How We Work
We have the tools and experience to use AI across the revenue cycle. We don't use it for everything, only where it fits the client's need.
Ten Stages, From Eligibility To Monthly Reporting
Hover over or select a stage to see who handles the work.
Before the visit
Eligibility and benefits
We verify coverage, benefits and patient responsibility before the visit.
- AI and software
- Automated checks run against payer systems and flag mismatches.
- Our team
- A billing specialist resolves flagged items and contacts your front desk as needed.
- What we need from you
- Your schedule and the insurance details collected at intake.
Prior authorization
We prepare and submit requests with your supporting documents, follow up with the payer and log each approval, unit count and expiration date.
- AI and software
- Reviews each packet for missing items and tracks status and upcoming expirations.
- Our team
- An authorization specialist reviews the packet, works with the payer and reports the outcome to you.
- What we need from you
- Orders and clinical notes for each request, and a contact for questions.
From visit to claim
Coding and charge capture
We code from your documentation and enter charges. When a note is unclear, we send the question to the provider.
- AI and software
- Suggests codes based on the documentation.
- Our team
- A certified coder reviews and confirms every code.
- What we need from you
- Completed visit notes and answers to coding questions.
Claim scrub
We check each claim against payer rules and standard edits before submission.
- AI and software
- Checks claims against payer rules and flags likely denials.
- Our team
- A biller corrects flagged items and releases the claim.
- What we need from you
- Answers on any flagged item only your office can resolve.
Submission
We submit claims electronically and confirm acceptance by the clearinghouse and payer.
- Our team
- A biller works any rejections and resubmits.
- What we need from you
- Only what's needed to resolve a rejection.
Getting paid
Payment posting
We post and reconcile payments and compare them with your contracted rates. Payers pay you directly, and we do not hold your funds.
- AI and software
- Compares each payment with your fee schedule and flags shortfalls.
- Our team
- A specialist confirms the shortfall and follows up with the payer.
- What we need from you
- Payer contracts, fee schedules and access to your remittances.
Denial management
We review each denial, correct and resubmit or appeal it, and track the root cause.
Corrected claims return to the scrub before resubmission.
- AI and software
- Ranks denials by value and likelihood of payment and drafts appeal letters.
- Our team
- A specialist reviews each appeal before it is sent.
- What we need from you
- Records we request for an appeal.
A/R follow-up
We work unpaid claims on a set schedule until they are paid or resolved.
- AI and software
- Prioritizes the work queue by likelihood of payment.
- Our team
- A/R specialists contact payers and resolve the claim.
- What we need from you
- Decisions on balances we recommend closing.
Patient balances
We send statements and reminders and answer patient billing questions.
- Our team
- Our team answers patient billing questions on your behalf.
- What we need from you
- Your patient balance policy and approval of statement wording.
Results
Reporting and monthly review
You receive regular reports and meet with us monthly to review results, issues and next steps.
- AI and software
- Flags changes in denial trends and payer behavior.
- Our team
- Your account manager reviews the results with you and agrees on next steps.
- What we need from you
- Time for the monthly meeting and decisions on what it raises.
Sample Claim: Denied, Then Corrected
One fictional claim, shown at four stages. Not a real client, patient, payer or result.
- PassedCoverage: active on the date of service
- PassedCodes and modifiers: 99214-25 and 20610 pass payer edits
- FlaggedReferring provider ID missing: biller adds it from the order, then rechecks
- PassedFiling limit: well inside the payer's window
| Line | Contract | Paid | Result |
|---|---|---|---|
| 99214-25 | $128.00 | $112.00 | $16.00 short |
| 20610 | $84.00 | $0.00 | Denied |
Both lines go to a specialist: the shortfall to the payer, and the denial (code 197) to stage 7.
- Day 18Denied: payer says no authorization was on file (code 197)
- Day 19Cause found: authorization was approved, but its number never reached the claim
- Day 20Corrected claim sent: with the authorization number, after a specialist's review
- Day 41Paid in full: $84.00 posted and checked against contract
Root cause closed: the scrub now checks for the authorization number on this payer's claims.
| Number | This month | Last month |
|---|---|---|
| First-pass rate | 86% | 84% |
| Denial rate | 8% | 9% |
| Days in A/R | 47 | 49 |
| Net collection rate | 93% | 92% |
Top denial cause this month: authorization number missing from the claim. Fix in place since the 12th.
Common Questions About AI
How do you catch AI errors?
AI flags issues and prepares drafts. A specialist reviews the work before anything is sent to a payer.
Can we see what was done?
Yes. Your reports show what was flagged, the decision made and the outcome.
How is patient data protected?
We sign a Business Associate Agreement before receiving any patient information, and we can tell you which AI tools are used with it.
Can we start small?
Yes. You can begin with one part of the cycle. Your data remains yours and is returned if the engagement ends.
Will this replace our staff?
It is meant to reduce repetitive checking, so your staff can focus on the claims that need judgment.
Do payments go through you?
No. Payers pay you directly. We do not receive or hold your funds.
How We Get You Started
- 1
Review Your Numbers
Once a BAA is signed, we review a sample of your claims, denials and A/R to set a baseline.
- 2
Start With One Workflow
We begin where you are losing the most. Where AI fits, it handles the checking, and our specialists make the decisions.
- 3
Report Results
We report savings and recoveries against the baseline, including what didn't work.
- 4
Equip Your Team
Your team receives the reports, worklists and training to stay on top of the work.
These examples show how the work is designed. They are not client results. Targets are goals, not guarantees, and payers determine whether and how much to pay.
Find Out What Your Practice Is Leaving Uncollected
Tell us about your practice and we'll show you where revenue is slipping through.
