End-to-end Revenue Cycle automation, stage by stage.
From eligibility verification through denial recovery. We automate the steps inside RCM where payor portals, EHRs, and clearinghouses force human keystrokes today.
Eligibility & Benefits Verification
Automated batch eligibility checks against payor portals and clearinghouse 270/271 transactions. Coverage details, copay, deductible, and out-of-pocket information land directly into the EHR or PM system before the patient encounter.
- Multi-payor portal automation (UiPath / Power Automate)
- 270/271 EDI consumption where supported
- Coverage, copay, deductible & OOP capture
- Push back into Epic / Cerner / athena / NextGen
Prior Authorization
Prior auth requirement determination, submission, status tracking, and follow-up — across the payors and procedures that drive your volume. Auth numbers and approval status flow back to scheduling and billing.
- Auth-requirement determination by CPT / payor
- Portal-based PA submission & document upload
- Status polling & clinician follow-up workflows
- Auth number write-back & expiration tracking
Claims Submission & Status
Claim scrubbing automation against payor-specific edits, plus claim status follow-up that closes the loop with the AR team. We focus on the claims that don’t clear cleanly the first time.
- Pre-submission scrubbing against payor edits
- Submission via clearinghouse / payor portals
- Automated claim status pulls (277 / portal)
- Aging-based work queue routing
Denial Management & Appeals
Denials get classified by category (eligibility, auth, coding, medical necessity), routed to the right work queue, and — for the high-volume preventable categories — appealed automatically with the right packet.
- CARC / RARC-based denial classification
- Root-cause routing to AR work queues
- Auto-generated appeal packets where rules allow
- Trend reporting back to upstream stages
Payment Posting & AR Reconciliation
ERA / EOB ingestion (IDP for paper EOBs), line-item posting, and reconciliation against expected reimbursement. Variances are flagged for the right downstream action — appeal, write-off, or patient bill.
- 835 ERA automated posting
- Paper EOB digitization & line-item extraction (IDP)
- Contract-rate variance detection
- AR aging & collection-queue automation
Which RCM stage is leaking the most?
Send us the stage — we’ll come back with a sized automation roadmap.