Insurance Verification & Eligibility
Before the patient ever enters the examination room, our team executes real-time 270/271 electronic eligibility transactions directly with the payer. We verify active policy status, primary vs. secondary coordination of benefits (COB), deductible balances, coinsurance percentages, and specific pre-certification rules.
Medical Coding & Chart Auditing
Our AAPC and AHIMA certified coders review clinical charting to assign exact CPT, ICD-10-CM, and HCPCS Level II codes. We ensure documentation substantiates medical decision making (MDM), apply appropriate modifier splits (e.g. 25, 59, 26, TC), and audit against NCCI edit tables to avoid unbundling disallowances.
Claim Scrubbing & Submission
Every claim is scrubbed through our multi-tier rules engine containing over 10 million payer-specific adjudication logic checks. Once scrubbed clean, claims are transmitted electronically via HIPAA-compliant 837P (CMS-1500) and 837I (UB-04) protocols to commercial payers and clearinghouses.
Payment Posting & Reconciliation
As Electronic Remittance Advices (835 ERAs) and manual EOBs arrive, our payment posters reconcile payments line-by-line. Contractual allowable amounts, co-insurance withholdings, and contractual write-offs are balanced against electronic bank deposits to guarantee zero accounting discrepancy.
Accounts Receivable (A/R) Follow-Up
Claims approaching 30 days without payer payment are automatically flagged in our priority queues. Our US-based AR specialists contact insurance representatives, verify receipt, identify pending payer review bottlenecks, and compel prompt payment before timely filing limits lapse.
Denial Resolution & Structured Appeals
When a denial occurs, our denial management team immediately analyzes the CARC/RARC codes. We correct clerical mismatches or formulate clinical appeal packets with charting notes, peer-reviewed medical necessity documentation, and references to statutory payer guidelines.
Revenue Optimization & Analytics Review
Revenue cycle management does not conclude with a check deposit. We conduct monthly executive briefings with your practice leadership—reviewing provider RVUs, fee schedule performance against regional percentiles, and recommending clinical documentation refinements to increase future reimbursements.
Our 30-Day Practice Onboarding Roadmap
Transitioning billing companies should never disrupt clinical cash flow. We run parallel clearinghouse testing and maintain strict shadow billing to ensure zero drop in collections during the 14-day transition.
Discovery & Audit
Complete baseline financial audit of current aging A/R, fee schedules, clearinghouse agreements, and provider enrollment rosters.
EHR & EDI Integration
Establish secure SFTP and API credentials with your PM/EHR software. Configure custom rules engines and automated 835 ERA feeds.
Parallel Batch Run
Validate electronic claim scrubbers with sample batches. Review modifier logic with practice providers and align front-desk intake protocols.
Full Go-Live & Reporting
100% active claim transmission and dedicated account manager assignment. Delivery of first automated bi-weekly executive financial dashboard.
Your Practice, Our Priority
Experience a Streamlined Billing Workflow
Discover how our 7-step process eliminates denials and accelerates reimbursement for your specialty practice.