PMHNP Foundations II · Credentialing & Billing

From application to reimbursement. In 9 modules.

The credentialing and billing course PMHNP school skipped. PECOS 2.0, 2026 CPT updates, combined-visit billing, denial appeals, telehealth modifiers, audit defense — built reference-first so you'll come back to it every time something breaks.

Modules 9
Contact hours 9.0 hr
Templates & tools 20+
Format Self-paced
View enrollment → See the curriculum
The math

The course pays for itself.

  • One prevented denial on a 99214 + 90833$217.11
  • One faster credentialing application$2,000+
  • One avoided audit recoupment$5,000+
  • One renegotiated payer contract$10,000+
Built for these moments

Five reasons you're here right now.

This course exists because PMHNP programs don't teach the business side of practice. Most clinicians arrive on this page because something specific is broken — or about to break. Sound familiar?

01
Your credentialing applications are stuck

PECOS keeps returning your application. You don't know why. Three months in, your start date is slipping and you don't know who to call.

02
Claims are getting denied and you don't know which fix

90791 vs 90792, missing modifiers, time documentation gaps, MDM that doesn't support the level. Each denial is a different fix and you're guessing.

03
You're losing money on combined visits

Med review plus therapy is 99214 + 90833 — not 99214 alone. The difference is real money per visit, multiplied across hundreds of visits per year.

04
Your telehealth billing is a guess

Modifier 95 vs 93. POS 10 vs 02. Audio-only coverage by payer. State licensure for telehealth across state lines. The rules changed again in 2026.

05
An audit notice arrived and you froze

High percentage of 99214s. Frequent 90837s. Identical-looking notes. The patterns that make sense clinically are also the patterns that get audited.

06
You're starting your own practice

NPI types, LLC structure, payer mix strategy, EMR setup, A/R management. You don't have time to figure out each piece from scratch.

Updated for 2026

The changes that actually matter this year.

Credentialing and billing content goes stale fast. This course is rebuilt every year against the current CPT cycle, current CMS guidance, and current payer policy. Here's what's new.

PECOS 2.0
The new CMS enrollment system
I&A multi-factor authentication required. Module 2 walks through the full enrollment in real time with screenshots.
G2211
Longitudinal-care add-on for psychiatry
Increasingly applied to ongoing complex psychiatric care in 2026. Real revenue if used correctly.
APCM codes
Behavioral health integration
New 2026 Advanced Primary Care Management codes for behavioral-health collaborative care — emerging revenue path.
42 CFR Part 2
SUD records aligned with HIPAA
As of February 16, 2026, a single TPO consent now covers substance-use records. Significant practice change.
JW / JZ
Drug-waste modifiers as hard-stop
No longer optional. Single-use-vial documentation is now required at the claim level. Affects long-acting injectable workflows.
90837
Strict midpoint-rule enforcement
53-minute psychotherapy minimum is now strictly enforced. 52 minutes billed as 90837 = upcoding finding.
Mod 95 + POS 10
Patient-at-home telehealth
Correct combination for non-facility telehealth reimbursement. Wrong combination triggers facility-rate underpayment.
Conversion factor
First substantial increase in years
2026 Medicare conversion factor up. NP rate $171.77 for 90792, $217.11 for 99214 + 90833. Reference card included.
The curriculum

Two halves. Nine modules. Reference-first.

Each module is structured as both a sequential lesson and a stand-alone reference. Most learners complete the course in 6–8 weeks; many return to specific modules years later when something specific breaks.

Part 1 — Credentialing 4 modules · 4 hours
i.
Credentialing Foundations

License vs credential vs privilege vs enroll. NPI Type 1 & 2. CAQH. The timeline reality. What to gather first.

60 min
ii.
Payer Enrollment by Payer Type

PECOS 2.0 walkthrough. Medicare opt-out option. State Medicaid and behavioral-health MCOs. Commercial payers. Closed panels.

65 min
iii.
Re-credentialing, Group Affiliations & Multi-State

Re-credential cycles. CAQH 120-day attestation. Adding a group, locum work. Telehealth across state lines. Hospital privileging.

55 min
iv.
When Credentialing Breaks

Diagnose the stalled application. The most common errors. Practice transitions. Disclosable events — malpractice, license actions, NPDB.

