# Nucleus Align > Nucleus Align LLC is a US medical billing and revenue cycle management company. We recover the revenue insurers underpaid under the No Surprises Act, handle hospital and facility billing, and run billing, coding and credentialing for healthcare organizations. Team billing for US practices since 2018. Last reviewed: 2026-10-27 - Website: https://www.nucleusalign.com - Phone: +1 332 252 4242 - Email: hello@nucleusalign.com - Hours: Monday to Friday, 9am to 5pm Eastern - Full text of every page: https://www.nucleusalign.com/llms-full.txt ## No Surprises Act and IDR - [No Surprises Act Billing, IDR and Open Negotiation](https://www.nucleusalign.com/no-surprises-act): No Surprises Act billing for providers: what it covers, open negotiation, federal IDR, the QPA and 2026 changes, with links to every topic page and our service. - [Air Ambulance Billing Under the No Surprises Act](https://www.nucleusalign.com/no-surprises-act/air-ambulance): The No Surprises Act bans balance bills for covered air ambulance transport, sets cost sharing by the lesser of billed amount or QPA, and allows federal IDR. - [Batching Claims in Federal IDR](https://www.nucleusalign.com/no-surprises-act/batching-claims): Which claims can share one federal IDR dispute: same NPI or TIN, same plan or issuer, same service code, one 30-business-day window and a 50 line item cap. - [No Surprises Act Questions Answered](https://www.nucleusalign.com/no-surprises-act/faq): Answers to No Surprises Act questions providers ask: urgent care, Medicare Advantage, IDR fees, who to call, late IDR payments and low out-of-network pay. - [Good Faith Estimates for Self-Pay Patients](https://www.nucleusalign.com/no-surprises-act/good-faith-estimates): Who must give a Good Faith Estimate under 45 CFR 149.610, the 1 and 3 business day deadlines, required content, co-provider roles, records and the $400 rule. - [The 2026 Federal IDR Operations Rule: What Changed](https://www.nucleusalign.com/no-surprises-act/idr-operations-rule): What the 2026 federal IDR operations final rule changed, what applies on October 25, 2026, and which parts wait for a portal announcement from the Departments. - [The Federal IDR Process Step by Step](https://www.nucleusalign.com/no-surprises-act/idr-process): How federal IDR works under 45 CFR 149.510: the 4 business day start window, entity selection, offers, the 30 business day decision, payment and fees. - [Notice and Consent: Waiving NSA Protections](https://www.nucleusalign.com/no-surprises-act/notice-and-consent): When a patient can waive No Surprises Act balance billing protections under 45 CFR 149.420, which services never qualify, timing, HHS forms and records. - [Open Negotiation Under the No Surprises Act](https://www.nucleusalign.com/no-surprises-act/open-negotiation): How open negotiation works under 45 CFR 149.510(b): the 30-business-day windows, notice content, how to send it and what to do if the payer is silent. - [Patient-Provider Dispute Resolution (PPDR) Explained](https://www.nucleusalign.com/no-surprises-act/patient-provider-dispute-resolution): How patient-provider dispute resolution works for self-pay bills over the Good Faith Estimate: the $400 test, 120-day window, fee, and what providers must do. - [The Qualifying Payment Amount (QPA), Explained](https://www.nucleusalign.com/no-surprises-act/qualifying-payment-amount): The qualifying payment amount is a payer-calculated median of contracted rates. Learn the 45 CFR 149.140 method, the required disclosures and its role in IDR. - [State Surprise Billing Laws and the Federal NSA](https://www.nucleusalign.com/no-surprises-act/state-surprise-billing-laws): How state surprise billing laws and the federal No Surprises Act fit together: specified state law, All-Payer Models, self-funded plans and CMS state resources. ## Hospital and facility billing - [Hospital and Facility Billing Services (UB-04)](https://www.nucleusalign.com/services/hospital-facility-billing): Hospital billing services for UB-04 inpatient, outpatient and ER claims: bill type and revenue code checks, payment reconciliation, plus CMS-1500 claims. - [Hospital Revenue Cycle Billing and RCM Services](https://www.nucleusalign.com/who-we-serve/hospitals): Hospital revenue cycle outsourcing explained for CFOs: MS-DRG and APC payment, the 3-day window, critical access hospitals, price transparency and denials. - [Billing for EDs and Freestanding ERs](https://www.nucleusalign.com/who-we-serve/emergency-departments): Emergency department billing for hospital EDs and freestanding ERs: facility and physician claims, EMTALA, No Surprises Act protections and out-of-network IDR. - [Freestanding ER Billing: Codes, POS and NSA Rules](https://www.nucleusalign.com/guides/freestanding-er-billing): How freestanding ER billing works: licensed vs unlicensed, hospital-affiliated vs independent, claim form, place of service, Medicare, Texas law and the NSA. ## Revenue cycle services - [Medical Billing and RCM Services](https://www.nucleusalign.com/services): Twenty-two medical billing and revenue cycle services for hospitals, ERs, urgent care and large groups: billing, coding, denials, A/R, out-of-network and IDR. - [Medical A/R Recovery Services](https://www.nucleusalign.com/services/accounts-receivable): A/R recovery for hospitals and groups: we work aged claims by bucket, chase payers, file appeals inside the window, and report what came back, by payer and age. - [Medical billing and coding audits](https://www.nucleusalign.com/services/billing-coding-audits): Paid medical billing and coding audits for hospitals and groups: sampling, E/M and facility levels, modifiers, NCCI, UB-04 fields and charge capture. - [CCM and RPM billing services for Medicare practices](https://www.nucleusalign.com/services/ccm-rpm-billing): CCM and RPM billing: Medicare consent, time thresholds, device-supply days, general supervision and one-practitioner-per-month rules, plus the 2026 RPM changes. - [Provider credentialing and enrollment services](https://www.nucleusalign.com/services/credentialing): Credentialing and enrollment for Medicare, Medicaid, CAQH and commercial payers, including IOP and PHP credentialing for facilities and providers. - [Denial Management Services for Hospitals and Groups](https://www.nucleusalign.com/services/denial-management): Denial management for hospitals and groups: every denial worked within 48 hours, CARC and RARC read correctly, Medicare and commercial appeals filed on time. - [Marketing for Medical Practices (SEO, AEO, GEO)](https://www.nucleusalign.com/services/digital-marketing): Website development, social media, content, SEO, AEO and GEO for medical practices, with HIPAA marketing limits spelled out and no ranking promises. Talk to us. - [Insurance eligibility verification services](https://www.nucleusalign.com/services/eligibility-verification): Insurance eligibility verification services: what to check on the 271 before each visit, ER and walk-in rules, COB, and Medicare Advantage vs Original Medicare. - [Hospital and Facility Billing Services (UB-04)](https://www.nucleusalign.com/services/hospital-facility-billing): Hospital billing services for UB-04 inpatient, outpatient and ER claims: bill type and revenue code checks, payment reconciliation, plus CMS-1500 claims. - [Licensing and business setup for medical practices](https://www.nucleusalign.com/services/licensing-business-setup): What a new practice, urgent care or freestanding ER must register before billing: NPI type 1 and 2, EIN, CLIA certificate, Medicare forms, state licensure. - [Professional medical billing services (CMS-1500)](https://www.nucleusalign.com/services/medical-billing): Professional medical billing on the CMS-1500 and 837P for physician groups, ER physician groups and large groups. Claims go out within 24 hours of charge entry. - [Medical Coding Services by Certified Coders](https://www.nucleusalign.com/services/medical-coding): Outsourced medical coding for hospitals, EDs and groups: CPT, HCPCS, ICD-10, modifiers, NCCI, ED levels and provider queries by AAPC and AHIMA certified coders. - [Medical records management services for billing teams](https://www.nucleusalign.com/services/medical-records-management): Medical records management for billing: release of information under 45 CFR 164.524, payer ADR responses, minimum necessary and retention rules we verified. - [MIPS and MACRA reporting services](https://www.nucleusalign.com/services/mips-macra-reporting): MIPS and MACRA reporting for performance year 2026: four categories and weights, low-volume test, 75-point threshold, March 31 deadline, MVPs and APMs. - [Out-of-Network Billing and IDR Disputes](https://www.nucleusalign.com/services/out-of-network-billing-idr): We recover revenue insurers underpaid under the No Surprises Act: open negotiation, federal IDR and state pathways, tracked from first notice to final payment. - [Patient billing and collections services](https://www.nucleusalign.com/services/patient-billing): Patient billing and collections for hospitals and groups: statements, payment plans, No Surprises Act balance billing limits and 501(r) rules for nonprofits. - [Payer contracting and rate negotiation services](https://www.nucleusalign.com/services/payer-contracting): Payer contracting support for hospitals and groups: fee schedule review against Medicare, contract terms, underpayment detection, and NSA QPA context. - [Prior authorization services for providers](https://www.nucleusalign.com/services/prior-authorization): Prior authorization services for hospitals and groups: workflow, emergency rules, retro authorization, CO-197 denials and the CMS prior auth final rule. - [Revenue Cycle Management for Hospitals and Groups](https://www.nucleusalign.com/services/revenue-cycle-management): Revenue cycle management for hospitals, ERs, urgent care and large groups: front end, mid cycle and back end, what we run, what you keep, and the KPIs to check. - [Virtual Medical Assistants for Practices](https://www.nucleusalign.com/services/virtual-assistant): Virtual medical assistants for scheduling, patient calls, insurance checks, prior auth follow-up and payment posting, under a BAA and HIPAA minimum necessary. - [Virtual medical scribe services for clinicians](https://www.nucleusalign.com/services/virtual-medical-scribe): Virtual medical scribe services: who signs the note under Medicare, HIPAA BAA rules for remote staff, and how clean documentation supports the E/M level billed. - [White-Label Medical Billing Services](https://www.nucleusalign.com/services/white-label-billing): White-label medical billing for consultants, management companies and MSOs: we do the billing under your brand, backed by a signed subcontractor BAA. - [Workers' comp and no-fault billing services](https://www.nucleusalign.com/services/workers-comp-no-fault-billing): Workers' comp and no-fault billing to state rules: claim numbers, fee schedules, bill review, disputes and Medicare secondary payer, with state examples. ## Who we serve - [Who We Serve: Hospitals, ERs, Urgent Care, Groups](https://www.nucleusalign.com/who-we-serve): Medical billing and revenue cycle management for hospitals, emergency departments, freestanding ERs, urgent care networks, large groups and health systems. - [Billing for EDs and Freestanding ERs](https://www.nucleusalign.com/who-we-serve/emergency-departments): Emergency department billing for hospital EDs and freestanding ERs: facility and physician claims, EMTALA, No Surprises Act protections and out-of-network IDR. - [Hospital Revenue Cycle Billing and RCM Services](https://www.nucleusalign.com/who-we-serve/hospitals): Hospital revenue cycle outsourcing explained for CFOs: MS-DRG and APC payment, the 3-day window, critical access hospitals, price transparency and denials. - [Billing for Large Groups and Health Systems](https://www.nucleusalign.com/who-we-serve/large-groups-health-systems): Billing for multi-specialty groups and health systems: multiple TINs and NPIs, reassignment of