Comprehensive · HIPAA-Compliant · Technology-Enabled · Specialty-Agnostic
Reducing front-end errors before claims are ever submitted
HIPAA-compliant inbound/outbound patient communication — scheduling, billing inquiries, insurance follow-up, pre-visit reminders, and payer coordination.
HIPAA-compliant, omnichannel patient communication and payer liaison support.
HIPAA-CompliantOmnichannelPayer LiaisonReal-time calendar management, multi-provider coordination, and referral tracking across multi-specialty practices. Reduces no-shows and scheduling gaps.
Referral MgmtMulti-SpecialtyScheduling AutomationProactive payer authorization for high-dollar procedures. Portal-based and telephonic follow-up eliminating last-minute denials and claim holds.
Denial PreventionPayer PortalsAuth TrackingReal-time 270/271 EDI checks confirming active coverage, co-pays, deductibles, out-of-pocket limits, and coordination of benefits before every visit.
270/271 EDIReal-TimeCOB ReviewAAPC & 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.
UB-04ICD-10-PCSRevenue CodesPhysician-level CPT, ICD-10-CM, and HCPCS coding across 40+ specialties ensuring compliant, maximum-value claim submissions.
CPTICD-10-CMHCPCSMS-DRG and APR-DRG assignment with DRG optimization and inpatient record coding for maximum compliant reimbursement.
MS-DRGAPR-DRGDRG OptimizationProspective and retrospective audits identifying compliance gaps, over-coding risk, and missed revenue opportunities. Internal and external audit readiness.
Compliance AuditRevenue IntegrityRisk AssessmentHCC coding for CMS risk adjustment and HEDIS measure abstraction for value-based care performance under MIPS/APM models.
HCCHEDISRisk AdjustmentMIPSFull 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.
End-to-EndEBOCharge CaptureAccurate ERA/EOB payment posting (835 auto-posting), contractual adjustment reconciliation, and daily deposit matching.
ERA/EOB835 Auto-PostReconciliationSystematic aging bucket follow-up (30/60/90/120+ days), payer escalation workflows, and patient collections to reduce DSO.
DSO ReductionAging AnalysisPayer Follow-UpContract variance analysis identifying payer underpayments and short-pays, with formal dispute workflows and recovery dashboards.
Contract AnalysisPayer DisputesShort-Pay RecoveryRoot-cause denial analytics using CARC/RARC codes, rapid appeals submission, and upstream prevention to protect the clean claim rate.
Appeals WritingCARC/RARCRoot CauseCompliant resolution of credit balances and structured recovery of aged AR during system conversions, practice transitions, or EHR migrations.
Overpayment RecoveryCMS Audit ReadyAR RecoverySpecialized 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.
ADA CodesBenefit LimitsWaiting PeriodsComplete end-to-end dental billing from claim creation to final patient balance management across dental and DSO practices.
ADA 2024 CodesDental EDIDSO SupportExpert CDT-to-CPT/ICD-10 cross-coding unlocks additional reimbursement from medical payers for procedures with established medical necessity — maximizing revenue from both dental and medical insurance.
CDT→CPTICD-10Dual InsuranceClients recovered over $180K in Year 1
Accelerating payer enrollment, maintaining compliance, and protecting your revenue stream
Type 1 & Type 2 NPI registration via NPPES, DEA & state license expiry tracking, fee schedule loading, and payer ID updates.
NPI Type 1 & 2NPPESLicense TrackingComplete CAQH ProView profile creation, quarterly attestation management, and ongoing maintenance ensuring continuous payer access.
CAQH ProViewAttestationQuarterly UpdatesEnd-to-end PECOS enrollment for Medicare Part A & B, Medicaid state plan applications, and re-validation workflows.
PECOSMedicareRe-validationCredentialing with BCBS, Aetna, Cigna, UHC, Humana, Tricare, Molina, and 50+ commercial payers — new enrollments and re-credentialing cycles.
BCBSAetnaCignaUHCEnterprise-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.
45 CFRMinimum NecessaryAdministrative, physical, and technical safeguards for all ePHI. Risk analysis updated annually per 45 CFR Part 164.
ePHI SafeguardsAnnual Risk AnalysisBusiness Associate liability, breach notification, and patient rights compliance per 2013 Omnibus Rule expansions.
Breach NotificationPatient RightsHIPAA/HITECH · NIST CSF · PCI-DSS v4.0 · SOC 2 Type II (target) · OIG Guidelines · CMS Conditions
🔐 256-bit AES Encryption · 📱 Multi-Factor Authentication · 🚫 Zero-Trust Architecture · 📄 Executed BAAs