Credentialing Guru

06/05/2026

AI IS EVERYWHERE ! I love AI.

it is a great tool to assist me in my work. I can ask it questions, it can find resources for me, it can create workflows and spreadsheets for me... but !!!!

the latest craze of course is this idea of handing off credentialing and payer enrollment to AI.

I see a growing number of companies pitching they are AI built and it will make a providers credentialing life better... no. we are not there yet.

Part of the trouble will be the payers themselves have such broken antiquated systems- AI on the provider end can't improve on that.

These platforms are trying to turn a highly customized, strategic compliance process into a assembly-line factory. For basic provider data cleanup? It's a step up. For complex facility enrollment and contracting? The human expert still ends up doing the heavy lifting to prevent a compliance disaster.

Don't be tempted to use an AI credentialing company for your provider needs. Not yet.

ifccredentialing.com

06/03/2026

New providers often don't know how to grow their practice in alignment with payer objectives. It's good to ask questions?

These are the questions I hear:

How do I negotiate reimbursement rates?

How do I build a value based program?

How do we prove that value?

On the surface those don't have anything to do with "credentialing and payer enrollment" ???? or do they? Yes they do. After verifying your credentials a payer wants to know you can provider value services to their member. That is your program description. It is what sets you apart from other providers.

The provider needs to have a revenue strategy. cash pay + insurance from commercial payers and/or/not government payers. The honest truth is payers don't want to pay. Just ask any billing person how frustrating claims processing is. So providers need to establish their value up front.

message me if you want help.

06/02/2026

When I onboard a new Facility client - I give them a 12 page onboarding form to fill out. It never fails- it comes back half empty. The objective is.... If you fill this all the way out with thoughtful and real answers ! I don't have to ask you later questions for each payer we want to contract you with. No two payer applications are the same. And some of them are quite detailed. Hello - they want to know what you do !

When I ask you "what are your psych testing protocols" it is not helpful to answer with " Whatever the therapist recommends and the client's ability to pay" .

you need help? message me.

04/14/2026

Is your facility growing—or just "applying"? 🛑
For years, I’ve been known as the Credentialing Guru. But in the 2026 landscape, "just getting credentialed" isn't enough to keep a facility's doors open. Between closed panels, narrow networks, and shifting payer requirements, the old ways of simply filling out forms are failing.

I’m reframing how we help the SUD and Behavioral Health community. We aren't just checking boxes; we are architecting Network Access.

How can we help you?

🏢 FOR FACILITY OWNERS & SUD PROVIDERS: Are you tired of hearing "the panel is closed"? We specialize in Strategic Market Access. We don’t just submit applications; we use data-driven advocacy and network adequacy analysis to force payers to the table. If you are looking to secure high-leverage contracts or expand your service lines (like Teen SUD or JUSTICE DIRECTED CARE), we provide the executive-level strategy to make it happen.

💼 FOR CREDENTIALING PROFESSIONALS: Are you ready to move beyond data entry? The industry is shifting. To survive as a pro in 2026, you need to understand Payer Portfolio Strategy. I’m here to help you level up from "clerical support" to a "Strategic Partner" for the facilities you serve.

Especially in saturated markets in So. Calif or Florida... It isn't as simple as filling out applications anymore.

The 2026 market is becoming more an more restricted, but the opportunities are there for those who know how to find the leverage.

👇 Which one are you? Drop a comment below or DM me. Let’s talk about how we secure your seat at the payer table.

04/08/2026

Currently, the standard drugs used to address opioid use disorder are themselves opioids, which adds to the stigma around addiction and makes accessing treatment challenging. The most common opioid used in this harm reduction approach is methadone, which has existed since the 1960s.

“What if you had to go somewhere, wait in a line, stand there while you're dosed, and do that every single morning of your life?” Stephen Loyd, M.D., an internal medicine and addiction medicine physician at Cedar Recovery in Tennessee, told Fierce. “If you had a tool that didn't carry that baggage, it's not only a needle changer, it is a paradigm shifter.”

The treatment paradigm is shifting. SUD-BH Providers need to be on top of their game.

04/06/2026

For SUD and BH facility owners/providers. We have a new guidebook.

finally put this together—for SUD facilities.

Over the years, I’ve worked with treatment centers trying to figure out one of the hardest parts of opening and growing a program:

👉 getting in-network with insurance
👉 navigating payer enrollment for detox, RTC, PHP, and IOP
👉 understanding what payers actually require (and what they don’t tell you)

And I kept seeing the same thing…

Facilities losing months of time and significant revenue because the process wasn’t clear, the sequence was wrong, or something small was missing.

