Comprehensive · HIPAA-Compliant · Technology-Enabled · Specialty-Agnostic — six pillars covering the entire revenue cycle, from patient access to final payment.
Reducing front-end errors before claims are ever submitted.
Streamlined appointment scheduling across multi-specialty practices with real-time calendar management, multi-provider coordination, and referral tracking.
Proactive payer authorization for high-dollar procedures and Medicare Advantage plans, with portal-based and telephonic follow-up.
Real-time 270/271 EDI eligibility checks confirming coverage, co-pays, deductibles, and coordination of benefits before every visit.
HIPAA-compliant inbound and outbound patient communication with U.S. timezone alignment.
AI-powered virtual assistant handling routine patient calls with seamless live-agent escalation for complex cases.
AAPC & AHIMA certified coders driving accuracy, compliance, and maximum reimbursement.
Accurate UB-04 facility coding for hospitals, ASCs, and outpatient departments.
Physician-level CPT, ICD-10-CM, and HCPCS coding across 40+ specialties.
MS-DRG and APR-DRG assignment with DRG optimization for maximum compliant reimbursement.
Prospective and retrospective coding audits identifying compliance gaps and missed revenue.
Risk adjustment coding and HEDIS measure abstraction for value-based care under MIPS/APM models.
Full back-office revenue recovery and financial performance management.
End-to-end RCM outsourcing from charge capture through final patient collections, with dedicated offshore account managers.
Accurate ERA/EOB payment posting, contractual adjustment reconciliation, and daily deposit matching.
Systematic aging bucket follow-up and payer escalation workflows to reduce DSO.
Contract variance analysis identifying underpayments, with formal dispute and recovery tracking.
Root-cause denial analytics using CARC/RARC codes, rapid appeals, and upstream prevention strategies.
Identification and compliant resolution of credit balances and payer overpayments.
Structured recovery of aged and legacy AR during system conversions or EHR migrations.
Exclusive, server-based Medicare Advantage enrollment excellence — this is not an add-on, it is our core specialty.
Guided beneficiary counseling on Medicare Advantage plan options, formularies, and provider networks.
CMS-compliant data entry into plan management systems, validated against CMS requirements before submission.
Real-time eligibility confirmation and proactive identification of Special Enrollment Period qualifying events.
Systematic collection, indexing, and retention of enrollment documentation per CMS record-keeping rules.
End-to-end onboarding including ID card tracking, welcome kits, and initial beneficiary education calls.
Accurate processing of disenrollments and CMS 834 outbound file management with zero tolerance for discrepancies.
Accelerating payer enrollment, maintaining compliance, and protecting your revenue stream.
Complete CAQH ProView profile creation, quarterly attestation, and ongoing maintenance.
End-to-end PECOS enrollment for Medicare Part A & B, Medicaid applications, and re-validation workflows.
Credentialing with BCBS, Aetna, Cigna, UHC, Humana, Tricare, Molina, and 50+ commercial payers.
Type 1 & Type 2 NPI registration, DEA and license expiry tracking, and fee schedule loading.
Enterprise-grade security frameworks protecting every patient record, transaction, and data exchange.
Role-based access, minimum-necessary data controls, and administrative, physical & technical safeguards for ePHI.
Compliance with HITECH Act requirements including Business Associate liability and breach notification.
Documented incident response plan with 60-day notification SLA per 45 CFR § 164.400.
256-bit AES encryption, MFA, zero-trust architecture, executed BAAs, and annual HIPAA risk assessments.
Compliance standards maintained: HIPAA/HITECH · NIST CSF · PCI-DSS v4.0 · SOC 2 Type II (target) · OIG Guidelines · CMS Conditions
From patient registration to final payment — every step optimized for maximum reimbursement.
Demographics, insurance capture, consent, Medicare Advantage plan confirmation.
270/271 EDI, benefits, COB, auth check, Medicare Part C eligibility validation.
CPT/ICD-10/HCPCS entry, charge audit, HCC capture for risk adjustment.
Edit checks, modifier validation, clean claim, AI-powered pre-submission review.
837P/837I EDI, clearinghouse, paper claims, Medicare Advantage plan-specific routing.
ERA 835 auto-posting, EOB, reconciliation, contractual variance flagging.
CARC/RARC analysis, appeals, root cause, upstream prevention.
Aging buckets, payer escalation, DSO management, underpayment recovery.
Statements, payment plans, balance resolution, financial counseling.
KPI dashboards, payer scorecards, Medicare Advantage enrollment metrics.
We work within your existing ecosystem — 70+ EHR / PM platform proficiency.
AdvancedMD, Kareo / Tebra, athenahealth, eClinicalWorks, NextGen, Greenway Health, Allscripts, Medisoft, Epic, Cerner
Availity, Change Healthcare, Waystar / Navicure, Office Ally, Optum iEDI, Zirmed, Emdeon / Change, Experian Health
Brightree, MatrixCare, CollaborateMD, Meditab, Meditech, TotalMD, NueMD, Billing Dynamix, Netsmart, EZClaim
Medicare Enrollment & RCM Systems: HealthTrio · Cognizant · Salesforce Health Cloud · PECOS · NPPES · CAQH ProView · CMS MARx · HPMS · CMS 834 Systems
Get a complimentary RCM assessment — no obligation, 48-hour turnaround.