benefits, provider-based status, split visits and reporting. - [Billing for Urgent Care Networks](https://www.nucleusalign.com/who-we-serve/urgent-care-networks): Urgent care billing for multi-site networks: POS 20, S9083 and S9088, E/M visits, occupational medicine, new-location credentialing and where the NSA fits. ## Specialties - [Medical Billing by Specialty: Codes, Rules, Denials](https://www.nucleusalign.com/specialties): Specialty billing and coding pages for hospital, surgical, medical and post-acute specialties: the codes, modifiers, payer rules and denials each one meets. - [Allergy and Immunology Billing Services](https://www.nucleusalign.com/specialties/allergy-immunology-billing): Allergy and immunology billing: skin test units and MUEs, 95165 dose counts, 95115 vs 95120, biologic J-code units, JW and JZ, and modifier 25 rules. - [ASC Billing and Coding Services](https://www.nucleusalign.com/specialties/ambulatory-surgery-center-billing): ASC billing services for the facility claim, payment indicators, multiple procedure discounting, implants, 73 and 74 modifiers, drugs and quality reporting. - [Anesthesia Billing: Time Units, Modifiers, Pay](https://www.nucleusalign.com/specialties/anesthesia-billing): How anesthesia is billed and paid: base and time units, AA, QK, QX, QY and QZ modifiers, CRNA and medical direction rules, 2026 conversion factors, NSA limits. - [Behavioral Health Billing: PHP, IOP and SUD](https://www.nucleusalign.com/specialties/behavioral-health-billing): Behavioral health program billing: PHP and IOP condition codes 41 and 92, IPF per diems, OTP bundles G2067 to G2080, Part 2 consent, ABA and parity. - [Cardiology Billing and Coding Services](https://www.nucleusalign.com/specialties/cardiology-billing): Cardiology billing services for practices and hospital cath labs: echo, stress test, cath and PCI coding, 26 and TC rules, NCCI bundles and denials. - [Cardiothoracic Surgery Billing Services](https://www.nucleusalign.com/specialties/cardiothoracic-surgery-billing): Cardiothoracic surgery billing: CABG graft codes, TAVR co-surgeon modifier 62 and Q0, ECMO, VATS lobectomy and 90-day globals, from CMS sources. - [Chiropractic Billing and Coding Services](https://www.nucleusalign.com/specialties/chiropractic-billing): Chiropractic billing for Medicare and commercial plans: CMT codes 98940 to 98942, the AT modifier, GA and GZ with the ABN, documentation and modifier 25. - [Critical Care Billing: Time, Procedures and Rules](https://www.nucleusalign.com/specialties/critical-care-billing): Critical care billing for ICU groups: 99291 and 99292 time, the 104-minute Medicare rule, bundled services, modifiers 25, FS and FT, and telehealth. ## States and cities - [State Billing Rules: Medicaid, Prompt Pay, Surprise Billing](https://www.nucleusalign.com/states): State billing rules for all 50 states and DC: Medicare MAC, Medicaid filing limits, prompt pay clocks and which states have a surprise billing law. - [Alabama Medical Billing: Medicaid, MAC, Prompt Pay](https://www.nucleusalign.com/states/alabama): Alabama billing rules: 1-year Medicaid filing with Gainwell, Palmetto GBA JJ for Medicare, 30 or 45 day prompt pay, and federal IDR for disputes. - [Alaska billing: Medicaid, Medicare, prompt pay](https://www.nucleusalign.com/states/alaska): Alaska billing rules: the 12-month Medicaid claim limit, Noridian Jurisdiction F, 30-day prompt pay with 15% interest and how federal IDR fits in. - [Arizona medical billing and payer rules](https://www.nucleusalign.com/states/arizona): AHCCCS 6 and 12 month filing limits, Noridian JF for Medicare, 30 day prompt pay, and how Arizona's SOONBDR program sits next to federal IDR. - [Arkansas Medical Billing: Medicaid, Novitas JH, Prompt Pay](https://www.nucleusalign.com/states/arkansas): Arkansas billing rules: 12-month Medicaid filing, ARHOME and PASSE plans, Novitas JH Medicare, 23 CAR 15-110 prompt pay and federal IDR for out-of-network. - [California medical billing and payer rules](https://www.nucleusalign.com/states/california): Medi-Cal's six month filing limit, Noridian JE for Medicare, AB 72 and DMHC or CDI dispute paths, plus the 30 calendar day prompt pay rule in force since 2026. - [Colorado medical billing and payer rules](https://www.nucleusalign.com/states/colorado): Colorado Health First Medicaid 365 day filing, Novitas JH Medicare, prompt pay deadlines and how state out-of-network law sits next to the No Surprises Act. - [Connecticut billing: HUSKY, Medicare, surprise billing](https://www.nucleusalign.com/states/connecticut): Connecticut billing rules: HUSKY Health's 12-month filing rule, NGS Medicare Jurisdiction K, 20-day prompt pay and C.G.S. 38a-477aa next to federal IDR. - [Delaware Medical Billing: Medicaid, Novitas JL, Prompt Pay](https://www.nucleusalign.com/states/delaware): Delaware billing rules: 12-month Medicaid filing, Gainwell portal, Novitas JL, 30-day prompt pay and Department of Insurance arbitration routes. - [Los Angeles billing: Medi-Cal, Kaiser and Cedars-Sinai](https://www.nucleusalign.com/states/california/los-angeles): Los Angeles billing detail: L.A. Care and Health Net Medi-Cal, capitated physician groups, county DHS hospitals, trauma centers and Kaiser claims rules. - [San Diego billing: Sharp, Scripps, UCSD and Kaiser](https://www.nucleusalign.com/states/california/san-diego): San Diego billing detail: four Medi-Cal plans, Sharp and Scripps systems, hospital districts, trauma centers, military hospitals and TRICARE's one year limit. - [Miami Hospital Billing: Payers, Trauma, Medicaid](https://www.nucleusalign.com/states/florida/miami): Miami hospital billing: Jackson Health System rules, Baptist plan lists dated Oct 2026, five trauma centers, Medicaid Region I and who decides ER payment. - [Atlanta billing: Georgia HB 888 arbitration for ER and OON](https://www.nucleusalign.com/states/georgia/atlanta): Atlanta hospital billing detail: Grady's Level 1 trauma center and South Fulton ED, Emory's split physician groups, Children's system and Georgia HB 888. ## EHR systems - [EHR and PMS Systems We Work In](https://www.nucleusalign.com/ehr): 54 EHR and practice management systems grouped by setting. See how our billing team works inside yours: named logins, BAA first, two-step login, reports. - [AdvancedMD Billing and RCM Support](https://www.nucleusalign.com/ehr/advancedmd): How we work inside AdvancedMD for independent practices: access setup, claim flow, ERA posting, reports and the billing checks we run on every account. - [Altera Digital Health Billing for Hospitals](https://www.nucleusalign.com/ehr/altera-digital-health): How Nucleus Align works inside Altera Digital Health systems such as Sunrise and Paragon: access setup, claims, ERA posting, denial work and reports. - [Amazing Charts Billing Support: EHR, PM and Claims](https://www.nucleusalign.com/ehr/amazing-charts): How Nucleus Align works with Amazing Charts: separate EHR and PM access, lab CLIA and modifier 25 checks, ERA posting, denials and the reports we pull. - [athenahealth Billing and RCM Support](https://www.nucleusalign.com/ehr/athenahealth): How Nucleus Align works inside athenahealth: access setup, claims, ERA posting, denial work, reports and billing checks for ambulatory groups and practices. - [Azalea Health Billing and RCM Support for Rural Hospitals](https://www.nucleusalign.com/ehr/azalea-health): How an outside team works inside Azalea Health: claim types, access setup, ERA 835 posting, reports and checks for rural hospitals and clinics. Book a call. - [CareCloud Billing Support for Practices and Groups](https://www.nucleusalign.com/ehr/carecloud): How an outside billing team works inside CareCloud: access, claim flow, remits, the reports we pull and the checks we run. No tie to the vendor. - [CentralReach ABA Billing Support for Therapy Providers](https://www.nucleusalign.com/ehr/centralreach): How we bill inside CentralReach for ABA and therapy providers: access setup, session-to-claim checks, 835 posting, denial queues and the reports we pull. - [CharmHealth Billing Support: Claims, ERA and Denials](https://www.nucleusalign.com/ehr/charmhealth): How Nucleus Align works inside CharmHealth and BillerPro: access setup, CMS-1500 claim settings, ERA posting, denial checks and the reports we pull. ## Codes - [Medical Billing Code Library: CPT, HCPCS, CARC, ICD-10](https://www.nucleusalign.com/codes): Reference library of medical billing codes: CPT, HCPCS Level II, modifiers, denial codes, revenue codes and ICD-10-CM, with the claim field each one goes in. - [CPT 00731: Anesthesia for upper GI endoscopy](https://www.nucleusalign.com/codes/cpt/00731): CPT 00731 is anesthesia for upper GI endoscopy with 5 base units. See monitored anesthesia care and QS, 00813 for combined scopes, time units and denials. - [CPT 00811: Anesthesia for lower GI endoscopy](https://www.nucleusalign.com/codes/cpt/00811): CPT 00811 is anesthesia for lower GI endoscopy, 4 base units. See 00812 for screenings, modifier PT after conversion, coinsurance steps and common denials. - [CPT 01402: Anesthesia for knee replacement](https://www.nucleusalign.com/codes/cpt/01402): CPT 01402 is anesthesia for total knee replacement with 7 base units. See time units, the AA, QK, QX, QY and QZ modifiers, nerve blocks, two knees and denials. - [CPT 11042: Debridement, skin and subcutaneous tissue](https://www.nucleusalign.com/codes/cpt/11042): CPT 11042 is debridement through subcutaneous tissue for the first 20 sq cm. See depth codes 11043 and 11044, add-on 11045, MUE values and when it bundles. - [CPT 11102: Tangential skin biopsy](https://www.nucleusalign.com/codes/cpt/11102): CPT 11102 is a tangential skin biopsy of one lesion, with 11103 for each added lesion. See same-lesion bundling, the 17000 edit, pathology, Mohs and MUE values. - [CPT 11721: Debride nails, 6 or more](https://www.nucleusalign.com/codes/cpt/11721): CPT 11721 is debridement of 6 or more nails. Medicare calls it routine foot care unless an exception applies. See Q7, Q8, Q9, Item 19 and the MUE of 1. ## Rules - [Medical Billing Rules and Guidelines Library](https://www.nucleusalign.com/rules): Plain-English medical billing rules for Medicare, MACs, states and payers: NCCI, timely filing, two-midnight, OPPS and EMTALA, each tied to its official source. - [340B drug pricing program basics for billing teams](https://www.nucleusalign.com/rules/340b-basics): 340B basics for hospital billing teams: who qualifies, why modifier TB replaced JG, how Medicare pays 340B drugs and where duplicate discounts come from. - [ABN (Advance Beneficiary Notice) Rules and Modifiers](https://www.nucleusalign.com/rules/advance-beneficiary-notice-abn): How the Medicare ABN (form CMS-R-131) works: when it is required, the three option boxes, emergency limits, retention, refunds, and when to use GA or GZ. - [CMS-1500 vs UB-04: which claim form to use](https://www.nucleusalign.com/rules/cms-1500-vs-ub-04): The CMS-1500 is the professional claim and the UB-04 is the institutional claim. See who files each, the 837P and 837I, key fields and what a wrong form costs. - [Critical access hospital billing: cost-based rules](https://www.nucleusalign.com/rules/critical-access-hospital-billing): Critical access hospital billing under 42 CFR 413.70: 101 percent of cost, Method II at 115 percent, the 96-hour rule, swing beds and the 3-day window. - [ED facility level coding: how hospitals set levels](https://www.nucleusalign.com/rules/ed-facility-level-coding): Medicare has no national point system for ED facility levels. Each hospital writes its own guidelines for 99281 to 99285, and CMS sets 11 principles for them. - [EMTALA and billing: what hospital ERs must know](https://www.nucleusalign.com/rules/emtala-and-billing): EMTALA bars an ER from delaying a screening exam or stabilizing care to ask about payment. See what registration may ask, who is covered and how the NSA fits. - [Global Surgery Periods: 0, 10 and 90 Day Billing Rules](https://www.nucleusalign.com/rules/global-surgery-periods): How