Medical Billing
What We Do
We manage the entire electronic claim lifecycle—from charge capture and demographic verification to primary, secondary, and tertiary electronic claim generation (CMS-1500 and UB-04). Our proprietary rules engines cross-check each claim against payer-specific LCD/NCD coverage policies, NCCI edit guidelines, and CPT/ICD-10 modifier requirements.
Clinical & Financial Benefits
Achieve an average clean claim rate above 97% on first submission, curtailing administrative write-offs and drastically reducing payer adjudication lag.
Revenue Cycle Management (RCM)
What We Do
An interconnected, full-practice financial optimization framework. We align front-desk scheduling, insurance eligibility, clinical coding accuracy, clearinghouse scrubbing, 835 ERA payment balancing, and patient balance collections into a synchronized ecosystem.
Clinical & Financial Benefits
Eliminates siloed department bottlenecks, accelerates cash conversion velocity, and yields an average revenue uplift of 15% to 30% within the first 180 days.
Accounts Receivable (AR) Recovery
What We Do
Our dedicated AR specialists conduct forensic audits of all claims residing in your 30, 60, 90, and 120+ day aging buckets. We establish direct payer contact, challenge bad-faith stalling tactics, re-submit corrected proof-of-timely-filing claims, and overturn aged write-offs.
Clinical & Financial Benefits
Recover trapped clinical capital without antagonizing patient goodwill. Average practices recover hundreds of thousands in previously written-off balances.
Denial Management & Appeals
What We Do
Every denied claim is captured automatically via electronic remittance advice (CARC/RARC codes). Our denial resolution unit diagnoses root causes—whether clinical necessity, modifier disallowance, or COB disputes—corrects errors, attaches supporting documentation, and submits structured appeals.
Clinical & Financial Benefits
Keep persistent net denial rates under 2%. Convert denials into realized cash within 24 to 48 hours of original adjudication.
Provider Credentialing Services
What We Do
We manage provider enrollment and re-credentialing with Medicare, Medicaid, and major commercial insurance carriers. We maintain CAQH ProView profiles, handle NPI registry updates, monitor state medical board licenses, and oversee hospital privilege re-attestation.
Clinical & Financial Benefits
Prevents catastrophic billing freezes caused by lapsed provider credentials. Accelerates in-network participation for newly hired clinicians.
Real-Time Insurance Verification
What We Do
Before patient arrival, our automated and staff-assisted verification processes confirm active coverage, primary/secondary coordination of benefits (COB), copay amounts, unmet deductibles, and required referral authorisations.
Clinical & Financial Benefits
Eliminates over 70% of downstream front-end denials. Equips your front desk to collect accurate point-of-service copayments with confidence.
Prior Authorization Management
What We Do
We coordinate with clinical staff to gather charting notes, diagnostic histories, and medical necessity justifications. We file authorizations through payer portals, track peer-to-peer deadlines, and secure documented approval codes prior to procedure execution.
Clinical & Financial Benefits
Prevents treatment delays and eliminates catastrophic retroactive claim rejections for expensive surgeries, infusions, and advanced imaging.
Payment Posting & Reconciliation
What We Do
Our team processes automated 835 Electronic Remittance Advice (ERA) files and manually keys paper EOB checks. We record allowable fees, co-insurance, contractual adjustments, and write-offs while performing exact daily bank deposit reconciliations.
Clinical & Financial Benefits
Guarantees that your accounting ledger mirrors your physical bank deposits down to the cent, triggering prompt secondary billing without lag.
Laboratory Billing
What We Do
High-throughput claims execution for independent clinical, genetic, pathology, and toxicology laboratories. We validate molecular panel codes, ensure adherence to PAMA statutory fee guidelines, and verify requisition medical necessity diagnoses.
Clinical & Financial Benefits
Mitigate clinical audit exposure, eliminate batch filing errors, and secure reliable reimbursements for high-volume automated testing workflows.
Behavioral Health Billing
What We Do
Specialized coding for psychiatrists, licensed psychologists, LCSWs, and group therapy clinics. We expertly navigate time-based psychotherapy increments (90832, 90834, 90837), interactive complexity (+90785), and telehealth parity regulations.
Clinical & Financial Benefits
Overcome commercial payer resistance to mental health parity, drastically reducing session disallowances and securing predictable clinical revenue.
Family Medicine Billing
What We Do
High-volume encounter coding optimized for medical decision making (MDM) guidelines. We ensure proper utilization of modifier 25 for same-day acute visits and wellness exams, alongside Chronic Care Management (CCM 99490) and Remote Patient Monitoring (RPM).
Clinical & Financial Benefits
Captures unbilled clinical time, protects against E/M down-coding audits, and increases primary care net reimbursements by an average of 22%.
Practice Management Advisory
What We Do
High-level operational consulting encompassing payer contract renegotiations, fee schedule benchmarking against regional percentiles, billing staff training, and EHR workflow configurations that reduce clinical charting friction.
Clinical & Financial Benefits
Transforms clinical operations into a profitable, scalable business model capable of sustaining long-term independent practice growth.
Your Practice, Our Priority
Need a Custom Billing Strategy for Your Practice?
Speak directly with a Senior Revenue Cycle Director. We will evaluate your current clearinghouse reports and build a custom optimization roadmap.