Aetna’s timely filing limit for in-network commercial claims is generally 90 days from the date of service, while out-of-network and non-participating claims get 12 months. But that’s a starting point, not a universal rule — the actual deadline on any given claim depends…
What Is an EOB (Explanation of Benefits)? A Guide for Physician Practices
An EOB, or Explanation of Benefits, is the statement a payer sends after processing a claim that shows what was billed, what the payer allowed, what it paid, and what the patient owes. It is not a bill itself — it’s the paper…
NPI Number: What It Is and How to Apply for One
An NPI number is a 10-digit identifier that CMS assigns to every healthcare provider and organization that bills insurance or shows up in a HIPAA-covered transaction. Every physician needs one before they can bill a single claim, and applying through NPPES online costs…
CAQH ProView: How to Set Up and Maintain Your Profile Correctly
A huge share of credentialing delays trace back to one thing: a CAQH profile that’s incomplete, expired, or just wrong in a small way nobody caught. CAQH ProView is the system nearly every commercial payer pulls from before they’ll even start credentialing a…
Patient Collections Without Surprises: A Front-Desk Revenue Cycle Checklist
Patient collections work best when expectations are clear before the visit, balances are accurate, and staff have a consistent workflow.
Payment Posting: The Quiet RCM Step That Finds Underpayments and Denial Patterns
Payment posting is more than data entry. It is where practices can catch underpayments, denial trends, patient balances, and payer issues early.
Claim Rejections vs. Claim Denials: What Your Billing Team Should Work First
Claim rejections and denials are often discussed together, but they require different workflows, owners, and reporting.
Clean Claim Rate: What It Measures and How Physician Practices Can Improve It
Clean claim rate is one of the clearest indicators of billing quality. Learn what affects it and how practices can improve claims before submission.
Prior Authorization Denials: A Practical Workflow for Physician Practices
A practical prior authorization workflow for physician practices that want fewer avoidable denials, cleaner documentation, and better follow-up.
Remote Therapeutic Monitoring Codes: A Revenue Line Most PT and Behavioral Health Practices Are Missing
See how remote therapeutic monitoring codes create revenue for PT and behavioral health practices when billing and documentation workflows are done right.