Medicare 0, 10 and 90 day global surgery periods work: what the package covers, how days are counted, modifiers 24, 25, 57, 58, 78, 79 and denial codes. - [HIPAA for Billing Vendors: BAAs and Safeguards](https://www.nucleusalign.com/rules/hipaa-for-billing-vendors): What HIPAA requires of a medical billing company: the business associate agreement, Security Rule safeguards, breach reporting, liability and offshore teams. - [Hospital price transparency rule: what must be posted](https://www.nucleusalign.com/rules/hospital-price-transparency): Hospital price transparency rule, 45 CFR part 180: the machine-readable file, 300 shoppable services, the 2026 file changes and daily penalty ceilings. - [Incident-To Billing: Medicare Rules and Limits](https://www.nucleusalign.com/rules/incident-to-billing): Incident-to billing under 42 CFR 410.26: which settings qualify, the supervision level, the new-patient limit, 2026 virtual supervision and audit risks. ## Payers - [Payer Billing Guides: Medicare, Medicaid, Commercial](https://www.nucleusalign.com/payers): Payer billing guides for Medicare, Medicaid, TRICARE, UnitedHealthcare, Aetna, Cigna and Blue plans: filing limits, appeals and portals from official sources. - [Aetna billing: timely filing, disputes, Availity](https://www.nucleusalign.com/payers/aetna): Aetna's provider manual leaves the filing limit to your agreement. See the 180-day reconsideration clock, the 60-day appeal, state exceptions and Availity. - [Anthem billing: Availity, disputes and state rules](https://www.nucleusalign.com/payers/anthem): Anthem billing by state: why there is no single filing limit, Availity claim disputes with 30 and 60 day decision times, secondary claim timing and denials. - [BCBS of Texas billing: HMO and PPO rules](https://www.nucleusalign.com/payers/blue-cross-blue-shield-of-texas): Blue Cross and Blue Shield of Texas billing: 180-day HMO and 365-day PPO filing limits, two-level claim review, Availity, payor ID 84980 and prior auth. - [Blue Cross Blue Shield billing: BlueCard and plan rules](https://www.nucleusalign.com/payers/blue-cross-blue-shield): Blue Cross Blue Shield billing: how BlueCard works, home plan vs host plan, the ID prefix, filing with your local plan and where each Blue plan sets limits. - [CareSource billing: Medicaid and Marketplace filing](https://www.nucleusalign.com/payers/caresource): CareSource filing is 180 days in Georgia Medicaid (2023 manual) and 365 in Ohio Marketplace (2024). Appeal deadlines, corrected claims, prior auth and denials. - [Centene and Ambetter billing: timely filing and manuals](https://www.nucleusalign.com/payers/centene-ambetter): Ambetter filing limits differ by state plan: PA is 180 days participating, 90 non-participating; FL is 180. Appeals, corrected claims, prior auth and denials. - [Cigna billing: timely filing, appeals, provider manual](https://www.nucleusalign.com/payers/cigna): Cigna publishes 90 days to file for participating providers and 180 out of network, plus a 180-day written appeal. See Medicare Advantage and prior auth. - [Florida Blue billing: provider manual and claim rules](https://www.nucleusalign.com/payers/florida-blue): Florida Blue's provider manual sets a 180-day filing limit, one year to appeal and frequency codes 7 and 8 for corrected claims. Availity and prior auth. - [Highmark billing: timely filing and corrected claims](https://www.nucleusalign.com/payers/highmark): Highmark's provider manual sets 365 days to file in PA, WV and NY and 180 in DE by default. Corrected claims get 455 days from Sept 1, 2026. Appeals by state. - [Humana billing: timely filing, Medicare Advantage, appeals](https://www.nucleusalign.com/payers/humana): Humana's 2026 Provider Manual sets 1 year to file Medicare claims and 18 months to dispute a claim. Portal, prior authorization, appeals and denial fixes. ## Guides - [Medical Billing Guides for Hospitals and ER Groups](https://www.nucleusalign.com/guides): Twenty long-form medical billing guides for hospital CFOs and ER group owners: No Surprises Act, facility billing, denials, KPIs, vendor choice and audits. - [Billing Company Contract Checklist: Terms to Check](https://www.nucleusalign.com/guides/billing-company-contract-checklist): A clause-by-clause checklist for a medical billing contract: scope, fees, termination, data return, BAA, reporting, liability, audit rights and credit balances. - [Chargemaster Review Guide: CDM Clean-Up for Hospitals](https://www.nucleusalign.com/guides/chargemaster-review-guide): How a hospital reviews its chargemaster: CDM line structure, HCPCS and revenue code mapping, quarterly triggers, denial-causing errors and price transparency. - [Choosing a Billing Partner: RFP Guide and Scorecard](https://www.nucleusalign.com/guides/choosing-a-billing-partner): How to choose a medical billing company for a hospital or large group: RFP contents, a weighted scorecard, questions to ask, fee models, SLAs and red flags. - [Credentialing New Locations: A Step-by-Step Guide](https://www.nucleusalign.com/guides/credentialing-new-locations): Add a new location to Medicare (CMS-855B, 855I, PECOS), Medicaid, commercial payers and CAQH: sequence, 30-day reporting, effective dates and retro billing. - [The Denial Management Playbook for Hospitals and Groups](https://www.nucleusalign.com/guides/denial-management-playbook): A denial management playbook: sort denials by CARC and group code, find root causes, rank work queues, write appeals, track by payer and stop repeat denials. - [ED Coding and Documentation Guide: E/M and Critical Care](https://www.nucleusalign.com/guides/ed-coding-and-documentation-guide): How to level ED visits 99281 to 99285 by medical decision making, bill critical care 99291 and 99292, use modifier 25 and write notes that survive payer review. - [ER Underpayment Recovery: Spot, Dispute and Collect](https://www.nucleusalign.com/guides/er-underpayment-recovery-playbook): How to find underpaid ER claims in your 835 remits, compare them with contract rates or the QPA, and dispute them by payer type, from variance report to IDR. - [Facility vs Professional Billing: Two Claims, One Visit](https://www.nucleusalign.com/guides/facility-vs-professional-billing): Facility vs professional billing for an ER visit, an outpatient procedure and an inpatient stay: who bills, which form and codes, and how each claim is paid. - [Freestanding ER Billing: Codes, POS and NSA Rules](https://www.nucleusalign.com/guides/freestanding-er-billing): How freestanding ER billing works: licensed vs unlicensed, hospital-affiliated vs independent, claim form, place of service, Medicare, Texas law and the NSA. - [Hospital Billing Audit Readiness: RAC, MAC, UPIC, OIG](https://www.nucleusalign.com/guides/hospital-billing-audit-readiness): How hospitals prepare for Medicare RAC, MAC, UPIC and CERT reviews: ADR deadlines of 45 and 30 days, the records packet, signatures, rebuttal and appeals. - [Front-End Denial Prevention: Registration to Prior Auth](https://www.nucleusalign.com/guides/hospital-denial-prevention-front-end): Prevent claim denials at the front end: registration accuracy, eligibility, prior authorization, COB, notices and EMTALA, with the denial codes each step stops. - [Hospital Revenue Cycle: Six Stages, Start to Cash](https://www.nucleusalign.com/guides/hospital-revenue-cycle-end-to-end): Walk the hospital revenue cycle stage by stage: eligibility, coding, claim, denials, payment and A/R, with UB-04, MS-DRG, OPPS and EMTALA details. - [How to Switch Billing Companies Without Losing Cash](https://www.nucleusalign.com/guides/how-to-switch-billing-companies): Switching billing companies step by step: A/R handoff, Medicare CMS-588 and ERA enrollment, clearinghouse and payer notices, access, and filing clocks. - [In-House vs Outsourced Billing Costs: A CFO Model](https://www.nucleusalign.com/guides/in-house-vs-outsourced-billing-costs): A cost model for comparing in-house and outsourced medical billing: six cost lines to fill in, cost to collect, a break-even fee and a made-up worked example. - [Is It Safe to Outsource Medical Billing? CFO Checklist](https://www.nucleusalign.com/guides/is-it-safe-to-outsource-medical-billing): Is outsourcing medical billing safe? A CFO checklist on BAAs, bank account control, access, audit rights, offshore teams and data return at exit. - [Medical Billing KPIs for CFOs: Formulas and Definitions](https://www.nucleusalign.com/guides/medical-billing-kpis-for-cfos): Formulas for days in A/R, clean claim rate, first-pass resolution, denial rate, net and gross collection, cost to collect and A/R over 90, plus an example. - [Billing Integration After a Practice Acquisition](https://www.nucleusalign.com/guides/medical-group-acquisition-billing-integration): Billing after a practice acquisition: TIN and NPI changes, Medicare ownership change and CMS-855 deadlines, payer contracts, A/R at closing, fee schedules. - [No Surprises Act for ER Groups: Billing and IDR Guide](https://www.nucleusalign.com/guides/no-surprises-act-for-er-groups): A playbook for ER group owners: which claims the No Surprises Act covers, the open negotiation and IDR calendar, staffing the work and what to track. - [Out-of-Network vs In-Network Strategy for ER Groups](https://www.nucleusalign.com/guides/out-of-network-strategy-for-er-groups): How an ER group can weigh in-network contracts against staying out of network and using IDR, with rule-based facts, CMS outcome data and a revenue model. - [Questions to Ask an NSA and IDR Company](https://www.nucleusalign.com/guides/questions-to-ask-an-nsa-idr-company): Thirteen questions for hospital and ER group buyers choosing a No Surprises Act and IDR partner: the rule behind each one and how Nucleus Align answers it. - [Urgent Care Billing Guide: Codes, POS 20, Payers](https://www.nucleusalign.com/guides/urgent-care-billing): How urgent care billing works: POS 20, S9083 and S9088, 99051, E/M levels, CLIA lab rules, workers' comp, self-pay estimates and denials, check-in to payment. ## Blog and news - [Medical Billing Blog for Hospitals and ER Groups](https://www.nucleusalign.com/blog): Practical medical billing posts on the No Surprises Act, UB-04 and facility billing, ER and urgent care coding, denials, A/R, payers and states, by topic. - [Medical Billing News and CMS Rule Changes](https://www.nucleusalign.com/news): Billing news from official sources: CMS final and proposed rules, corrections, notices and NCCI edit releases, each with its publication and effective dates. - [Why Credentialing Takes So Long and Where It Stalls](https://www.nucleusalign.com/blog/why-credentialing-takes-so-long): Commercial plans set their own timelines. See Medicare's published processing standards, the five places applications stall and how to avoid each. - [Who Pays IDR Fees and Who Gets Them Back](https://www.nucleusalign.com/blog/who-pays-idr-fees): Each party pays an administrative fee and an entity fee. See which is refunded, when the winner's fee comes back and what an unpaid fee does to your offer. - [Which emergency services the No Surprises Act covers](https://www.nucleusalign.com/blog/which-emergency-services-nsa-covers): The No Surprises Act covers the ER screening exam, stabilizing treatment and later care in the same visit. See which facilities, plans and services are in. - [Which Denials Are Worth Appealing?](https://www.nucleusalign.com/blog/which-denials-are-worth-appealing): Decide which denials to appeal: confirm it is an appealable denial, check the deadline, compare expected recovery with cost and find the break-even balance. - [Which payer contract terms cause the most denials?](https://www.nucleusalign.com/blog/which-contract-terms-cause-the-most-denials): No official source ranks contract terms by denials, so rank them in your own remits. Clause-to-denial-code map, a ranking method and a made-up example. - [Which Claims Can You Batch in One IDR Dispute](https://www.nucleusalign.com/blog/which-claims-can-be-batched-in-idr): A batch needs the same NPI