What we run
The administrative half of getting paid
Clinical quality does not collect a claim. Most of what delays payment is administrative: an eligibility check nobody ran, a modifier the payer changed, an appeal that missed a filing window.
Eligibility and benefits verification
Coverage, plan, benefit and authorisation status checked ahead of the visit through payer portals and clearing house tools, with the findings written back into the record the front desk uses.
Prior authorisation requirements are flagged before service rather than discovered in a denial, which is the cheapest place to fix a claim.
Fewer avoidable denials, because the check happened before the visit.
Charge entry and claim submission
Demographics, charges and modifiers entered, claim scrubbing worked to clean, and electronic submission with rejection queues cleared the same shift.
Clearing house rejections are treated separately from payer denials, because they are quick to fix and are frequently left to age alongside genuine disputes.
Claims that leave clean and rejections that do not sit for a week.
Denials and appeals
Denials worked by reason code with a documented action per code, corrected claims resubmitted, and appeals prepared with the clinical documentation your team supplies.
Filing deadlines are tracked per payer, because the appeal that is never sent is a write-off nobody records as a decision.
Denials worked by cause, with the deadline visible on every one.
Coding support
Coding review and support alongside your certified coders: documentation queries prepared, code and modifier checks against payer policy, and edit resolution.
Where documentation does not support a code, the query goes to your clinician. We do not close that gap by choosing a code that will pay.
Coding queries raised properly rather than resolved conveniently.
Payment posting and reconciliation
Remittance advice posted, contractual adjustments applied, underpayments against the fee schedule identified, and unapplied cash reconciled to the bank.
Underpayments are reported as a pattern per payer and per plan, which is how a systematic contract issue becomes visible.
Posted cash that reconciles, and underpayments that get noticed.
Patient billing enquiries
Statement queries, balance explanations, payment plan administration within your policy, and financial assistance signposting to your own programme.
Calls are handled to your scripts and your escalation rules, and anything touching clinical advice or a complaint is routed to your staff.
Patients who get a clear answer without being transferred twice.