45 min
Part 2 — Billing & Revenue Cycle 5 modules · 5 hours
v.
2026 CPT Code Stack for PMHNPs

90791 vs 90792. New 2026 E/M MDM table. Standalone psychotherapy. Crisis codes. G2211. APCM. Decision tree included.

70 min
vi.
E/M + Psychotherapy Combined Visits

The four non-negotiable rules. Add-on selection by therapy time. Modifier 25. Two-section note structure that defends both codes.

60 min
vii.
Telehealth Billing in 2026

Modifier 95 / 93. POS 10 / 02 / 11. Audio-only coverage by payer. Ryan Haight & DEA telemedicine flexibilities. Multi-state licensure.

50 min
viii.
Documentation That Defends the Code

MDM walkthrough. Time-based billing. Audit triggers to know about. Responding to a record request without making it worse.

60 min
ix.
Revenue Cycle, Denials & Appeals

Reading A/R aging. Top denials. Appeal-letter templates. Negotiating contracts. When to fire a payer. The monthly RCM rhythm.

65 min
What you'll keep

Twenty templates and tools you'll actually use.

The course is reference-first by design. Every module ships with downloadable templates, decision trees, and checklists you'll use long after you complete the course.

i.

Credentialing Timeline Worksheet

Build your timeline working backward from your start date.

ii.

PECOS 2.0 Pre-Submission Checklist

Catch the errors that cause 'Returned' status before you submit.

iii.

Master Credentialing Tracker

One spreadsheet with every renewal date and reminder.

iv.

PMHNP CPT Decision Tree

Visual flowchart for selecting the right code every time.

v.

2026 Medicare Rate Reference

Every code that matters to a PMHNP, with current rate.

vi.

Combined Visit Note Template

Two-section structure that defends 99214 + 90833.

vii.

Telehealth Modifier & POS Tree

Where was the patient? What modality? Output: correct claim.

viii.

Appeal-Letter Templates (5)

Medical necessity, missing modifier, time documentation, eligibility, authorization.

ix.

Monthly RCM Checklist

Five tasks. 30 minutes a month. Saves your A/R.

x.

Payer Performance Scorecard

Track denial rate, days to pay, contracted rates by payer.

xi.

Audit Response Decision Tree

What to do (and not do) the day an audit notice arrives.

xii.

Practice Setup Master Checklist

Four phases. Every step from EIN to first claim submitted.

Honest answers

What you're actually wondering.

A few objections that come up before purchase. We'd rather address them directly than dance around them.

My practice has a biller. Why do I need this?

Because you're still legally responsible for the codes attached to your name. A biller follows your direction; if you don't know what's right, the biller can't fix it. Audits land on the clinician's name and license. The course makes you the informed director of your billing function — not a passenger.

Is this just generic billing content with PMHNP slapped on?

No. Every example is PMHNP-specific. The 90791 vs 90792 confusion. Combined E/M plus psychotherapy. Crisis codes. Audit patterns specific to psychiatric practice (high 99215 use, 90837 frequency, retroactive note edits). Multi-state telehealth. Built around the actual scenarios PMHNPs hit.

Will this be outdated next year?

The course updates annually with each new CPT cycle. Active learners receive update modules at no charge for 12 months from enrollment. Modules 5 and 6 (CPT and combined visits) get refreshed each January. Other modules are reviewed quarterly for material policy changes. The "updated for 2026" badge is real, not marketing.

I'm an experienced PMHNP. Will this be too basic?

Probably not. The course is for anyone responsible for credentialing or billing oversight in their practice — including established clinicians who never got formal training in this. Even experienced PMHNPs typically learn 3–5 specific things that pay back the tuition. If you're a CPC or specialized medical coder, this isn't the course for you. For everyone else, there's something here.

I'm just starting my PMHNP program. Too early?

Yes — wait until your final 6 months. The course assumes you have clinical training and are now responsible for the business side. If you're early in your program, focus on clinical content. Bookmark this and come back when you're 6 months from graduation, or after your first denied claim — whichever comes first.

Three ways to enroll

Choose the path that fits.

Standalone enrollment, alumni discount, or member rate. All three include the same content, the same templates, and the same 12 months of access.