or TIN, the same plan, a similar condition and one 30 business day window. Use this sort to split an out-of-network claim list. - [Where emergency physician groups lose revenue](https://www.nucleusalign.com/blog/where-emergency-physician-groups-lose-revenue): Where ED physician groups lose revenue: level selection, missed critical care, same-day claims, unworked denials and NSA underpayments, with the check for each. - [When Urgent Care Can Bill 99051 After-Hours Services](https://www.nucleusalign.com/blog/when-urgent-care-can-bill-99051): Bill 99051 only when the visit is in your regular evening or weekend hours and the payer pays it. Compare the four after-hours codes and set a rule per payer. - [When to write off a balance and how to document it](https://www.nucleusalign.com/blog/when-to-write-off-a-balance): When to write off a balance: four reasons, five checks before posting, why Medicare copays cannot be waived routinely, and what the write-off record must show. - [When to Use Modifier 25 and When It Gets Denied](https://www.nucleusalign.com/blog/when-to-use-modifier-25): Four questions decide whether an E/M visit earns modifier 25 with a same-day procedure, which pairings qualify, what the note must show and how to fix denials. - [When you can start IDR after open negotiation fails](https://www.nucleusalign.com/blog/when-to-start-idr-after-open-negotiation): Federal IDR can start only after the 30-business-day open negotiation period ends, and you then have 4 business days. See the dates, a worked example and traps. - [When a hospital should outsource its billing office](https://www.nucleusalign.com/blog/when-a-hospital-should-outsource-its-billing-office): Outsource when claims near the filing limit, denials pass the appeal window or bad debt files cannot be proved. A test to run, and what the hospital must keep. - [What to Tell ED Patients About Out-of-Network Bills](https://www.nucleusalign.com/blog/what-to-tell-ed-patients-about-out-of-network-bills): A plain script for ED billing staff: what the No Surprises Act limits, what the patient still owes, when the notice is due and who to call about a bill. - [What to do when a payer recoups a payment](https://www.nucleusalign.com/blog/what-to-do-when-a-payer-recoups-a-payment): A payer took money back? Read the remark code, tie the amount to claims, set the deadline, and use Medicare's limits or your contract to repay or dispute. - [What to Check in a Medical Billing Company Contract](https://www.nucleusalign.com/blog/what-to-check-in-a-billing-company-contract): Read a medical billing contract for ten weak phrases and swap in clearer wording, with sample clauses, the rules behind them and questions for the sales call. - [What to change in your IDR workflow after the 2026 rule](https://www.nucleusalign.com/blog/what-the-idr-rule-changes-for-providers): A date-by-date list of the workflow edits the 2026 federal IDR operations rule asks of provider billing teams, from fees and batching to remittance codes. - [What Percent of Denials Are Overturned on Appeal?](https://www.nucleusalign.com/blog/what-percent-of-denials-are-overturned-on-appeal): What percent of denials are overturned on appeal? The official OIG, CMS and OMHA figures, what each measures and how to calculate your own rate. - [What the qualifying payment amount is and how it is set](https://www.nucleusalign.com/blog/what-is-the-qualifying-payment-amount): The QPA is the payer's own indexed median of its 2019 in-network rates. Learn how it is set, what it controls and the checks to run on every remittance. - [What prior authorization is and how to speed it up](https://www.nucleusalign.com/blog/what-is-prior-authorization-medical-billing): Prior authorization is a payer's approval before a planned service. See which payers face federal decision clocks, what to send, and how to speed each request. - [What medical credentialing is: a guide for new providers](https://www.nucleusalign.com/blog/what-is-medical-credentialing): Medical credentialing is the payer's check of a provider's license and history before it enrolls them to bill. See the steps, documents, forms and timing. - [What a UB-04 is and who has to file it](https://www.nucleusalign.com/blog/what-is-a-ub-04-claim-form): The UB-04 (CMS-1450) is the institutional claim that hospitals and facilities file. See who uses it, how locators are grouped and what Medicare ignores. - [What an IDR Entity Considers Besides the QPA](https://www.nucleusalign.com/blog/what-idr-entities-weigh-besides-qpa): The IDR entity must weigh the QPA and five listed circumstances. Learn what evidence supports each one and which facts the entity may not use. - [Leaving a Billing Company: Your Data and Open Claims](https://www.nucleusalign.com/blog/what-happens-to-your-data-and-claims-when-you-leave-a-billing-company): What HIPAA requires when a billing contract ends, the data package to ask for, who owns open claims after you leave and the deadlines that keep running. - [What happens after an IDR decision and when payment is due](https://www.nucleusalign.com/blog/what-happens-after-an-idr-decision): After an IDR decision the selected amount is due in 30 calendar days. See the payment math, repayment rule, fee refunds, the 90 day pause and a checklist. - [What a Virtual Medical Scribe Does in One Visit](https://www.nucleusalign.com/blog/what-does-a-virtual-medical-scribe-do): A virtual medical scribe drafts the visit note while the clinician treats the patient. See a visit timeline, who does what and the check before signing. - [What a Billing Company Does, Task by Task, With Proof](https://www.nucleusalign.com/blog/what-does-a-medical-billing-company-do): What a medical billing company does at each step from claim to payment, who owns each task, and the proof to ask for so you can tell the work is happening. - [POS 20 vs POS 11 for urgent care claims](https://www.nucleusalign.com/blog/urgent-care-pos-20-vs-pos-11): Should urgent care use place of service 20 or 11? CMS definitions, why Medicare pays both the same, how to set the rule per payer and fix CARC 5 and 58. - [How to appeal a UnitedHealthcare denial](https://www.nucleusalign.com/blog/unitedhealthcare-appeal-process): Fix, reconsider, then appeal: the order UnitedHealthcare's administrative guide sets for a denied claim, what to attach at each step and the 12-month clock. - [Which claim form: UB-04 or CMS-1500?](https://www.nucleusalign.com/blog/ub-04-vs-cms-1500): Use the UB-04 when the facility bills and the CMS-1500 when a practitioner bills. Get a field crosswalk, scenario table and steps to rebuild a wrong-form claim. - [UB-04 type of bill codes explained for billers](https://www.nucleusalign.com/blog/ub-04-type-of-bill-codes-explained): Decode the UB-04 type of bill in FL 4: facility type, classification and frequency digit. See xx7 corrections, 112 and 117 interim bills and common edits. - [UB-04 form locators that cause claim rejections](https://www.nucleusalign.com/blog/ub-04-form-locators-that-cause-rejections): See which UB-04 form locators the CMS manual makes required or format-specific, what to check on each and how to work a returned facility claim in one pass. - [The two-midnight rule: inpatient or observation](https://www.nucleusalign.com/blog/two-midnight-rule-inpatient-or-observation): How the two-midnight rule decides inpatient or observation, what a valid admission order needs and how each outcome is billed. Checklists and denial fixes. - [Billing two ED visits for one patient on the same day](https://www.nucleusalign.com/blog/two-ed-visits-same-day-same-patient): Two ED visits for one patient on one date: condition code G0 on the hospital claim, one E/M for the physician side, and how to clear a CO-18 duplicate denial. - [Billing TRICARE: what providers need to know](https://www.nucleusalign.com/blog/tricare-billing-for-providers): How to bill TRICARE: the regional contractor, the required claim data, the one-year deadline and 90-day returned-claim rule, exceptions and common denials. - [The three-day payment window and what gets bundled](https://www.nucleusalign.com/blog/three-day-payment-window-what-gets-bundled): What the 3-day payment window bundles into an inpatient claim, how its four dates are counted, which ED and lab lines move and how to fix duplicate bills. - [Texas TDI arbitration or federal IDR: which one applies](https://www.nucleusalign.com/blog/texas-tdi-arbitration-or-federal-idr): Check the plan, the service and the billing entity to see whether a Texas out-of-network claim goes to TDI mediation, TDI arbitration or federal IDR, with dates - [Using Texas prompt pay law when a payer pays late](https://www.nucleusalign.com/blog/texas-prompt-pay-law-for-delayed-payer-payments): How to use the Texas prompt pay law on a late claim: the 30 and 45 day clocks, proof of receipt, what pauses them, penalty tiers and how to ask for payment. - [How to Bill Telehealth Visits in 2026](https://www.nucleusalign.com/blog/telehealth-billing-guide): Bill telehealth with the same CPT code, POS 02 or 10 and only the modifiers a payer requires. Medicare dates through 2027 and 2028 from the CMS FAQ. - [How to tell whether state or federal law governs a bill](https://www.nucleusalign.com/blog/state-or-federal-law-which-governs-a-bill): Sort a surprise bill by plan type, state, service and billing entity. A claim-level worksheet shows when a state law applies and when federal IDR does. - [SLAs and Penalties to Put in a Billing Contract](https://www.nucleusalign.com/blog/service-level-agreements-and-penalties-in-a-billing-contract): Which measurable service levels a billing contract needs, which official definitions and deadlines to anchor them to, and how credits and cure periods work. - [Self-pay pricing and estimates in urgent care](https://www.nucleusalign.com/blog/self-pay-pricing-and-estimates-in-urgent-care): What an urgent care must tell self-pay patients before a visit: the two coverage questions, the Good Faith Estimate notice, walk-in limits and deadlines. - [S9083 vs E/M Billing in Urgent Care](https://www.nucleusalign.com/blog/s9083-vs-e-m-billing-in-urgent-care): Bill itemized E/M and procedure codes unless a payer tells you to use S9083. A payer check in five steps, a claim build and a worked dollar comparison. - [A Weekly Revenue Cycle Routine for Small Practices](https://www.nucleusalign.com/blog/revenue-cycle-management-small-practices): A small practice can run its revenue cycle with a daily queue check, a weekly payment and denial hour and a four-number monthly scorecard, with formulas. - [How to bill a provider-based clinic as an HOPD](https://www.nucleusalign.com/blog/provider-based-clinics-billing-hospital-outpatient-departments): Bill a hospital clinic on a 13X UB-04 with modifier PO or PN where it applies, and the physician on a CMS-1500 with POS 19 or 22. Steps, modifiers and fixes. - [Pre-Bill vs Post-Bill Coding Audits: Which Do You Need?](https://www.nucleusalign.com/blog/pre-bill-vs-post-bill-coding-audits): Pre-bill audits fix errors before a claim goes out; post-bill audits measure what already went. See what each catches, what it costs and how to combine them. - [A pre-bill checklist for clean hospital claims](https://www.nucleusalign.com/blog/pre-bill-checklist-for-hospital-claims): What to check before a hospital claim is released: UB-04 form locators, codes, charges, authorization and edits, in order, with a worked hold-queue example. - [PR-1, PR-2, PR-3: Patient Responsibility Codes](https://www.nucleusalign.com/blog/pr-1-pr-2-pr-3-patient-responsibility-codes): PR-1 is the deductible, PR-2 is coinsurance and PR-3 is the copay. See how they fit on one remit, what to bill the patient and which lines to hold. - [Post-stabilization care and the notice and consent rule](https://www.nucleusalign.com/blog/post-stabilization-care-notice-and-consent): Post-stabilization care stays protected from balance billing unless four conditions in 45 CFR 149.410(b) are met. See the notice items and the plan notice. - [How