CAQH Proview                    CAQH Proview is an online database that stores healthcare provider information. Health care providers grant access to their information to health insurance companies through CAQH Proview rather than submitting medical credentialing applications separately fo...

MIPS The Merit-based Incentive Payment System (MIPS) is one of the two payment tracks created under MACRA; the other is the Advanced Alternative Payment Model (AAPM) track. MIPS adjusts payment based on performance in four performance categories: Quality (45%) – based on the Physician Quality Repo...

EDI Enrollments EDI is an abbreviation for Electronic Data Interchange, an innovative electronic communication technology. It is a structured way to transmit data between computer systems using established message formats and standards.  When utilizing healthcare EDI transactions healthcare provide...

Medicare credentialing  All the providers must be credentialed with Medicare before start billing for their services. Group practices and the providers within the group must be separately credentialed and linked together to start billing. All the enrollment applications must be submitted to the cor...

Provider credentialing Physician credentialing is the process by which insurance networks, healthcare organizations, and hospitals obtain and evaluate documentation regarding a medical provider’s education, training, work history, licensure, regulatory compliance record, and malpractice histor...

EOB (Explanation Of Benefits) After a claim processes in medical billing, payment follows. Each payment is accompanied by an explanation of benefits, or EOB. The EOB is sent to the patient and the provider to show how the claim processed. It also lets the provider know whether any remaining balance ...