thinking... of course. 120 days is the norm.
( this is closer to 134 days). Providers believe it when I tell you 90-120 days. (credentialing and enrollment)

Congratulations! You are officially an Evernorth Behavioral Health (Evernorth) contracted provider.

Effective date: 5/7/2025

05/06/2025

Providers: Just so you can have some insight into the chaos of the insurance world... imagine my struggle needing to get you in network in this system.

Insurance Company Subsidiaries... Dozens of Companies Hidden within UnitedHealth Group, The Cigna Group, CVS Health, Elevance Health (Anthem Blue Cross).

United Health Group has United Health Insurance, UMR, Optum, OptumRx, Emisar, Optum Specialty Pharmacy, Change Healthcare, Interqual, The Advisory Board Company, Kelsey-Seybold, WellMed, Atrius and dozens more.

The Cigna Group has Cigna Healthcare, Allegiance, Evernorth, Express Scripts, Ascent Health Services, Accredo, eviCore, MDLive, VillageMD and Summit Health and many more.

CVS Health has Aetna, Meritain, CVS Caremark, CVS Specialty Pharmacy, CVS Retail Pharmacies, Cordavis and many more.

Elevance Health has Anthem, Wellpoint, Carelon, AIM Specialty Health, Millenium Physician Group and many more.

All of these insurance subsidiaries 1) give the false impression of choice and competition in the health insurance market and 2) are the result of growth by acquisition financed by cheap debt, NOT growth by superior customer value (i.e. better, faster, cheaper).

And are now mostly front facing with auto bots and foreign call centers. The system is broken on all fronts.

You can find this fabulous resource on you tube Dr. Eric Bricker

Insurance Company Subsidiaries... Dozens of Companies Hidden within United, Cigna, CVS, Blue Cross.The four major health insurance carriers--United Health Gr...

05/05/2025

Software programs are fabulous. Apps are cool. Spreadsheets are ugh.... even though I use them, I still use paper. I love paper. I have folders and papers. I even have white boards on the wall with all my notes in big reminder print I can see !

I make to-do notebooks for my day to day tracking and anger management. (yelling at call centers). You can make a whole notebook (just print it out) or you can print out sheets as you go.

My happy credentialing management FREE share for the day for my "old school" friends.

https://livewise2023.gumroad.com/l/mldep

05/05/2025

Credentialing Professionals, stay ahead of the curve!

Navigating the complexities of recredentialing and revalidating can be time-consuming and confusing for beginners. That's why I've created a basic resource to explain the process and help with tracking. This is not for - medical reappointments or privileging- it is specific to payer contracts and the process of recredentialing to remain INN with that payer.

This short guide covers key aspects and basics you need to know. Equip yourself with the knowledge to confidently manage these critical tasks.

Click on the link to download.

➡️ Click here to access the PDF: https://livewise2023.gumroad.com/l/dftntl