Payor Guides

Comprehensive guides for every major insurance payor — credentialing, billing, denials, and more

Major Commercial Payors

5 Detailed Guides

Aetna

Complete credentialing, authorization, and billing guide

Anthem / Blue Cross Blue Shield

State-specific BCBS plans and policies

Cigna

Network enrollment, claims submission, and denial management

UnitedHealthcare / Optum

UHC, Optum, and affiliated plan guidance

Humana

Medicare Advantage, commercial, and specialty plans

State Medicaid Programs

State-specific enrollment guides, MCO information, and billing requirements

California Medicaid (Medi-Cal)

Texas Medicaid

Florida Medicaid

New York Medicaid

Pennsylvania Medicaid

Ohio Medicaid

Browse by Common Issue

Top Denial Codes by Payor

• CO-197: Precertification/authorization absent • CO-50: Non-covered services • CO-16: Missing or incomplete information

Prior Authorization by Payor

• Aetna prior auth requirements • UnitedHealthcare authorization portal • Cigna medical necessity criteria

Credentialing Timelines

• Average processing times by payor • CAQH vs. payor-specific applications • How to expedite enrollment

Rate Negotiation Guides

• Understanding fee schedules • When to request a rate increase • Behavioral health rate benchmarks

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