to Bill a Medicare PT Visit on the CMS-1500](https://www.nucleusalign.com/blog/physical-therapy-billing-guide): A line-by-line walk through a Medicare physical therapy claim: certifying NPI, GP and CQ modifiers, units from minutes, the 2026 KX threshold and denial fixes. - [What to do when a payer does not pay an IDR award](https://www.nucleusalign.com/blog/payer-did-not-pay-idr-award): A payer has 30 calendar days to pay an IDR award. Check your posting, send a written demand and file a CMS complaint. The steps, the file and what CMS says. - [How the patient-provider dispute process works for GFEs](https://www.nucleusalign.com/blog/patient-provider-dispute-resolution-process): A patient disputes a bill at least $400 over the estimate. Here is what you do on day one, what to send in 10 business days, and when settling beats waiting. - [Discharge status codes and how they change payment](https://www.nucleusalign.com/blog/patient-discharge-status-codes-and-payment): Why the UB-04 patient discharge status code matters: transfer per diem payment, post-acute rules, home health within 3 days and how to correct a wrong code. - [How Orthopedic Practices Maximize Reimbursement](https://www.nucleusalign.com/blog/orthopedic-billing-guide): Orthopedic practices recover more by charging bilateral and multiple-procedure lines correctly, documenting unrelated global-period work and filing on time. - [NSA protection for ancillary providers at in-network sites](https://www.nucleusalign.com/blog/nsa-protection-for-anesthesia-radiology-pathology): Yes. Anesthesia, radiology and pathology at a participating hospital or surgery center cannot balance bill, and no consent form changes that. See the steps. - [How to run open negotiation under the No Surprises Act](https://www.nucleusalign.com/blog/nsa-open-negotiation-step-by-step): Send a written notice with your offer within 30 business days of the initial payment or denial. Here is the desk checklist, the send steps and a dated example. - [When a patient can waive NSA balance billing protection](https://www.nucleusalign.com/blog/nsa-notice-and-consent-when-patients-can-waive): A patient can waive only for non-emergency care by an out-of-network provider at a participating facility. Use this gate and timing check first. - [An IDR submission checklist for billing teams](https://www.nucleusalign.com/blog/nsa-idr-submission-checklist): The documents, fields and fees a billing team needs at each IDR stage, from the remittance advice to the offer, with the errors that stall federal disputes. - [How New York's out-of-network dispute process works](https://www.nucleusalign.com/blog/new-york-surprise-bill-independent-dispute-resolution): Steps for a New York provider to start a DFS surprise bill dispute: case number, application, fees, evidence and the 45 business day decision clock. - [Modifier KX and therapy threshold documentation](https://www.nucleusalign.com/blog/modifier-kx-and-therapy-thresholds): When to add KX to Medicare therapy claims: the 2026 thresholds, a worked visit that crosses one, what the record must show and recovery from a KX denial. - [Modifier JW and JZ: reporting drug waste correctly](https://www.nucleusalign.com/blog/modifier-jw-and-jz-drug-waste): How to report drug waste on Medicare Part B claims: which lines take JW or JZ, a worked weight-based dose, chart entries and the fix for a returned claim. - [Modifier GA vs GZ and When an ABN Is Needed](https://www.nucleusalign.com/blog/modifier-ga-and-gz-abn-rules): GA means a valid ABN is on file and GZ means you expect a denial with none. See which modifier fits, how to complete the ABN, what voids it and who pays. - [Modifier 91 and repeat lab tests on the same day](https://www.nucleusalign.com/blog/modifier-91-repeat-lab-tests): When a lab test run again the same day takes modifier 91, a worked panel and repeat claim, the repeats Medicare will not pay and how to fix bundling denials. - [Modifier 76 vs 77 for repeat procedures](https://www.nucleusalign.com/blog/modifier-76-and-77-repeat-procedures): Modifier 76 is a repeat by the same clinician, 77 by a different one. Worked ECG and breathing-treatment claims, look-alikes that are not repeats, denial fixes. - [Modifier 59 vs XE, XS, XP and XU: Which to Use](https://www.nucleusalign.com/blog/modifier-59-vs-xe-xs-xp-xu): Pick between modifier 59 and the X modifiers in three checks, see which reason each one names, what CMS calls misuse and what the note must show to back it. - [How to bill bilateral procedures with modifier 50](https://www.nucleusalign.com/blog/modifier-50-bilateral-procedures): Step by step: check the code wording, read the bilateral indicator in the CMS fee schedule file, build one line with modifier 50 and check what Medicare pays. - [Modifier 26 vs TC: Which Goes on Your Claim](https://www.nucleusalign.com/blog/modifier-26-and-tc-explained): Decide between modifier 26, TC or the global code with three checks: the PC/TC indicator, what your group did and where the patient was, plus fixes for denials. - [Modifier 25 for Urgent Care Procedures With a Visit](https://www.nucleusalign.com/blog/modifier-25-for-urgent-care-procedures): When an urgent care visit with a laceration repair, splint or injection earns a separate E/M with modifier 25, what the note must show and how to fix denials. - [Mental Health Billing: Therapy Codes and Insurance](https://www.nucleusalign.com/blog/mental-health-billing-guide): Bill therapy in order: find the payer that holds the behavioral benefit, pick the visit type, let documented minutes set the code, then set POS and modifiers. - [Medicare vs Medicaid billing: the differences that matter](https://www.nucleusalign.com/blog/medicare-vs-medicaid-billing-differences): Medicare and Medicaid billing differ on who you bill, filing limits, payment timing, appeals and prior authorization. See each rule side by side, with sources. - [Medical Billing vs RCM: Where Billing Ends and RCM Begins](https://www.nucleusalign.com/blog/medical-billing-vs-revenue-cycle-management): Medical billing vs revenue cycle management, sorted by the HIPAA standard transaction each task uses, with a denial example and how to pick the scope you need. - [How Medical Billing Outsourcing Works Week to Week](https://www.nucleusalign.com/blog/medical-billing-outsourcing-guide): How outsourced medical billing runs after you sign: what your office does daily, weekly and monthly, where payments land and how to check the work. - [Medicaid managed care vs fee-for-service billing](https://www.nucleusalign.com/blog/medicaid-managed-care-vs-fee-for-service): How Medicaid managed care billing differs from fee-for-service: where claims go, filing limits, prompt pay, authorization, appeals and wrong-payer fixes. - [Interim billing for long inpatient stays](https://www.nucleusalign.com/blog/interim-billing-for-long-inpatient-stays): Bill a long Medicare inpatient stay with interim claims at least 60 days apart: bill type 112, then 117, patient status 30 until discharge. Steps and dates. - [In-House Billing vs Outsourcing: The One-Biller Test](https://www.nucleusalign.com/blog/in-house-medical-billing-vs-outsourcing-cost): In-house billing cheaper? Three tests for small offices: what stops when your only biller is out, which payer clocks keep running and who holds the know-how. - [ICD-10 Coding Mistakes That Cost You Money](https://www.nucleusalign.com/blog/icd-10-coding-mistakes): The eight most common ICD-10-CM coding mistakes under the FY2027 guidelines, with the rule for each, a worked example and the check that stops it. - [How to handle Humana Medicare Advantage denials](https://www.nucleusalign.com/blog/humana-medicare-advantage-denials): Why Humana denies Medicare Advantage claims, which dispute path and deadline fits each denial code, the packet to send and a worked timeline. - [How Urgent Care Bills In-House Lab and X-Ray](https://www.nucleusalign.com/blog/how-urgent-care-bills-in-house-lab-and-x-ray): Bill the visit, the x-ray and the lab test on one claim: when the x-ray is global or TC only, where the CLIA number goes and which denials to expect. - [How to write a Good Faith Estimate for self-pay patients](https://www.nucleusalign.com/blog/how-to-write-a-good-faith-estimate): Write a compliant Good Faith Estimate in seven steps: screen the patient, set the clock, collect co-provider data, fill each field, add disclaimers, deliver. - [How to Write a Claim Appeal Letter That Works](https://www.nucleusalign.com/blog/how-to-write-a-claim-appeal-letter): Write a one-page claim appeal letter in the right order: identifiers, the denial reason, one request, dated facts, the policy and a numbered exhibit list. - [How to work aged A/R over 90 days](https://www.nucleusalign.com/blog/how-to-work-aged-ar-over-90-days): How to work claims older than 90 days: read claim status codes, sort by the nearest deadline, give each claim one owner and action, and set a write-off cutoff. - [How to Verify Out-of-Network Benefits Before a Visit](https://www.nucleusalign.com/blog/how-to-verify-out-of-network-benefits-before-a-visit): Check that the plan has out-of-network benefits, ask the plan seven questions, test whether the No Surprises Act applies and record it all before the visit. - [How to collect state prompt pay interest from payers](https://www.nucleusalign.com/blog/how-to-use-prompt-pay-laws-to-collect-interest): You can collect interest on late clean claims only where a law or contract creates it. Steps, worked math for FL, NY, CA and Medicare, and where to complain. - [How to track underpayments by payer](https://www.nucleusalign.com/blog/how-to-track-underpayments-by-payer): Build an underpayment register and a monthly by-payer report: the fields, the four measures, a worked three-payer example and when to escalate a pattern. - [A 30-Day Calendar for Switching Billing Companies](https://www.nucleusalign.com/blog/how-to-switch-medical-billing-companies): A dated 30-day calendar for switching medical billing companies without a cash flow gap: who does what each week, the go or no-go check and the day-30 review. - [How to spot payer underpayments before the window closes](https://www.nucleusalign.com/blog/how-to-spot-payer-underpayments): Screen remittances for payer underpayments without a contract table: code red flags, a grouping method for short pays, a worked example and dispute windows. - [How to Speed Up Prior Authorization Turnaround](https://www.nucleusalign.com/blog/how-to-speed-up-prior-authorization-turnaround): Cut prior authorization turnaround with complete requests, the right channel and lead time, and the federal decision clocks for Medicare, MA and Medicaid plans. - [How to Set Up and Maintain a CAQH Profile](https://www.nucleusalign.com/blog/how-to-set-up-and-maintain-a-caqh-profile): Set up a CAQH profile in five steps and keep it current: documents to gather, plan authorization, the 120-day re-attestation and matching records. - [How to Set ED Facility E/M Levels for Hospital Claims](https://www.nucleusalign.com/blog/how-to-set-ed-facility-e-m-levels): CMS lets each hospital set its own ED facility level guideline. See the 11 principles it must meet, how to build and test one, and the UB-04 lines. - [How to pick an E/M level by medical decision making](https://www.nucleusalign.com/blog/how-to-select-e-m-level-by-medical-decision-making): How to choose an E/M level by MDM or time using what CMS says: the method rules, a step-by-step scoring routine, what the note must show and a time example. - [How to Revalidate Medicare Enrollment Before It Lapses](https://www.nucleusalign.com/blog/how-to-revalidate-medicare-enrollment): Find the due date, file in PECOS within 60 days of the notice, protect group reassignments and avoid the payment hold and deactivation that follow a miss. - [How to Respond to a RAC Audit and Appeal Findings](https://www.nucleusalign.com/blog/how-to-respond-to-a-rac-audit-and-appeal-findings): Respond to a RAC audit: the 45-day records request, the 30-day discussion