AC Billing & Credentialing Specialists

04/27/2026

Humana Military would like to remind all mental health providers that they must meet the "Requirements for Documentation of Treatment in Medical Records" policy as outlined in the TRICARE Policy Manual (TPM). Compliance with this policy is essential for all TRICARE network providers.

Providers are required to demonstrate completion of required, specific mental health outcome measure assessment(s) for each patient.

Please review the article on our website for helpful information, including the tools and assessments that need to be used for post traumatic stress disorder (PTSD), and anxiety and depressive disorders.

Ensuring that the appropriate outcome measure assessments are completed, and that the results are documented in the medical record, supports compliance with TRICARE standards and helps to optimize patient care.

If you have questions, please email us at Healthcarequality@HumanaMilitary.com.

Thank you for your attention and cooperation.

Humana Military

04/27/2026

CGS has identified all E/M claims that were denied in error due to the system issues which began March 27, 2026. This also includes QPP adjustments that were denied in error. Claims are actively being adjusted to ensure all affected claims are reprocessed appropriately. In addition, any improper overpayment demands that resulted from incorrect denials will be fully addressed as part of the correction process, with no provider action required. CGS will continue to provide updates as adjustments and overpayment resolutions are completed.

04/24/2026

nightmare from

04/22/2026

Network Notification – Humana Healthy Horizons in Ohio


The Ohio Department of Medicaid (ODM) plans to revise OhioRISE eligibility and enrollment rule 5160-59-02 to make OhioRISE enrollment effective on the first day of the calendar month in which eligibility is established. This update is intended to align enrollment timing with the Humana Healthy Horizons in Ohio managed care program and to reduce the need for manual retroactive enrollments related to inpatient behavioral health admissions. The proposed effective date for this rule change is July 1, 2026.
Clarification of financial responsibility for behavioral health services provided to children and youth is found in the OhioRISE Mixed Services Protocol (Protocol). Managed care plans are still expected tobe responsible for CANS assessments completed prior to OhioRISE enrollment. The Protocol will be updated as needed to support the rule change.

04/22/2026

Under the Microscope: What CMS’s Fraud Crackdown and Rising Claim Denials Mean for Providers in 2026
wchinsightsApril 22, 2026

Two forces are squeezing healthcare providers from opposite directions in 2026. From the regulatory side, CMS leadership is pursuing its most aggressive fraud and billing compliance campaign in years — revoking provider privileges, launching 50-state audits, and signaling that high-volume billing outliers will face consequences. From the operational side, claim denial rates continue to climb, driven by prior authorization complexity, documentation gaps, and new CMS payment models that extend pre-approval requirements into Traditional Medicare for the first time. For provider organizations managing financial stability this year, understanding both forces together is not optional.

Discover how 2026's CMS enforcement and rising claim denial rates challenge healthcare providers, impacting financial stability and compliance.

04/17/2026

We are a bit late posting but we want to congratulate Rachel on Employee of the quarter. From the moment Rachel joined our team, she has shown an incredible ability to learn quickly, adapt to new systems, and master complex workflows with ease. She consistently takes on extra work without hesitation and is always willing to jump in for trainings, meetings, and new responsibilities. What stands out most is her willingness to step outside of her comfort zone... not just to help the team, but to grow her own skills and strengthen our operations.
Her initiative, reliability, and eagerness to learn make a real difference every single day. We are truly thankful for her dedication, her work ethic, and the positive energy she brings to our team.

03/26/2026

Happy Medical Billers day to our medical billers!!
Without them, providers would not get paid and continue to see patients and grow their practices. We are thankful for their knowledge and assistance with helping patients daily with what they do.

03/25/2026

Ohio team lunch today but we missed Jessie. 💛

03/25/2026

From numerous EHR Systems: We are currently experiencing delays in receiving ERA (835) and acknowledgement files (999, 277CA) from the following payers due to an issue with Office Ally: J5 National Part A (05901), Medicare Indiana (MR089), Medicare Iowa (05102), Medicare Kansas (05202), Medicare Michigan (08202), Medicare Missouri (05302), Medicare Nebraska (00655), Tricare for Life (TDDIR), and Tricare Overseas (FOREN). This impact applies to files dated 03/07/2026 to present. We are actively working with Office Ally and the payer to resolve this issue and restore normal processing as quickly as possible. No action is required at this time, and updates will be provided as more information becomes available.

03/18/2026

Now Contracting with Experienced Medical Billing Professionals

AC Billing & Credentialing Specialists, LLC is seeking long‑term 1099 Medical Billing Contractors who are looking for stability and the opportunity to grow their own business while partnering with ours. Contractors will have access to permanent office placements and ongoing support as part of our network.

Requirements:
Minimum 2 years of medical billing experience
Strong professionalism, accuracy, and reliability
Commitment to long‑term partnership
If you’re ready to expand your business and join a supportive, growth‑focused team, submit your application to:

📧 Apply@acbilling.org