Fewer denials.
Faster days-to-pay.
Your billers spend their days re-keying claims, working denials, chasing eligibility, and clicking through payer portals instead of collecting. We automate the busywork in your revenue cycle so cash comes in faster, and you only pay out of what we save.
Sound familiar?
Every day, your team loses hours to manual eligibility checks, prior authorization follow-up, claim scrubbing, denial rework, and posting. The result is slower days-to-pay, avoidable write-offs, and A/R that keeps aging while your most experienced billers do robot work.
None of that is a staffing problem. It is a volume problem. The revenue cycle generates more repetitive, rules-driven tasks than any team can keep up with, and the tasks that get skipped are almost always the ones that cost you money later.
- Denials worked by hand, one claim at a time, weeks after the payer sent them
- Eligibility and benefits verified manually the morning of the visit, or not at all
- Prior authorizations tracked in a spreadsheet nobody owns
- Remittances posted line by line, with unapplied cash sitting for days
- Claim status checked by logging into six payer portals, one claim at a time
- A/R over 90 days growing because nobody has hours left to work it
Industry surveys have long put the share of denied claims that are never reworked at roughly half, and a large share of denials as preventable at the front end. Those are industry norms, not our numbers, but they describe the same leak we find in almost every billing operation: the work is knowable, it is just never finished.
The five places the revenue cycle leaks.
We do not replace your billing system. We automate the manual steps around it, one workflow at a time, starting with whichever one is costing you the most.
Denials worked in minutes, not weeks.
Most denials are not mysteries. They repeat: wrong plan on file, missing modifier, no authorization on record, filed past the window. Automation reads the 835 and the payer correspondence the moment it lands, assigns a root cause, and routes the claim to correction, resubmission, or appeal with the supporting documentation already attached.
- Denial and rejection intake parsed automatically from 835 remittances and payer portals
- Root-cause categorization by CARC and RARC code, then grouped by payer, provider, and CPT
- Corrected claims rebuilt and resubmitted without re-keying the encounter
- Appeal packets assembled from the chart, the authorization, and the payer policy
- Timely-filing clocks tracked per payer so appeal windows stop expiring quietly
- Recurring denial patterns surfaced as a report your team can fix at the source
arrives, not the month after
Verify benefits before the patient walks in.
A clean claim starts days before the visit. Automation pulls tomorrow's schedule, runs a 270 eligibility request for every appointment, reads the 271 response, and writes coverage, copay, deductible, and plan status back into the practice management system. Anything that comes back inactive, termed, or needing a different plan gets flagged for a human while there is still time to fix it.
- Batch eligibility checks run automatically against the upcoming schedule
- Active coverage, plan, group, copay, coinsurance, and deductible captured and posted to the patient record
- Termed, inactive, and coordination-of-benefits mismatches escalated to staff by exception
- Benefit detail captured for the specific service being scheduled, not just the plan headline
- Verification history logged so you can prove what the payer said and when
there is still time to fix it
Authorizations that get submitted, tracked, and closed.
Prior auth is where revenue quietly disappears. A service gets scheduled, the authorization never gets requested, and the denial shows up sixty days later with no appeal path. Automation watches the schedule and the order stream, identifies which CPT and payer combinations require authorization, prepares the request, submits it through the payer portal or clearinghouse, and keeps following up until there is an approval, a denial, or a peer-to-peer scheduled.
- Auth requirements identified by payer, plan, and procedure code before scheduling
- Requests assembled from the order, the chart notes, and the clinical criteria the payer asks for
- Submission through payer portals and clearinghouse channels, with confirmation captured
- Status polled on a schedule instead of by memory, with pending requests aging on a live board
- Approval numbers, units, and date ranges written back so billing files against the right auth
- Expiring authorizations and exhausted visit counts flagged before the next appointment
it is approved or resolved
Remittances posted the day they arrive.
Posting is high-volume, rules-driven work, which makes it the single best candidate for automation in the revenue cycle. ERAs are retrieved, matched to claims, and posted with adjustments, write-offs, and patient responsibility split correctly. Paper EOBs and correspondence checks get read and structured the same way. What does not balance gets escalated instead of guessed at.
- ERA retrieval and 835 posting against the correct claim and line item
- Contractual adjustments, write-offs, and patient responsibility applied by payer rules
- Paper EOBs and lockbox correspondence captured and converted to postable data
- Deposits reconciled to remittances and to the bank record, with variances flagged
- Unapplied and unidentified cash surfaced daily instead of discovered at month end
- Underpayments compared to the contracted rate and queued for appeal
instead of aging in a queue
Every claim followed until it resolves.
The claims that never get worked are the ones that quietly become write-offs. Automation checks status across payer portals and 276 and 277 transactions on a cadence, moves claims through the buckets, and puts a human on the accounts where a human actually changes the outcome. Your best billers stop clicking through portals and start working the exceptions that pay.
- Claim status checked automatically across payer portals and clearinghouse transactions
- Aging buckets worked on a schedule instead of whenever someone gets to them
- No-response and lost-claim scenarios detected early and refiled inside the filing window
- Patient balance statements and reminders sent on a consistent cadence
- Work queues prioritized by dollar value, payer behavior, and days remaining to file
- A/R over 90 reported by payer and provider so you can see where the leak is
until they pay or resolve
No rip-and-replace.
We are not selling you a new billing platform. We build automation around the systems your billers already know, using the interfaces those systems already expose: APIs where they exist, standard EDI transactions where they do not, and supervised portal automation for the payers who still make you log in.
Clearinghouses
Claim submission, 835 remittance retrieval, and 276 and 277 claim status through the clearinghouse you already file with.
Practice management & EHR
Reading schedules and encounters and writing back eligibility, authorization, and posting data through supported integrations for common PM and EHR systems.
Payer portals
Status checks, authorization submission, and correspondence retrieval on the payer sites that have no other channel, with credentials handled under your access policy.
Accounting & reporting
Deposit and revenue data synced to QuickBooks and to the reporting your leadership already reviews, so posting and the books agree.
Every environment is different. Part of the free audit is confirming exactly which of your systems we can reach, and how, before anyone commits to anything. We will tell you when a workflow is a bad fit.
Patient data comes first. We work within HIPAA requirements, sign a BAA before we touch anything, keep PHI inside your existing EHR, practice management, and clearinghouse systems, and build around the tools your billers already use. Access is scoped to the workflow, every automated action is logged, and nothing leaves your control.
Start with a free 30-minute Waste Audit. If we automate something, we charge 15% of documented savings, and you keep 85%. No savings, no fee. No rip-and-replace. It works with the systems you already use.
More on automating the revenue cycle.
- Denial management automation for medical billing companiesRoot-cause detection, resubmission, and appeals that go out on time.
- Insurance eligibility and benefits verification automationRunning VOB against tomorrow's schedule instead of this morning's waiting room.
- Prior authorization automation for medical billingSubmission, tracking, and follow-up that closes the loop on every request.
- Everything we automateThe full catalog of workflows, across the whole back office.
- ResultsHow we document savings and what the engagement looks like.
See what your revenue cycle is leaving on the table.
A free 30-minute Waste Audit. We map the manual steps in your billing workflow, put a number on the hours and the delayed cash, and show you what automating them is worth. No savings, no fee.