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Billing, coding and credentialing, explained properly

The operational side of healthcare is badly served online. Clinical content is everywhere. Guidance on actually getting a claim paid is not. These are the articles we wanted and could not find.

Billing & Denials 12 Coding 6 Credentialing 3 Practice Operations 1
Aetna timely filing limits infographic comparing the 12-month out-of-network deadline with in-network filing limits determined by provider contracts and plan-specific rules.
Billing & Denials 10 min read

Aetna Timely Filing Limit: 12 Months Out of Network, Your Contract In Network

Aetna gives out of network providers 12 months to file medical claims. In network, its provider manual points to your agreement, not a number. Here is what Aetna does publish: Texas and New York rules, the 180 day reconsideration and 60 day appeal clocks, Medicare Advantage, Aetna Better Health by state, and Signature Administrators cards.

Cigna timely filing limit infographic highlighting the 90-day deadline for participating providers, corrected claim resubmissions
Billing & Denials 8 min read

Cigna Timely Filing Limit: 90 Days, Even for Corrected Claims

Cigna Healthcare gives participating providers 90 days after the date of service to file a claim, and out of network providers 180. Here is how the clock runs for hospital stays and secondary claims, why a corrected claim gets no new clock, the 180 day appeal window, Evernorth behavioral claims, and where Cigna’s Medicare plans went.

CO-253 medical billing infographic illustrating the 2% Medicare sequestration adjustment and its impact on provider reimbursement.
Billing & Denials 5 min read

CO-253: The 2 Percent Medicare Sequestration Cut, Worked Through

CO-253 isn’t a denial. It’s Medicare’s 2 percent sequestration cut, taken from Medicare’s payment after the deductible and coinsurance, so the patient’s share never changes. Here is the math in Medicare’s order, the rate by date of service, why you can’t bill it to the patient, and how Medicare Advantage plans handle it.

Optum Behavioral Health timely filing infographic explaining the two 90-day claim deadlines and the importance of tracking submission dates and plan-specific rules.
Billing & Denials 6 min read

Optum Behavioral Health Timely Filing: Two Clocks, Both 90 Days

Optum Behavioral Health runs two 90 day clocks. Claims must reach Optum within 90 days of the date of service, but corrections run 90 days from the day Optum received the first claim, not from the remittance. Here is how to count both, how to send a correction, what proves a claim was on time, and where California, Medicaid and VA claims differ.

Behavioral health credential modifiers infographic comparing LCSW, LPC, LMFT, PhD, and PsyD licenses, with common billing modifiers
Coding 8 min read

Credential Modifiers by License: LCSW, LPC, LMFT, PhD and PsyD

There is no national credential modifier for an LCSW, LPC or LMFT. CMS defines degree levels and two licenses, and Medicare reads the license from enrollment instead. Indiana Medicaid uses HE for four licenses, Ohio gives each license its own U modifier, and Michigan’s Blue plans use HO and AJ. Here is each one, from the payer’s own documents.

UMR timely filing limits infographic explaining how employer-sponsored health plan rules determine claim submission deadlines.
Billing & Denials 5 min read

UMR Timely Filing Limits: Why the Employer’s Plan Sets the Clock

UMR does not publish a timely filing limit, because UMR is not an insurer. It runs claims for employers that fund their own plans, so the employer’s plan and your network contract set the clock. Here is how to find the limit for one plan, what UMR’s own FAQ says about corrected claims and proof, and the 180 day appeal rule for private employer plans.

Provider tax ID lookup by NPI infographic showing where to find a provider’s TIN using provider directories, insurance portals, CMS resources, and direct contact.
Credentialing 7 min read

Provider Tax ID Lookup: What the NPI Registry Will Not Show You

There is no free public lookup that turns an NPI into a tax ID. CMS planned to publish organizations’ EINs in 2007, then hid every nine digit number after some providers entered Social Security numbers as their corporation’s EIN. Here is where the tax ID goes on a claim, why payers match it to your NPI, and where to get one legitimately.

CO-50 denial code infographic explaining medical necessity, ABN documentation, and the appeals process for medical billing claims.
Billing & Denials 8 min read

CO-50 Denial Code: Find the Policy, Then Decide Who Pays

CO-50 means the payer decided your service was not medically necessary. Unlike a timely filing denial, it can often be argued, but only once you find the policy the payer used. Here is how to read the group and remark codes, when an ABN moves the cost to the patient, what Medicare Advantage plans may not do, and what an appeal needs.

UnitedHealthcare timely filing limits for 2026 infographic comparing claim submission deadlines by plan type, including commercial.
Billing & Denials 10 min read

UnitedHealthcare Timely Filing Limits for 2026, by Plan Type

Most sites say UnitedHealthcare gives you 90 days to file. Its own 2026 guide sends you to your contract instead, and the 90 days on its website is an example. What UHC does publish is which clock each plan runs, and a corrected claim can be late on one of those clocks while it would be on time on another. Here is each one, quoted from UHC, Optum and UMR.

CO-29 denial code medical billing infographic explaining how to overturn a timely filing denial by reviewing the EOB
Billing & Denials 6 min read

CO-29 Denial Code: When a Timely Filing Denial Can Be Overturned

CO-29 means the payer says your claim arrived after its filing limit. From Original Medicare, that denial is not subject to appeal at all, and only four narrow exceptions reopen the door. From every other payer, it is won or lost on dates and proof. Here is how to tell which kind you have before anyone writes an appeal.

Detox and residential behavioral health H codes infographic showing H0015–H0018 and H0035–H0038 code ranges
Coding 6 min read

Detox and Residential H Codes: Read the Grid, Then Read Your State

Seven detox codes form a neat grid by setting and intensity, and four residential codes split on length of stay and room and board. Then Virginia bills adult residential treatment as H0010, a code whose national name is subacute detox, while Nevada reads the same range close to the letter. Here is the grid, and how to check your own state's map before you bill a stay.

Behavioral health H codes infographic explaining that national codes follow different state Medicaid policies, commercial payer guidelines, contract requirements, and local regulations.
Coding 7 min read

Behavioral Health H Codes: The Code Is National, the Rules Are Not

H0031 has a national definition five words long. Washington bills it in 15 minute units, South Carolina once per encounter, and Oregon put it on its substance use disorder fee schedule. All 94 H codes are marked not payable by Medicare, and nearly half never say what a unit is. Here is what CMS defines, what it leaves to your state, and where that catches billers.