Compliance Archives - MedBillingTech

Provider Credentialing: The Complete Guide

Provider credentialing is the gateway between hiring a clinician and that clinician generating revenue. It's also poorly understood and getting harder in 2026. This complete guide defines what credentialing actually is, walks through the full process, covers the systems involved, and links to detailed deep-dives on every subtopic.

By Mark Wood June 8, 2026Credentialing

Credentialing

Medicare Enrollment Through PECOS 2.0: What Changed in 2026

CMS quietly launched PECOS 2.0 in late 2025 and the production system is now rolling out to every Medicare-enrolled provider through the end of 2026. The new system runs real-time validation against IRS, NPPES, and EFT data, flags inconsistencies as "Stay of Enrollment," and gives CMS expanded revocation authority. Here's what actually changed, what's already costing practices revenue, and how to prepare before your enrollment migrates.

By Mark Wood June 1, 2026Credentialing

Credentialing

Why Credentialing Applications Get Denied and How to Fix Yours

Most credentialing applications don't get denied because the provider is unqualified. They get denied because of eight or nine recurring mistakes in how information is submitted, verified, or matched across systems. Here's what each one looks like, why it happens, and how to fix it before the next submission.

By Mark Wood May 20, 2026Credentialing

Credentialing

CAQH ProView: The Profile That Quietly Controls Your Credentialing

Most new providers think the credentialing application is what payers verify. It isn't. For commercial payers, the source of truth is your CAQH ProView profile, and most credentialing delays start with something in that profile being wrong, incomplete, or out of date. Here's how it actually works.

By Mark Wood May 18, 2026Credentialing

Credentialing

Re-Credentialing: The Deadline Nobody Remembers Until It’s Too Late

Most practices don't lose revenue because credentialing failed. They lose it because re-credentialing got forgotten. Here's a plain look at the 36-month NCQA cycle, the 5-year Medicare revalidation, the 120-day CAQH attestation rule, and what actually happens when one of them slips past the deadline.

By Mark Wood May 8, 2026Credentialing