Standard
For any PMHNP or APRN
$497
  • 9 modules · 9 contact hours
  • 20+ templates and decision trees
  • Capstone case with faculty grading
  • 40-question final knowledge check
  • 12 months access
  • Annual update modules included
  • Certificate of completion
  • CE accreditation in progress (AANP)
Join wait list →
Circle Members
Practice Circle or Mentorship tier
$347$497
  • Everything in Standard
  • 30% Circle member discount
  • Course discussion in member forum
  • Office-hours Q&A access
Join member wait list →

Group rates & institutional pricing

For three or more enrollees from the same practice or organization. Group of 3–9 at $397 per seat. Group of 10+ at $297 per seat. Residency programs and hospital systems: custom pricing for 10–50 seats with optional cohort calls and customized content.

Get a group quote →
Why this matters

Updated annually — not just at launch.

Most credentialing and billing courses are recorded once and quietly age out. Codes change. Payer policies shift. Regulatory frameworks update. By Year 2, half the content is wrong. We don't do that.

Our annual update commitment

Each January, Modules 5 and 6 (CPT codes and combined visits) are refreshed against the new CPT cycle and the new Medicare conversion factor. Quarterly, we review every module for material policy changes — DEA telehealth flexibilities, payer policy shifts, regulatory updates — and patch as needed.

Active enrollees receive the update modules at no additional charge for 12 months from enrollment. After that, course access continues with the version current at your enrollment, or you can opt into a renewal at member rates.

This is the only credentialing course we know of that publishes a Recent Updates log inside the course itself, so you can see exactly what's changed since your last visit.

Common questions

Last things before you enroll.

How long does it take to complete?

Most learners complete the course in 6–8 weeks at a pace of about one module per week. The longest module is 70 minutes; the shortest is 45. You'll come back to specific modules later as a reference — that's by design. Maximum completion window for the certificate is 180 days; you have access to recordings and templates for 12 months.

Will I get CE credit?

CE accreditation is in progress through AANP for individual activity approval. Once granted, learners will receive 9 contact hours. We don't claim AANP approval until it's officially granted — you'll be notified before your access period ends whether AANP credit is confirmed for your enrollment cycle.

Is there a refund policy?

Full refund within 14 days of enrollment if you've completed less than 25% of the course content. After that, no refunds — but you can transfer your enrollment to a colleague one time. We're confident in the course; if it's not for you, we'd rather refund quickly than have you stuck.

Do I need to be currently in practice?

No. The course is valuable for senior PMHNP students within 6 months of graduation, new PMHNPs entering practice, established clinicians taking on credentialing or billing oversight, and anyone starting their own practice. The capstone is structured around a practice-launch scenario, so it's directly relevant to anyone in transition.

What if my state has different rules?

The course is built on federal and national-level frameworks (Medicare, AMA CPT, AANP guidance) that apply nationally. State-specific elements — Medicaid programs, MCO contracts, state telehealth registries, scope-of-practice details — are addressed with framework guidance and resources to find your state's specific rules. The course gives you the structure; you'll fill in your state-level specifics.

Can I enroll my whole team?

Yes. Group rates start at 3 seats. Residency programs and hospital systems can purchase 10+ seats at custom pricing with optional cohort discussion calls and content tailored to your setting. Reach out via the group-quote button above.

Will this course teach me to code at the level of a Certified Professional Coder?

No. This is not a coding-certification course. It's the practical billing knowledge a PMHNP needs to operate a practice, defend their codes, supervise their billing function, and avoid audit exposure. If you're aiming to become a CPC, you'll want different training. For everyone else, this is the right depth.

Launch promo · First 50 enrollments

$397 (save $100). While seats last.

After the first 50 enrollments, standard tuition applies. Updated for 2026, with annual update modules included for 12 months. Recoup the tuition with one prevented denial.

Join the wait list → 14-day refund within 25% completion. No questions.
CE accreditation disclosure This activity is currently in the application process for continuing education approval through the American Association of Nurse Practitioners® (AANP). The course will deliver 9 contact hours upon AANP approval. AANP approval is not yet granted; learners will be notified of accreditation status. This activity is not eligible for AANP credit until and unless approval is granted.
Educational content disclaimer This course provides general educational information about credentialing, billing, coding, and revenue-cycle management for PMHNP practice. It is not legal, billing, regulatory, or compliance advice for any specific situation. Clinicians remain solely responsible for codes, claims, documentation, and decisions in their own practice. Always verify current rules with current AMA CPT, CMS, payer, and state regulatory sources.