Full-Cycle RCM Services

Real-time insurance eligibility checks before services are rendered. We verify active coverage, plan type, deductibles, copays, coinsurance, and authorization requirements to prevent claim denials before they happen.

Detailed plan coverage breakdowns communicated to patients and providers upfront. We verify coverage directly with insurers and clarify patient financial responsibility to improve transparency and reduce A/R delays.

Full prior authorization workflow management — collecting clinical documentation, submitting PA requests, following up with payers, and providing real-time status updates. We reduce appointment delays and prevent auth-related denials.

Accurate patient registration, demographic entry, and financial counseling. We ensure clean data from the start — correct insurance information, proper subscriber details, and complete documentation to support downstream billing.

Patient appointment scheduling and optimization. We manage scheduling workflows to reduce no-shows, improve provider utilization, and ensure a smooth patient experience from first contact.

Every service is documented, coded, and prepared for billing with precision. We audit charges for accuracy, ensure proper code pairing, and catch errors before claims are submitted — maximizing your clean claim rate.

Expert CPT, ICD-10, and HCPCS coding across specialties. We provide professional fee coding, facility coding, risk adjustment coding, and coding audit services. Accurate codes mean accurate reimbursement.

End-to-end claim creation, validation, editing, and electronic submission through clearinghouses. We handle CMS-1500 and UB-04 forms, manage payer-specific requirements, and ensure timely filing across all carriers.

Systematic follow-up on all aging claims — 30, 60, 90, and 120+ days. We handle rebilling, secondary claim submissions, payer calls, and status tracking to reduce your days in A/R and accelerate cash flow.

Root cause analysis of every denied claim. We prepare and submit appeals, correct documentation, resubmit claims, and implement denial prevention strategies. We track denial trends to eliminate recurring issues at the source.

Accurate, timely posting of insurance and patient payments. We reconcile EOBs and ERAs, resolve discrepancies, identify underpayments, and ensure every dollar is accounted for correctly in your system.

Timely identification, reporting, and resolution of credit balances to maintain CMS compliance, financial accuracy, and patient trust. We ensure overpayments are properly refunded and accounts stay clean.

Professional patient statement generation, balance follow-ups, and payment plan management. We handle patient inquiries with courtesy and compliance, improving collection rates while maintaining patient satisfaction.

Full provider enrollment and credentialing with insurance networks — CAQH profile management, Medicare and Medicaid enrollment, NPI registration, license verification, and re-credentialing tracking. We handle the paperwork so you can start billing faster.

Specialized billing for Durable Medical Equipment — wheelchairs, CPAP machines, prosthetics, orthotics, and supplies. We navigate the unique requirements of DME billing including CMNs, prior authorizations, and HCPCS Level II coding.

Detailed financial reports covering collections, aging analysis, denial rates, payer performance, and KPI tracking. Data-driven insights that help you make informed decisions about your practice's revenue and operational efficiency.