Revenue Cycle Management, Run as One Operation

Patient records created and updated in your system from the registration documents you supply. Demographics, contact details and guarantor information are entered to your field standards, and anything missing or illegible comes back as a flagged exception rather than a guess.

Payer, plan, policy and group numbers, subscriber relationship and coverage dates captured from the card or referral, then checked for internal consistency against the rest of the account before it moves on.

Accounts flagged where the name, date of birth or identifiers suggest a record already exists. We flag and document; the decision to merge stays with you, because merging two charts in error is far harder to undo than leaving them apart.

Coverage confirmed for the scheduled date of service through your portals and eligibility tools. The response and the date it was obtained are recorded on the account, so the next person to touch it can see what was actually checked instead of assuming it was.

Whether the scheduled service requires a prior authorization or a referral under the patient's plan, identified and flagged to your team ahead of the visit. Obtaining and submitting the authorization itself stays with your staff.

Charges entered into your billing system from the encounter forms, superbills or EHR extracts you provide, then checked back against that documentation for completeness and internal consistency before a claim is built.

Code data processed as it appears on your documentation and validated against your established workflows and payer edits. This is coding-data validation support, not independent clinical coding: the codes originate in your documentation and with your coders, and anything ambiguous is queried rather than assigned.

Modifiers applied according to the rules you document, and dates of service checked against the encounter record. Where a modifier is ambiguous under those rules the charge is held and queried rather than assumed.

Claims prepared and submitted through your clearinghouse and payer portals, with paper claims produced where a payer still requires them, on the batch schedule agreed during transition.

Claims followed from submission through to acceptance, with clearinghouse and payer rejections identified, categorized by reason and routed for correction rather than left to accumulate in a report nobody opens.

Rejected and returned claims corrected against the reason given, documented on the account and resubmitted. Where the fix needs a decision only your team can make, it comes back with the reason and the proposed correction attached.

Electronic remittance files and scanned EOBs posted line by line to the correct account and date of service, with payment, adjustment and patient-responsibility amounts recorded separately rather than collapsed into one figure.

Contractual adjustments, denial reason and remark codes, and patient payments posted against your approved reason codes. Capturing the denial data at the moment of posting is what makes the denial reporting further down possible at all.

Posted payments reconciled against the deposit, with unapplied and unidentified cash tracked as its own queue and variances listed for your review rather than cleared into a suspense account.

Open balances worked by payer and by age in the priority order you set, with every contact, reference number, payer response and next action documented on the account as it happens.

The AR read by bucket, payer and balance so the queue is sequenced by what is recoverable and what is approaching a filing deadline, rather than by whatever happens to be sitting at the top of it.

Payments compared against the expected reimbursement you supply, whether that is your fee schedule or your contracted rates, with shortfalls flagged and the variance shown so the decision to pursue or accept is yours to make on the numbers.

Denials grouped by reason and remark code, by payer, and by the step in the cycle that produced them, so the reporting shows where denials are being created and not simply that they arrived.

Appeal and reconsideration packets assembled from the documentation you provide, against the payer's stated requirements and filing deadline. The clinical narrative and the decision to appeal remain with your team.

Recurring denial patterns reported with the originating step identified, alongside the registration, eligibility or charge-entry change that would address the cause. Whether to act on any recommendation is your call.