period, recoupment after 41 days and the 120-day redetermination, with dates. - [How to Ask a Payer to Show How It Calculated the QPA](https://www.nucleusalign.com/blog/how-to-request-qpa-calculation-details): Send a written request that cites 45 CFR 149.140(d)(2) and lists four numbered questions. Here is what to ask, when to send it and what to do with the answer. - [How to reduce medical claim denials](https://www.nucleusalign.com/blog/how-to-reduce-medical-claim-denials): Cut claim denials by measuring the rate at claim level, tagging one root cause per denial, and fixing the costliest causes first. Steps and a 90-day plan. - [How to read NCCI edits before you bill](https://www.nucleusalign.com/blog/how-to-read-ncci-edits): Read an NCCI PTP edit in the right order: file and quarter, Column One and Two, dates, modifier indicator, then the chart. Steps and a worked example. - [How to Read an ERA 835 Remittance Line by Line](https://www.nucleusalign.com/blog/how-to-read-an-era-835-remittance): Read an ERA 835 from top to bottom: payment header, claim, service lines, adjustments, remark codes and provider-level changes, with a balanced example. - [How to read a 271 eligibility response](https://www.nucleusalign.com/blog/how-to-read-a-271-eligibility-response): Read a 271 in order: errors first, then the patient match, the status and dates, the plan and payer, and the cost-share lines. See what CMS's own examples show. - [How to Prioritize an A/R Follow-Up Worklist](https://www.nucleusalign.com/blog/how-to-prioritize-an-ar-follow-up-worklist): Rank open claims into tiers by what can still be lost, then by deadline and balance, with a worked six-claim example and a weekly reset routine. - [Registration Errors That Cause Denials and How to Stop Them](https://www.nucleusalign.com/blog/how-to-prevent-registration-errors-that-cause-denials): The registration errors with their own denial codes, the CMS-1500 items and MBI format behind them, and a front-desk routine that catches each one. - [How to Prepare for a Peer-to-Peer Review](https://www.nucleusalign.com/blog/how-to-prepare-for-a-peer-to-peer-review): Prepare for a peer-to-peer review: get the payer's criteria, match them to the chart, know the window and run the call, using two payer manuals. - [How to Pick the Right ED E/M Level](https://www.nucleusalign.com/blog/how-to-pick-the-right-ed-em-level): Pick the ED visit level from medical decision making alone. Score problems, data and risk against the CPT grid, and write a note that holds. - [Negotiate escalators and timely filing in payer contracts](https://www.nucleusalign.com/blog/how-to-negotiate-escalators-and-timely-filing-terms-in-payer-contracts): Ask for a named annual rate increase and a filing window that fits your workflow. Clause list, Medicare and Texas benchmarks and dated examples. - [How to Move ERA and EFT to a New Billing Company](https://www.nucleusalign.com/blog/how-to-move-era-and-eft-to-a-new-billing-company): Which part of ERA and EFT moves when you change billing companies, the Medicare steps in order, what to ask commercial payers and how to catch misrouted money. - [How to Handle Payer Downgrades of ER Visit Levels](https://www.nucleusalign.com/blog/how-to-handle-stealth-downgrades-of-er-visit-levels): Spot and appeal payer downgrades of ER visit levels: read the 835, check public UnitedHealthcare and Centene policies and build the facility-resource appeal. - [How to sort out coordination of benefits](https://www.nucleusalign.com/blog/how-to-handle-coordination-of-benefits): Decide which plan pays first: Medicare rules, Medicaid last, then the plans' own order such as the birthday rule. See the questions and the claim steps. - [How to Handle OA-18 and CO-18 Duplicate Denials](https://www.nucleusalign.com/blog/how-to-handle-co-18-duplicate-claim-denials): CARC 18 means the payer already holds your claim. Find the first claim, read the remark code and fix only a true separate service. Steps for ED teams. - [How to Get Retro Authorization for an Emergency Stay](https://www.nucleusalign.com/blog/how-to-get-retro-authorization): Retro authorization depends on the payer's own manual. See the emergency rules, the notice clocks and the records to send when no authorization was on file. - [How to fix CO-97 bundled service denials](https://www.nucleusalign.com/blog/how-to-fix-co-97-bundled-service-denials): Fix a CO-97 by finding the paid line that absorbed the service, naming the cause (NCCI, global period or packaging) and adding a modifier only if charted. - [How to Fix CO-197 Prior Authorization Denials](https://www.nucleusalign.com/blog/how-to-fix-co-197-prior-authorization-denials): A CO-197 means the payer found no matching authorization. Sort the denial into three cases, fix the claim or request the approval, and appeal with proof. - [How to Fix a CO-4 Modifier Denial](https://www.nucleusalign.com/blog/how-to-fix-a-co-4-modifier-denial): CO-4 means the modifier does not fit the procedure code on that line. Read the remark code, fix the line against the chart and send a correction. Steps inside. - [How to fix a CO-16 denial and resubmit](https://www.nucleusalign.com/blog/how-to-fix-a-co-16-denial): Fix a CO-16 by reading the remark code, correcting the field at its source and resubmitting inside the filing limit. Steps, field locators and what to skip. - [How to file a federal IDR dispute in the CMS portal](https://www.nucleusalign.com/blog/how-to-file-federal-idr-dispute-portal): File the Notice of IDR Initiation inside the 4-business-day window with proof of open negotiation, the QPA and your entity pick. See each screen and an example. - [How to Enroll a Provider in Medicare With PECOS](https://www.nucleusalign.com/blog/how-to-enroll-a-provider-in-medicare-with-pecos): Step by step: NPI, CMS-855I fields, the group reassignment in section 4F, PECOS signatures, the 120-day inactivity rule and the effective date. - [How to dispute a workers comp underpayment](https://www.nucleusalign.com/blog/how-to-dispute-a-workers-comp-underpayment): Check the payment against the state fee schedule, read the explanation of review, then file the state dispute step in time. California and Florida steps. - [How to Compare Two RCM Proposals Fairly](https://www.nucleusalign.com/blog/how-to-compare-two-rcm-proposals): Compare two RCM proposals on one grid: scope, all-in cost as a share of collections, defined KPIs, deposit control and exit terms, then score them. - [How to Choose Your Offer Amount in Federal IDR](https://www.nucleusalign.com/blog/how-to-choose-your-idr-offer): An IDR offer is a dollar figure and its percentage of the QPA. Learn how the entity picks between offers and how to set a number your documents can support. - [How to pick the right revenue code on a UB-04](https://www.nucleusalign.com/blog/how-to-choose-the-right-revenue-code): Choose a UB-04 revenue code from the department that produced the charge, pair it with HCPCS, order the lines and total them. Includes an ER example. - [10 Questions to Ask a Billing Company on the First Call](https://www.nucleusalign.com/blog/how-to-choose-medical-billing-company): A 10-question script for the first call with a medical billing company, with what a checkable answer sounds like and the rule behind each question. - [How to Check Your Billing Company Reports All Collections](https://www.nucleusalign.com/blog/how-to-check-your-billing-company-is-reporting-all-collections): Check that a billing company reports every dollar: tie payer remittances to bank deposits and the collections report each month, and control the account. - [How to review an IDR entity for conflicts of interest](https://www.nucleusalign.com/blog/how-to-check-idr-entity-conflicts): Check a certified IDR entity for conflicts before you name it: the conflict types in 45 CFR 149.510, the 5% financial test, the attestation and how to object. - [How to calculate days in A/R and what to compare it to](https://www.nucleusalign.com/blog/how-to-calculate-days-in-ar): How to calculate days in A/R the HFMA FM-1 way: where each input comes from, a worked quarter, the net versus gross trap, and what to compare the result with. - [How to Calculate Cost to Collect](https://www.nucleusalign.com/blog/how-to-calculate-cost-to-collect): Calculate cost to collect: total revenue cycle cost divided by patient service cash collected, which costs to include, a worked example and how to read it. - [How to bill trauma activation and team response](https://www.nucleusalign.com/blog/how-to-bill-trauma-activation): Bill a trauma activation with revenue code 068x, HCPCS G0390 and critical care 99291 on the same date. Who qualifies, the one-unit rule and common fixes. - [How to bill hospital observation stays correctly](https://www.nucleusalign.com/blog/how-to-bill-observation-stays): How to bill an observation stay on the UB-04: order, revenue code 0762, G0378 hours, same-claim rules and the 8-hour comprehensive payment test, with fixes. - [How to bill when Medicare is the secondary payer](https://www.nucleusalign.com/blog/how-to-bill-medicare-secondary-payer): Bill the primary payer first, then send Medicare the paid amounts. See the 837 loops, the three-way payment formula, a worked example and the denials to expect. - [How to bill ED observation services](https://www.nucleusalign.com/blog/how-to-bill-ed-observation-services): How to bill observation that starts in the ED: what the hospital claim carries, which physician bills which code, and the denials to fix before resubmitting. - [How to avoid MUE denials](https://www.nucleusalign.com/blog/how-to-avoid-mue-denials): What a medically unlikely edit is and how to stop MUE denials: pick the right CMS table and quarter, count units as the manual does, and fix a denial correctly. - [How to Avoid DRG Validation Downgrades](https://www.nucleusalign.com/blog/how-to-avoid-drg-validation-downgrades): Avoid DRG validation downgrades: who validates, why CC and MCC diagnoses get removed, the OIG malnutrition findings and the pre-bill steps that hold the DRG. - [Avoid billing ER patients above in-network cost sharing](https://www.nucleusalign.com/blog/how-to-avoid-billing-emergency-patients-more-than-in-network-cost-sharing): The billing workflow that keeps ER balance bills from going out: where the safe patient amount comes from, which 835 lines to post and a worked example. - [How to Audit an Outsourced Billing Company Monthly](https://www.nucleusalign.com/blog/how-to-audit-an-outsourced-billing-company-each-month): A monthly routine for auditing an outsourced billing company: the eight reports to pull, what to compare, red flags and how to handle an overpayment. - [Audit an acquired practice's billing before closing](https://www.nucleusalign.com/blog/how-to-audit-an-acquired-practices-billing-before-closing): Four checks before closing a practice purchase: A/R value, coding sample, overpayment exposure and payer enrollment. Includes a made-up A/R valuation. - [How to Appeal a Timely Filing Denial](https://www.nucleusalign.com/blog/how-to-appeal-a-timely-filing-denial): Medicare does not allow a formal appeal of a CO-29 denial, but you can ask for an exception or review. Build the proof packet and request, step by step. - [How to appeal a CO-50 medical necessity denial](https://www.nucleusalign.com/blog/how-to-appeal-a-co-50-medical-necessity-denial): Appeal a CO-50 by reading the policy the payer applied, matching the chart to it and filing before the deadline. Medicare steps, packet contents and dates. - [How to Answer an ADR (Additional Documentation Request)](https://www.nucleusalign.com/blog/how-to-answer-an-additional-documentation-request-adr): Answer a Medicare ADR on time: the 45-day and 30-day deadlines, what goes in the packet, signature fixes, proof of delivery and what to do if you miss the date. - [How to Add a Provider to a Group Payer Contract](https://www.nucleusalign.com/blog/how-to-add-a-provider-to-a-group-contract): Add a new provider to an existing group contract: the order of work, where