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Will AI Replace Medical Billing and Coding or Transform It?

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  Artificial Intelligence (AI) is no longer a future concept—it’s actively reshaping industries worldwide. From finance and cybersecurity to manufacturing and digital marketing, automation and intelligent systems are streamlining operations at scale. Healthcare is no exception. Within healthcare, Revenue Cycle Management (RCM) —particularly medical billing and coding—has become one of the most discussed areas for AI adoption. This has sparked a critical question across the industry: Will AI replace medical billing and coding professionals, or will it simply redefine their roles? This guide explores the reality behind AI’s role in medical billing, separating hype from facts. AI in Medical Billing: Replacement or Reinforcement? With over 15 years of experience in healthcare RCM, the practical answer is clear: AI will not fully replace medical billing and coding professionals—at least not anytime soon. Instead, AI is pushing the industry toward a hybrid model , where automation suppor...
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Understanding CO-170 Denial Code: Provider Eligibility Denials, Revenue Impact & Resolution Strategy

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  CO-170 is a denial code that appears frequently on ERA/835 remittances, and although the message is concise, its implications are significant: the payer is stating that the service, as billed, is not payable to the specific provider type on the claim . This form of denial is not about medical necessity, coding accuracy, or documentation depth. Instead, CO-170 identifies a provider-eligibility obstacle—a disconnect between payer policy , provider credentials/taxonomy , and the CPT/HCPCS reported . This guide explains what CO-170 means, why it happens, how it affects reimbursement, and the most reliable method to resolve and prevent it. What Does CO-170 Mean? CO-170 corresponds to Claim Adjustment Reason Code (CARC) 170: “Payment is denied when performed/billed by this type of provider.” The accompanying group code “CO” indicates a contractual obligation: Generally not billable to the patient Typically requires provider write-off You may also see remark code N95 attached, which rei...
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Solving CO-210 Denials: Why They Happen and How to Protect Your Reimbursement

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  CO-210 is one of the most frustrating denial codes in medical billing because it usually doesn’t reflect an issue with care quality — only with process. When authorization is required and isn’t received before treatment, payers can deny or reduce payment, leaving providers responsible for the balance. The good news? CO-210 is preventable. And once you understand where the breakdowns occur, you can put systems in place to stop the losses. What CO-210 Really Means When a payer uses denial code CO-210, they are stating that precertification or authorization was not obtained in time. Because this falls under Contractual Obligation , the provider cannot shift the cost to the patient. This means: If the authorization step is skipped — even unintentionally — the practice may lose reimbursement. Why CO-210 Denials Occur CO-210 doesn’t show up randomly. It signals specific operational gaps like: Authorization skipped or overlooked The team may have assumed the service didn’t require appro...
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CO-252 Denial Code: The Hidden Claim Killer Sabotaging Your Revenue

 If you’ve ever felt the frustration of a claim denial that makes no sense , you’ve probably met the infamous CO-252 denial code . It often arrives quietly on your remittance advice, without dramatic warnings—yet it carries the power to stall payments, disrupt workflow, and drain monthly revenue. The worst part? CO-252 is almost always preventable. This denial typically arises when payers can’t validate provider information. Whether it's a missing NPI, an outdated taxonomy, or a credential mismatch, small details can turn into expensive delays. For a full technical definition, you may refer to: https://imedclaims.com/co-252-denial-code/ . Let’s unpack this denial from a different angle—why it happens, what it really signals about your billing workflow, and what you can do to eliminate it permanently. Why CO-252 Happens: A Closer Look Behind the Scenes Every payer has its own data-matching system. When your claim arrives, it goes through multiple automated checkpoints. If any ...
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Therapist Insurance Credentialing: A Complete Guide to Becoming an In-Network Provider

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 Across the United States, the demand for therapy continues to grow, and more clients depend on insurance to help cover the cost of treatment. Because of this, therapists who want steady appointments and long-term practice growth must get credentialed with major insurance companies. Whether you're planning to accept Medicare, Medicaid, or major commercial plans like UnitedHealthcare, Aetna, Cigna, or Blue Cross Blue Shield, credentialing is the step that opens the door. Many therapists, however, find the enrollment process confusing and time-consuming. Every payor has its own rules, documents, and approval timelines. Trying to manage all of this while running a practice can feel overwhelming. That’s why having a clear path—or the help of credentialing experts—makes such a big difference. At I-Med Claims , we simplify the entire process so therapists can get enrolled faster and without stress. What Is Insurance Credentialing for Therapists? Insurance credentialing is the verific...
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How Much Does Credentialing Cost for Healthcare Providers? A Complete Breakdown

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  Credentialing is one of the most important steps healthcare providers must complete before they can treat patients, join insurance networks, or receive reimbursements. While the process is essential, many practices and independent providers are unsure about how much credentialing truly costs. This guide breaks down every expense involved—direct fees, administrative work, and long-term maintenance—so you can understand the full financial picture. For a detailed cost overview, you can also visit: https://imedclaims.com/medical-credentialing-costs/ 1. Application & Verification Fees Some state agencies, hospitals, and payers may charge small fees to process credentialing applications or verify provider documents. These charges differ based on provider specialty and location. Estimated cost: 💲 $50 to $300 per application 2. Commercial Insurance Enrollment Costs Most commercial payers do not charge an official fee for enrolling providers. However, the work required to collect d...
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Credentialing vs. Privileging: A Clear Guide for Healthcare Providers and Facilities

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 In the complex world of healthcare administration, credentialing and privileging are two processes that are often confused — but they serve very different (and equally critical) roles. Understanding how they work can help providers and facilities maintain compliance, ensure patient safety, and operate more efficiently. Here’s a clear, practical breakdown of what credentialing and privileging are, why they matter, and how they differ. What Is Credentialing? Credentialing is the formal process of verifying a healthcare provider's background, qualifications, and professional history. It involves: Checking education, training, board certifications, and licensure. Relias +2 ASHP +2 Performing background checks, such as malpractice history and regulatory sanctions. I-Med Claims +2 NCBI +2 Conducting primary source verification — meaning the facility or payer confirms credentials directly from the issuing institutions (e.g., medical schools, licensure boards). I-Med Claims...
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