Revenue cycle management software that cuts denials and rework AI agents check eligibility, code, and appeal, and your billing team approves

Payer rules change often, and each payer has its own. Charges get missed, authorizations expire, and claims go out with errors that a check would have caught.

Hospitals, clinics, ambulatory centers, and pharmacies each have their own version of the problem. In every case, staff spend their day in payer portals and spreadsheets instead of on the claims that need judgment.

Many denials start at the front desk. An agent checks coverage and benefits with each payer through X12 270 and 271 transactions or the payer's portal, and flags gaps before the visit.

For prior authorizations, it reads the order and the chart and drafts the request with the clinical notes the payer asks for. Once your staff approve it, the request goes through an X12 278 transaction or a portal such as Availity. The agent follows up until there's an answer.

Agents read the clinical note and suggest ICD-10 and CPT codes, with the lines of the note that support each one. Coders confirm, change, or reject each suggestion, and the reasons are kept.

When the note is missing something a code needs, the agent drafts a query to the clinician, so the gap is closed before the claim leaves.

Each claim is checked against payer rules before it's sent as an X12 837, and claim status is tracked until the payer answers. When an 835 remittance comes back with a denial, the agent reads the reason code, finds the cause, and drafts a corrected claim or an appeal letter.

Your billers approve each one before it goes out. Patterns across denials, by payer and by reason, show which fix at the front end would stop them coming back.

• Claim checks before submission
• Denial reasons read from every 835
• Corrected claims and appeals drafted for review

Electronic remittances are posted against billed charges, and differences are flagged for a person to review. Underpayments against contract rates are raised, not written off.

Patients get clear statements, payment plans, and reminders by text or email. Fewer patients call to ask what they owe.

We report the revenue cycle KPIs your finance team already uses, worked out the same way every month. Days in A/R is total accounts receivable divided by average daily charges. Initial denial rate is claims denied on first submission divided by claims submitted.

Cost to collect is the cost of running the revenue cycle divided by the cash it collects. Each one can be cut by payer, location, and service line, so you see where to act.

Healthcare revenue cycle management is the work of getting paid for care, from registration and scheduling to the final payment. It covers eligibility, authorization, coding, claims, denials, payment posting, and collections. Each step has to be right for the money to arrive on time.

Delayed and denied payments leave gaps in cash that limit what a provider can do for patients. Every denial also costs staff time to fix. A cycle that gets claims right the first time keeps cash steady and frees staff for the cases that need them.

It checks eligibility before the visit, confirms authorizations, checks codes against the note, and scrubs each claim before it's sent. When a denial still comes back, it finds the cause and drafts the fix. Patterns in denials then show which upstream step to change.

Yes. We connect to Epic, Oracle Health, MEDITECH, athenahealth, and eClinicalWorks, and connect to clearinghouses, payer portals such as Availity, and payment processors. Data moves through X12 transactions, HL7 v2, FHIR, and APIs, so your staff stop re-keying it.

Outsourced billing is usually priced as a share of collections, and software as a license. We build and run software on your systems, priced for the work. We start with a five-day review of one stage of your cycle, then quote from what we found.

No. Agents draft, check, and route, and a person on your team approves each claim, appeal, and authorization before it goes. Every step is recorded, so you can see what the agent did and why.

Start with days in A/R, initial denial rate, clean claim rate, and cost to collect. Agree how each one is worked out before you compare it month to month. We report them by payer and location so the cause of a change is easy to find.