So I wrote the guide I wish every SUD operator had from the beginning.

This is not a general credentialing book.
It is specifically for substance use disorder treatment facilities.

It walks through:

✔ Facility enrollment
How to set up your business correctly.
✔ ASAM levels of care and how they impact applications
✔ 42 CFR Part 2 in the context of credentialing
✔ SAMHSA, DEA, and state licensing interplay
✔ Behavioral health carve-outs (Carelon, Optum, etc.)
✔ What documentation payers actually ask for- program specifics,
✔ Why applications get delayed or denied—and how to avoid it
Sample applications and checklists- so you can see exactly what payers are asking for.


If you’re opening a facility, expanding, or trying to stabilize your payer mix, this will give you a clear roadmap.

There is nothing like this on the market - it is a one of a kind book.

https://livewise2023.gumroad.com/l/zeslb?_gl=1*12iui8o*_ga*MTU4NDAzODQ3MC4xNzY3MTM0ODA2*_ga_6LJN6D94N6*czE3NzU1MDgzMzgkbzMzJGcxJHQxNzc1NTA5MDA1JGo2MCRsMCRoMA..

04/01/2026

For behavioral health providers or those in credentialing those providers- who need some extra help in what the 2026 updates are to the JACHO standards. I have put together a summary. If you are interested-check it out.

ifccredentialing.com

If you’ve ever opened the Joint Commission Behavioral Health manual and thought,“Where do I even start?” — this guide was created for you.This is a clear, structured breakdown of the most important Joint Commission Behavioral Health standards — translated into plain language with real-worl...

03/18/2026

For years I have watched credentialing professionals struggle with the same problem.

They know how to complete payer enrollments, but they have never been taught how to price their work.

Most credentialing consultants enter the field from billing, administration, or provider operations. They understand CAQH, PECOS, Medicaid enrollment, payer portals, and the technical process of credentialing.

But the business side of credentialing consulting is rarely discussed.

And the result is predictable.

Consultants often charge based on how long they think an application should take — not on the true lifecycle of payer enrollment.

The reality is that the application is only the beginning.

The real work happens in the weeks and months that follow:

• payer portal monitoring
• documentation requests
• corrections and resubmissions
• follow-ups with credentialing departments
• resolving administrative friction between providers and payers

In many credentialing projects, follow-ups alone consume 60–70% of the total labor.

This is why so many credentialing professionals feel like they are working far harder than they are being paid for.

Over the past several months, I began organizing my own time-tracking data, contractor invoices, and pricing models to better understand the economics of credentialing consulting.

That process turned into something larger.

I’ve just finished writing a new resource:

The Credentialing Consultant’s Pricing Workbook:
How to Price Insurance Credentialing and Provider Enrollment Services. Check it out ! It will change how you think about pricing your services.

ow to Price Insurance Credentialing and Provider Enrollment ServicesMost credentialing professionals know how to complete payer enrollments.But very few know how to price their services properly.As a result, many credentialing consultants unknowingly undercharge, overwork, and struggle to build sust...

03/12/2026

Some people have beautifully organized desks.
Color-coded folders.
Neatly stacked papers.
A calm workspace where everything has a place.
And then there are the rest of us…

The “creative filing system” professionals — where important documents live somewhere inside a small mountain of papers, sticky notes, coffee cans, and the occasional pen that has mysteriously lost its cap.

The truth is, organization doesn’t come naturally to everyone.

But studies show that cluttered workspaces actually increase stress and reduce our ability to focus because the brain has to process all the visual noise around us. When things are organized, our brains can concentrate on the work that actually matters.

So if your desk occasionally looks like a paper tornado passed through… you’re not alone.

Just remember: sometimes purpose and productivity start with something very simple —

clearing one small corner of your desk.
(And maybe finding that document you printed three days ago.)

If your desk looks like this… don’t worry.
Mine has looked this way too.
But when it comes to credentialing, payer enrollment, and practice operations, a good system makes all the difference.

If you’re a behavioral health facility owner/provider who needs help getting organized with credentialing and contracting or growing your practice— I’m always happy to talk..

03/11/2026

working on our website. We have neglected it... https://ifccredentialing.com/

still not sure I love it. BUT... that being said. Our goal is to have more resources available and to highlight our services specific to coaching and consulting for other credentialing professionals. Personal and customized. We want to share what we know. Let us know if you have questions about how to best work with SUD
facilities and groups

Credentialing, consulting and insurance enrollment and contracting for mental health providers, facilities and groups.