Revenue-cycle technology from eligibility through payment.
Connect payer transactions, business rules, exception management and actionable financial intelligence.
- EHR/
PM - Eligibility and claim validation services
- Clearinghouse/
payer APIs (X12/ FHIR where applicable) - Response correlation
- Exception workbench
- Posting/
BI
Manual rekeying, incomplete claims, payer-specific edits, authorization delays and disconnected remittance data increase handling costs and create avoidable work queues.
We engineer the integration and automation layers around revenue-cycle operations: coverage and benefits, prior authorization, claims exchange, status, remittance, denials and performance reporting. Solutions can integrate EHR/PM systems, clearinghouses, payer APIs and document workflows without assuming that every payer or jurisdiction uses the same transaction standards.
How we approach it.
- Map payer and provider transactions
- Implement X12/appropriate FHIR API connectivity
- Apply versioned validation rules
- Route exceptions to staff
- Correlate requests, responses and payment events
- Report process outcomes
What it includes.
- Eligibility and benefits verification
- Prior authorization intake and orchestration
- Claims validation and submission
- Claims status monitoring
- ERA/remittance ingestion and posting support
- Denial and appeal worklists
- Patient financial communication
- RCM dashboards and payer performance
Where it fits.
- Automate 270/271 eligibility inquiry at scheduling
- Validate 837 claims against completeness and payer edits
- Reconcile 835 remittance with posted charges
- Create denial root-cause analytics
- Monitor claim status through 276/277 inquiry
- Route missing-document exceptions for manual review
- Patient estimate and payment communications