UnitedHealthcare, Aetna and Medicare want the request and the effective date trap. - [How the QPA compares with IDR awards](https://www.nucleusalign.com/blog/how-the-qpa-compares-with-idr-awards): CMS data shows prevailing offers above the QPA in about 87 percent of 2025 federal IDR decisions, with median offers by specialty and cost band. - [How Billing Staff Turnover Changes In-House Cost](https://www.nucleusalign.com/blog/how-staff-turnover-changes-the-cost-of-in-house-billing): Each billing departure adds hiring, training, ramp-up and delayed-cash costs plus HIPAA and enrollment tasks. Use this model to price turnover in your office. - [How OPPS and APCs pay hospital outpatient claims](https://www.nucleusalign.com/blog/how-opps-and-apcs-pay-outpatient-claims): Medicare OPPS pays each outpatient line by status indicator and APC weight. Follow one ED claim line by line and learn why some lines pay $0. - [How Much Aged A/R Can You Actually Recover?](https://www.nucleusalign.com/blog/how-much-aged-ar-is-recoverable): No federal source publishes a recovery rate for aged A/R. Size what is recoverable from open filing and appeal windows, then apply your own collection history. - [How MS-DRGs set inpatient payment for hospitals](https://www.nucleusalign.com/blog/how-ms-drgs-set-inpatient-payment): An MS-DRG sets Medicare inpatient payment from the diagnoses and procedures on the claim. See one pneumonia stay priced at three severity levels. - [How long until outsourcing billing pays for itself?](https://www.nucleusalign.com/blog/how-long-until-outsourcing-billing-pays-for-itself): Payback depends on your numbers, not a fixed month. Here is the arithmetic, a month-by-month cash table with made-up figures and what moves the date. - [How hospitals report Medicare bad debt](https://www.nucleusalign.com/blog/how-hospitals-report-medicare-bad-debt): How a hospital claims Medicare bad debt on the cost report: the four criteria, the 120-day collection rule, indigent and dual-eligible patients, the listing. - [How freestanding ERs bill facility fees](https://www.nucleusalign.com/blog/how-freestanding-ers-bill-facility-fees): How freestanding ERs bill facility fees: the visit level line, procedure and ancillary lines, the Texas disclosure match, and what the patient owes. - [Getting paid when a payer underpays an ER out of network](https://www.nucleusalign.com/blog/how-er-groups-get-paid-when-the-payer-underpays-out-of-network): The path from a short payment to cash for an ER group: open negotiation, federal IDR, the day counts and a dated example from claim to final payment. - [How critical access hospitals bill Medicare](https://www.nucleusalign.com/blog/how-critical-access-hospitals-bill-medicare): A critical access hospital bills inpatient on 11X and outpatient on 85X, is paid 101 percent of cost, and chooses Method I or II for professional fees. - [How Big a Chart Sample Does a Coding Audit Need?](https://www.nucleusalign.com/blog/how-big-a-chart-sample-for-a-coding-audit): What official sources say about coding audit sample sizes: OIG's basic guide, the 100-item floor for estimating overpayments, and how to decide for your group. - [How add-on codes work and why they get denied](https://www.nucleusalign.com/blog/how-add-on-codes-work-in-billing): What an add-on code is, the Type 1, 2 and 3 rules, how to bill one with a listed primary code, why add-on lines deny and how to fix each cause. - [Handling credit balances and overpayment refunds](https://www.nucleusalign.com/blog/hospital-credit-balances-and-refunds): How a hospital works credit balances: find them, decide whose money it is, refund Medicare by adjustment bill, meet the 60-day clock and handle the CMS-838. - [HIPAA and Outsourced Billing: What You Still Must Do](https://www.nucleusalign.com/blog/hipaa-compliance-medical-billing): HIPAA puts duties on a billing company and on you. A table of who owns each one, plus when your 60-day breach clock can start if the vendor finds the breach. - [A 90-Day Plan to Get More Patients Online](https://www.nucleusalign.com/blog/healthcare-digital-marketing-get-more-patients): A 12-week plan for a medical practice to get more patients online: facts, Google profile, website, reviews and a tracking sheet, plus the rules for each step. - [Google Business Profile Setup for a Medical Practice](https://www.nucleusalign.com/blog/google-business-profile-medical-practice): Set up a Google Business Profile for a medical practice: who gets a profile, what goes in each field, how verification works and what to keep out of the name. - [Florida surprise billing law for ER claims](https://www.nucleusalign.com/blog/florida-surprise-billing-law-for-providers): How Florida prices out-of-network ER claims: the payment formula, the AHCA dispute steps and deadlines, and when federal IDR applies instead. - [How to find payer underpayments against your contract](https://www.nucleusalign.com/blog/find-payer-underpayments-against-your-contract): Compare every remittance to your contract rate to find underpayments: the build, the formula, the CARCs that explain a short pay, and a worked example. - [How to find charge capture leaks in hospital billing](https://www.nucleusalign.com/blog/find-charge-capture-leaks-in-hospital-billing): Find missed hospital charges by matching orders to charges and charges to claim lines. Steps, the manual rules behind each leak, and a worked sample audit. - [Facility fee vs professional fee: who bills which](https://www.nucleusalign.com/blog/facility-fee-vs-professional-fee): A facility fee is billed by the hospital on a UB-04. A professional fee is billed by the clinician on a CMS-1500. See who bills which service and what denies. - [EMTALA and Billing: What You Can Ask Patients](https://www.nucleusalign.com/blog/emtala-and-billing-what-you-can-ask-patients): An ED may ask if a patient is insured, but not delay the exam or seek authorization first. See the action table, a compliant timeline and wording to avoid. - [An eligibility verification checklist for front desks](https://www.nucleusalign.com/blog/eligibility-verification-checklist): Check coverage on the date of service, plan type, network, cost share, authorization and other payers before every visit. Use this front desk checklist. - [ED documentation that supports the level you bill](https://www.nucleusalign.com/blog/ed-documentation-that-supports-the-level-billed): What an ED chart must show to support a 99284 or 99285: CMS documentation rules, a chart-audit method, note fixes, late entries and the CARC 150 appeal. - [How to Document Critical Care Time for 99291 and 99292](https://www.nucleusalign.com/blog/document-critical-care-time-99291-99292): Document total critical care minutes, the critical illness and what you excluded. See what counts toward time, the Medicare thresholds and a sample statement. - [Do you have to change your EHR to outsource billing?](https://www.nucleusalign.com/blog/do-you-have-to-change-your-ehr-to-outsource-billing): No. A billing company works inside the EHR you have. Here is what changes: access roles, how charges and payments move, and where payment lands. - [Do self-funded employer plans have to follow the NSA](https://www.nucleusalign.com/blog/do-self-funded-plans-have-to-follow-the-nsa): Yes, the federal No Surprises Act reaches self-funded ERISA plans. See how the dispute route, the party you name and your batches change for those claims. - [Do No Surprises Act protections apply to freestanding ERs?](https://www.nucleusalign.com/blog/do-nsa-protections-apply-to-freestanding-ers): Do No Surprises Act protections apply to freestanding ERs? Yes for commercial plans and licensed facilities. A five-question test, with limits and IDR rights. - [How to count No Surprises Act deadlines in business days](https://www.nucleusalign.com/blog/count-nsa-deadlines-in-business-days): Count weekdays that are not federal holidays, and know which day is day 1 for each period. A dated example with the holiday traps and the calendar-day mix-ups. - [When to use condition and occurrence codes on a UB-04](https://www.nucleusalign.com/blog/condition-codes-and-occurrence-codes-on-ub-04): Which UB-04 condition and occurrence codes to report, in which form locators, for no-pay claims, ABNs and same-day visits. A decision guide with fixes. - [CO-45: Write-Off or Underpayment? How to Check](https://www.nucleusalign.com/blog/co-45-contractual-obligation-or-underpayment): A CO-45 adjustment is a valid write-off only if the allowed amount matches your contract rate. Compare the allowed amount, then dispute any shortfall. - [Clean Claim Rate vs First-Pass Resolution Rate](https://www.nucleusalign.com/blog/clean-claim-rate-vs-first-pass-resolution-rate): Clean claim rate vs first-pass resolution rate: what each measures, how to calculate each from scrubber and 835 data, a worked month and which to track. - [How to request reconsideration of a Cigna denial](https://www.nucleusalign.com/blog/cigna-claim-reconsideration): Call Cigna first, then file a reconsideration or a written payment-review appeal within 180 calendar days. See the paths, form, records and timelines. - [How to set clearinghouse edits for UB-04 claims](https://www.nucleusalign.com/blog/choose-clearinghouse-edits-for-ub-04-claims): Which clearinghouse edits matter most for UB-04 claims, how to rank and set them as hold or warn, and how to tune them from your own rejection data. - [A chargemaster review checklist for hospitals](https://www.nucleusalign.com/blog/chargemaster-review-checklist): Review the chargemaster at least once a year and again when CMS code files change. Use this line-by-line worksheet tied to UB-04 form locators. - [What Makes Cardiology Billing Hard](https://www.nucleusalign.com/blog/cardiology-billing-guide): Cardiology billing is hard because tests split into two components, the setting decides who bills which, and bundles hide in every test. Six errors and fixes. - [Can You Bill 99285 and 99291 on the Same Day](https://www.nucleusalign.com/blog/can-you-bill-99285-and-99291-same-day): Medicare allows an ED visit and critical care on one date only when the visit came first and was separate. See the three tests, modifier 25 and the note. - [California rules for non-contracted provider payments](https://www.nucleusalign.com/blog/california-surprise-billing-for-non-contracted-providers): What California's AB 72 requires a plan to pay a non-contracted provider at a contracting facility, plus the dispute steps, fees and 365-day windows. - [Billing Fracture Care in Urgent Care](https://www.nucleusalign.com/blog/billing-fracture-care-in-urgent-care): Which codes to bill for a splint, a closed fracture treatment and a referral, how the 90-day global period hits follow-up visits and why splint lines deny. - [Billing occupational medicine visits in urgent care](https://www.nucleusalign.com/blog/billing-employer-and-occupational-visits-in-urgent-care): Bill workers' comp, DOT physicals and employer drug screens in urgent care: pick the payer for each service, split mixed visits and fix CARC 19, 22 and 109. - [Billing Company Fee Models Compared](https://www.nucleusalign.com/blog/billing-company-fee-models-compared): Percent of collections, flat fee, per claim or hybrid: what each pays the billing company to do, what Medicare's agent rule says and how to compare quotes. - [How out-of-state Blue Cross claims work through BlueCard](https://www.nucleusalign.com/blog/bcbs-out-of-state-claims-and-bluecard): Where to send a Blue Cross claim for a patient from another state: the local plan, the prefix, lab and DME routing, status checks and the denials to expect. - [The Five Levels of Medicare Appeals in Plain Words](https://www.nucleusalign.com/blog/appeal-levels-for-medicare-claims): See which Medicare appeal level you are on, what to file next, where it goes and what evidence each level will accept, with a dated example. - [An annual code update checklist for billing teams](https://www.nucleusalign.com/blog/annual-code-update-checklist-for-billing-teams): A