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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
State Prompt Pay Laws: The Clean Claim Clock and How to Collect the Interest
Almost every state gives a payer 30 to 45 days to pay a clean claim and charges interest when it is late, but the interest rarely arrives on its own. Here is how the clean claim clock works, what Texas, New York, California and Florida require, which plans are exempt, and how to bill the payer for what it owes.
The Prior Authorization Metrics Payers Now Publish, and How to Use Them
Since January 1, 2026, Medicare Advantage, Medicaid managed care and Exchange plans must decide standard authorizations in seven days, give a specific denial reason, and publish annual authorization metrics. Where to find the reports, what they show, a worked comparison of two plans, and three ways to use them.
How to Prepare for a Peer-to-Peer Review: Scripts, Evidence and Timing That Work
A peer-to-peer review is often the last chance to overturn a prior authorization denial before a formal appeal, and most practices walk in unprepared. Here is how to schedule it, what the physician should have on the desk, a five-minute script, and how to document the call so the outcome sticks.
UnitedHealthcare June 2026 Bulletin: Five Lab Testing Policies Start September 1
UnitedHealthcare's June 2026 reimbursement bulletin, posted June 1, introduces five commercial lab testing policies effective September 1, 2026: allergen testing, hepatic fibrosis, chemotherapy assays, testosterone and vitamin B12. What each limits, the codes involved and what to check now.
Mid-Year Payer Policy Changes for July 2026: Anthem, Aetna and the Sweep
Anthem posted reimbursement policy updates on May 1, 2026 that take effect July 1, and Aetna's allowed maximum fee schedule update starts July 15. We explain what has been announced, why mid-year changes catch practices off guard, and the six-week payer policy sweep we run every May and June.
Prior Authorization for Imaging: What Radiology Benefit Managers Check First
Most imaging prior authorization requests are decided by a radiology benefit manager, not the health plan, and the decision follows a fixed set of questions. We explain who EviCore, Carelon, Evolent and HealthHelp are, what they ask for a lumbar MRI, how to get a same-day approval and what changed in 2026.
UnitedHealthcare Changes Modifier 78 Payment on June 1, 2026: What to Check
UnitedHealthcare's May 2026 reimbursement bulletin moves modifier 78 payment from a flat 84 percent to the CMS intraoperative percentage for each code, effective June 1 for commercial claims. Here is what changes, a worked example, how to model your exposure, and the other policies that picked up code updates.
Medicaid Managed Care Billing: Enrollment, Taxonomy Codes and Retro Eligibility
Medicaid managed care billing fails for reasons that have nothing to do with the visit: a missing state enrollment, a taxonomy code that does not match the state file, coverage that arrived three months late, or a filing window that closed. Here is how the rules work and how we set a practice up for them.
Aetna Gold Carding Starts May 1, 2026 in Colorado: How the Exemptions Work
Aetna's April provider newsletter announced a prior authorization exemption program for fully insured Colorado commercial members beginning May 1, 2026. Here is how gold carding prior authorization works, which states and payers have it, and how to build the approval log that earns it.
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