Your Go-To Hub For Healthcare News

News update

Jul 23, 2025

Texas Medicaid Implements Medication and Prior Authorization Updates

Yorvipath will require new prior authorization procedures, which will start on September 1, 2025, and Zoryve will have an additional check on plaque psoriasis included in clinical criteria.

It is advised that providers take another look at the updated criteria and make sure that they comply by the effective date.

The official documentation can be used to have full details

In case of questions or further help, you can chat on UnitedHealthcare Provider Portal.

Services

Credentialing

Credentialing is the rigorous process of verifying a healthcare provider’s qualifications, including their education, training, licenses, and clinical experience. This service ensures that practitioners meet the high standards required by insurance networks and hospitals to provide care and receive reimbursement.

Billing & Collection

Billing and Collection service involves confirming a patient’s insurance coverage, active status, and specific benefits before their appointment. By identifying co-pays, deductibles, and required prior authorizations upfront, staff can prevent claim denials and help patients understand their financial responsibilities.

Eligibility Verification

Eligibility verification is the process of verifying a patient’s health insurance coverage and benefits to determine what services are covered and the level of coverage available. This process is essential for healthcare providers to ensure that they receive proper reimbursement for services rendered and that patients are not left with unexpected medical bills.

Revenue Cycle Management

RCM is the financial process that manages the entire lifecycle of a patient’s account, from the initial appointment scheduling to the final balance payment. It integrates eligibility, coding, billing, and collections into a single, cohesive workflow aimed at maximizing a practice's profitability.

Post Tabs

Latest

Popular

What is Accreditation VS Licensure in Health Care?

June 12, 2026

The Difference Between Credentialing And Privileging

June 12, 2026

What Is Delegated Credentialing? The Pros and Cons

June 5, 2026

1 2 3 … 175 Next »

Testimonials

It has been a wonderful experience working with Sean. He made the credentialing process a breeze with his knowledge and communication skills. I highly recommend Capline.

I

Islamorada Dentistry

Rylan is wonderfull representetive, and very quick to complete all his task. We recomend his services, great company and great costumer service. We give him a 5 star.

D

Dentricity Dental Berkeley

Myra Claire was exceptionally professional and efficient in ushering me through the credentialing process! She maintained communication and was very responsive when I had questions! Very pleased!