checklist for yearly and quarterly code updates: CPT and NCCI on January 1, HCPCS and NCCI each quarter, ICD-10 on October 1, deleted codes and a version log. - [How air ambulance claims are handled under the NSA](https://www.nucleusalign.com/blog/air-ambulance-billing-under-the-nsa): Bill the plan, not the patient: cost sharing is capped, the plan has 30 calendar days to pay, and unpaid balances go to open negotiation and IDR. The steps. - [How to appeal an Aetna claim denial](https://www.nucleusalign.com/blog/aetna-claim-appeal-process): Decide reconsideration or appeal, file it on Availity inside the deadline and attach the right records. Aetna's one-level provider appeal process, step by step. - [What is accounts receivable in medical billing?](https://www.nucleusalign.com/blog/accounts-receivable-medical-billing): Accounts receivable is billed money not yet collected. How to read an aging report, work out days in A/R and bring a high balance down, in order. - [Transparency in Coverage final rule published](https://www.nucleusalign.com/news/transparency-in-coverage-final-rule): The Transparency in Coverage final rule (91 FR 63748, effective December 7, 2026) changes payer price files and adds phone pricing. See the dates. - [CMS proposes rule on provider directories under CAA 2026](https://www.nucleusalign.com/news/provider-directory-and-pbm-proposed-rule): CMS-4214-P (91 FR 66408) proposes Medicare Advantage directory accuracy rules, Part D PBM rules and a $0 generic copay. Comments are due December 15, 2026. - [CMS proposes the CY 2027 physician fee schedule](https://www.nucleusalign.com/news/physician-fee-schedule-proposed-rule): CMS proposed the CY 2027 physician fee schedule on July 16, 2026. See the lower estimated conversion factors, the new G-codes and the telehealth proposals. - [CMS finalizes the CY 2026 physician fee schedule](https://www.nucleusalign.com/news/physician-fee-schedule-final-rule): CMS issued the CY 2026 physician fee schedule final rule on October 31, 2025. See the two conversion factors, the efficiency adjustment and supervision changes. - [CMS proposes the CY 2027 OPPS and ASC rule](https://www.nucleusalign.com/news/opps-asc-proposed-rule): CMS proposed the CY 2027 OPPS and ASC rule on July 7, 2026. See the 2.4 percent update, the 340B drug payment proposal and Botulinum toxin prior authorization. - [CMS finalizes the CY 2026 OPPS and ASC rule](https://www.nucleusalign.com/news/opps-asc-final-rule): CMS issued the CY 2026 OPPS and ASC final rule on November 21, 2025. See the 2.6 percent update, the $91.415 conversion factor and the IPO list phase-out. - [CMS corrects the CY 2026 OPPS final rule](https://www.nucleusalign.com/news/opps-asc-final-rule-correction): CMS corrected the CY 2026 OPPS and ASC final rule on February 23, 2026. See the added C-APCs, the Inpatient Only list end date and the fixed code descriptors. - [NCCI PTP edits version 32.3, effective October 2026](https://www.nucleusalign.com/news/ncci-ptp-edits-version-32-3): CMS Transmittal 13829 puts NCCI PTP edits version 32.3 into effect October 1, 2026. Release dates, file sizes, change lists and how to rework Q4 denials. - [NCCI PTP edits version 32.2 and add-on edits, July 2026](https://www.nucleusalign.com/news/ncci-ptp-edits-version-32-2): CMS released NCCI PTP edits version 32.2 and the Q3 2026 add-on code edits, effective July 1, 2026. Dates, file sizes and what billing teams should check. - [CMS adds 15 DMEPOS items to Medicare prior authorization](https://www.nucleusalign.com/news/medicare-prior-authorization-required-list-update): CMS added 7 items to the Medicare DMEPOS Required Prior Authorization List in January 2026 and 8 more in July 2026, effective October 28. Dates, codes, steps. - [CMS finalizes the FY 2027 inpatient payment rule](https://www.nucleusalign.com/news/ipps-final-rule): CMS published the FY 2027 IPPS final rule on August 4, 2026, effective October 1, 2026. See the 2.3 percent update and the new and deleted MS-DRGs. - [CMS corrects the FY 2027 IPPS final rule](https://www.nucleusalign.com/news/ipps-final-rule-correction): CMS corrected the FY 2027 IPPS final rule on September 29, 2026 after a hospital was wrongly excluded. See what was recalculated and the corrected figures. - [CMS proposes electronic prior authorization for drugs](https://www.nucleusalign.com/news/interoperability-and-prior-authorization-for-drugs-proposed-rule): CMS and ONC proposed electronic prior authorization for all drugs with an October 1, 2027 compliance date. CMS-0062-P: what it covers and what is open. - [CMS finalizes FY 2027 inpatient psychiatric rates](https://www.nucleusalign.com/news/inpatient-psychiatric-facility-payment-final-rule): CMS finalized the FY 2027 inpatient psychiatric facility rates, effective October 1, 2026, then corrected them. See the per diem, ECT rate and outlier changes. - [IDR operations rule takes effect August 3](https://www.nucleusalign.com/news/idr-operations-rule-takes-effect): The federal IDR operations rule took effect August 3, 2026, but only some parts apply then. See what is live, what starts November 1 and what awaits the portal. - [Correction notice issued for the IDR operations rule](https://www.nucleusalign.com/news/idr-operations-rule-correction): The August 28, 2026 correcting amendment (91 FR 55462) fixes typos and omitted text in the federal IDR operations rule. See what changed and what did not. - [DOL submits No Surprises Act IDR data collection to OMB](https://www.nucleusalign.com/news/idr-information-collection-notice): A November 26, 2025 notice (90 FR 54399) sent the No Surprises Act IDR information collection, OMB 1210-0169, to OMB. See the burden estimates and status. - [CMS proposes the CY 2027 home health payment rule](https://www.nucleusalign.com/news/home-health-payment-proposed-rule): CMS proposed a 2.1 percent home health payment update for CY 2027 with a 3.0 percent temporary reduction. See the PDGM, DME and comment details. - [Federal IDR operations final rule published](https://www.nucleusalign.com/news/federal-idr-operations-final-rule): The 91 FR 33900 final rule cuts the federal IDR fee to $15 per party, caps batches at 50 line items and adds a payer registry. See what changed and when. - [CMS proposes the CY 2027 ESRD payment rule](https://www.nucleusalign.com/news/esrd-payment-proposed-rule): CMS proposed the CY 2027 ESRD payment rule on June 26, 2026. See the $299.55 base rate, phosphate binder bundling and the home training add-on increase. - [CMS publishes federal IDR public use files](https://www.nucleusalign.com/news/cms-federal-idr-public-use-files): CMS's latest federal IDR public use files cover 2025 Q3 and Q4 as of July 22, 2026 and name the certified IDR entity on each line item. See what they hold. - [HHS finalizes the 2027 benefit and payment parameters](https://www.nucleusalign.com/news/benefit-and-payment-parameters-final-rule): HHS finalized the 2027 Notice of Benefit and Payment Parameters on May 20, 2026. What billing teams need: the $12,000 limit, bronze and non-network plans. ## Tools - [Medical Billing Calculators and Tools](https://www.nucleusalign.com/tools): Five billing calculators: NSA and IDR deadlines, timely filing, A/R days and denial rate, collection rate, and in-house vs outsourced cost. Formulas shown. - [A/R Days and Denial Rate Calculator](https://www.nucleusalign.com/tools/ar-days-denial-rate-calculator): Enter your A/R balance, charges and claim counts to get days in A/R and denial rate. Formulas, a worked example and the mistakes that skew both numbers. - [Collection Rate Calculator: Gross and Net](https://www.nucleusalign.com/tools/collection-rate-calculator): Enter charges, payments and contractual adjustments to see gross and net collection rate side by side. Includes the formulas, an example and common mistakes. - [In-House vs Outsourced Billing Cost Calculator](https://www.nucleusalign.com/tools/in-house-vs-outsourced-billing-cost-calculator): Compare a year of in-house billing cost with a vendor paid a percent of collections. Enter salaries, software and collections to see the break-even percent. - [NSA Deadline Calculator: Open Negotiation and IDR](https://www.nucleusalign.com/tools/nsa-deadline-calculator): Enter the date an insurer paid or denied an out-of-network claim to see each open negotiation and federal IDR deadline in business days, skipping weekends. - [Timely Filing Calculator for Medical Claims](https://www.nucleusalign.com/tools/timely-filing-calculator): Enter the date of service and payer limit to get the last day to file. Medicare is 1 calendar year (42 CFR 424.44); commercial limits come from your contract. ## Glossary and resources - [Medical Billing Glossary: Terms in Plain English](https://www.nucleusalign.com/glossary): A medical billing glossary in plain English: No Surprises Act, UB-04, CMS-1500, MS-DRG, CARC and RARC, NCCI and payer terms, each linked to the rule behind it. - [Billing Resources: Guides, Codes, Rules, Tools](https://www.nucleusalign.com/resources): Find the right billing resource: guides, the code library, rules, payer guides, the glossary, tools, the blog and news, each matched to the question it answers. ## Company - [About Nucleus Align](https://www.nucleusalign.com/about): Nucleus Align LLC is a US medical billing and revenue cycle management company. Learn who we are, who we serve, how we work and where our team is based. - [Careers at Nucleus Align](https://www.nucleusalign.com/careers): Interested in working with Nucleus Align? We do not list open roles on this page. Email hello@nucleusalign.com with your background and the role you want. - [Contact and Book a Call](https://www.nucleusalign.com/contact): Contact Nucleus Align by phone at +1 332 252 4242 or at hello@nucleusalign.com, Monday to Friday, 9am to 5pm Eastern, or book a call with a billing lead. - [Editorial Policy: How We Write and Review](https://www.nucleusalign.com/editorial-policy): How Nucleus Align pages are researched from official sources, who writes and reviews them, how last-reviewed dates work and how to report an error. - [Offices: Vancouver, Richmond, Dubai, Islamabad](https://www.nucleusalign.com/offices): Nucleus Align team offices are in Vancouver, BC, Dubai, UAE and Islamabad, PAK, with a US registered office at 212 N. 2nd St., Richmond, KY 40475. - [Pricing for Billing, Credentialing and NSA Work](https://www.nucleusalign.com/pricing): Nucleus Align pricing: billing is 4 to 8% of collections, credentialing is $150 to $300 per application, and NSA and IDR work is a monthly retainer. - [Privacy Policy](https://www.nucleusalign.com/privacy): Nucleus Align privacy policy: what we collect through our website and booking form, how we use it, HIPAA safeguards, SMS consent and how to reach us. - [Security and HIPAA at Nucleus Align](https://www.nucleusalign.com/security): How Nucleus Align protects client data: a Business Associate Agreement with every client, HIPAA training, two-step login, encrypted backups, compliance officer. - [Our Team: Billing and Coding Experts](https://www.nucleusalign.com/team): Meet the people behind Nucleus Align: Salman Saeed, CEO and Co-Founder, and Sania Ilyas, COO, who lead a team with AAPC and AHIMA certified coders. - [Terms of Use](https://www.nucleusalign.com/terms): Terms of use for the Nucleus Align website and services: agreement, SMS terms, acceptable use, intellectual property, confidentiality, liability and disclaimer. ## IOP and PHP credentialing - [IOP and PHP credentialing with commercial payers](https://www.nucleusalign.com/services/credentialing#iop-php): Nucleus Align gets Intensive Outpatient Programs (IOP) and Partial Hospitalization Programs (PHP) approved and credentialed with commercial payers, at the facility level and at the individual provider level. - [Behavioral health billing](https://www.nucleusalign.com/specialties/behavioral-health-billing): PHP and IOP claims, condition codes and the credentialing step that comes before billing.