Comprehensive · HIPAA-Compliant · Technology-Enabled · Specialty-Agnostic
Scheduling, prior auth, eligibility & call center — reducing front-end errors.
4 ServicesAAPC & AHIMA certified coders driving accuracy, compliance & max reimbursement.
5 ServicesFull back-office revenue recovery and financial performance management.
7 ServicesCDT-CPT cross-coding unlocking medical payer revenue for dental practices.
3 ServicesPayer enrollment, CAQH management & NPI maintenance protecting your revenue.
4 ServicesEnterprise-grade security frameworks protecting every patient record.
6 FrameworksReducing front-end errors before claims are ever submitted
Real-time calendar management, multi-provider coordination, and referral tracking across multi-specialty practices. Reduces no-shows and scheduling gaps.
Proactive payer authorization for high-dollar procedures. Portal-based and telephonic follow-up eliminating last-minute denials and claim holds.
Real-time 270/271 EDI checks confirming active coverage, co-pays, deductibles, out-of-pocket limits, and coordination of benefits before every visit.
HIPAA-compliant inbound/outbound patient communication — scheduling, billing inquiries, insurance follow-up, pre-visit reminders, and payer coordination.
AAPC & AHIMA certified coders driving accuracy, compliance, and maximum reimbursement
Accurate UB-04 facility coding for hospitals, ASCs, and outpatient departments using ICD-10-PCS and facility-specific revenue codes.
Physician-level CPT, ICD-10-CM, and HCPCS coding across 40+ specialties ensuring compliant, maximum-value claim submissions.
MS-DRG and APR-DRG assignment with DRG optimization and inpatient record coding for maximum compliant reimbursement.
Prospective and retrospective audits identifying compliance gaps, over-coding risk, and missed revenue opportunities. Internal and external audit readiness.
Hierarchical Condition Category (HCC) coding for CMS risk adjustment and HEDIS measure abstraction for value-based care performance under MIPS/APM models.
Full back-office revenue recovery and financial performance management
End-to-end RCM outsourcing — from charge capture and charge entry through final patient collections. Dedicated account managers.
Accurate ERA/EOB payment posting (835 auto-posting), contractual adjustment reconciliation, and daily deposit matching.
Systematic aging bucket follow-up (30/60/90/120+ days), payer escalation workflows, and patient collections to reduce DSO.
Contract variance analysis identifying payer underpayments and short-pays, with formal dispute workflows and recovery dashboards.
Root-cause denial analytics using CARC/RARC codes, rapid appeals submission, and upstream prevention to protect your clean claim rate.
Compliant resolution of credit balances and structured recovery of aged AR during system conversions, practice transitions, or EHR migrations.
Specialized revenue cycle solutions built for dental practices and DSOs
Pre-visit dental benefit verification covering coverage limits, frequency limitations, missing tooth clauses, waiting periods, and deductible tracking.
Complete end-to-end dental billing from claim creation to final patient balance management across dental and DSO practices.
Expert CDT-to-CPT/ICD-10 cross-coding to unlock additional reimbursement from medical payers for procedures with established medical necessity. A unique capability maximizing revenue from both dental and medical insurance. Clients have recovered over $180K in Year 1 from this service alone.
Accelerating payer enrollment, maintaining compliance, and protecting your revenue stream
Complete CAQH ProView profile creation, quarterly attestation management, and ongoing maintenance ensuring continuous payer access.
End-to-end PECOS enrollment for Medicare Part A & B, Medicaid state plan applications, and re-validation workflows.
Credentialing with BCBS, Aetna, Cigna, UHC, Humana, Tricare, Molina, and 50+ commercial payers — new enrollments and re-credentialing cycles.
Type 1 & Type 2 NPI registration via NPPES, DEA & state license expiry tracking, fee schedule loading, and payer ID updates.
Enterprise-grade security frameworks protecting every patient record, transaction, and data exchange
Role-based access limits PHI exposure to minimum-necessary data. Annual staff training and policy reviews per 45 CFR.
Administrative, physical, and technical safeguards for all ePHI. Risk analysis updated annually per 45 CFR Part 164.
Business Associate liability, breach notification, and patient rights compliance per 2013 Omnibus Rule expansions.
Data at rest and in transit encrypted to military-grade standards
MFA enforced for all staff accessing ePHI systems and portals
Least-privilege access with role-based controls and audit trails
Executed BAAs with all clients, subcontractors, and vendors
Get a complimentary assessment — we'll identify revenue leakage across any of these service areas.