Transform your organizations financial performance with tailored revenue cycle management solutions.
The RCM process starts with capturing patient encounter details, diagnoses, procedures, provider documentation, and insurance information. Medical coders assign appropriate ICD-10, CPT, and HCPCS codes based on the clinical documentation.
Once coding is completed, claims are generated within the Practice Management (PM) or EHR system with all required billing information.
Ensure every patient encounter is captured accurately for clean claim generation.
Before submission, claims are reviewed through claim scrubbing tools to identify errors, missing information, coding inconsistencies, and payer-specific rule violations.
Automated validation helps prevent denials caused by invalid diagnosis codes, missing modifiers, incorrect provider details, eligibility issues, and duplicate claims.
Stop denials before they start with automated scrubbing and validation.
Validated claims are electronically transmitted to clearinghouses or directly to insurance payers using EDI transactions (837 Professional/Institutional claims).
The clearinghouse performs additional validations before forwarding claims to insurance companies, ensuring compliance and reducing rejection rates.
Accelerate reimbursement with seamless electronic claim submission.
Claims rejected by the clearinghouse are corrected immediately and resubmitted. Rejections occur before the payer processes the claim and usually involve formatting or data issues.
Common rejection reasons include invalid subscriber ID, missing patient details, incorrect provider credentials, invalid payer ID, and formatting errors. Reducing turnaround time by correcting rejected claims quickly is the primary objective.
Reduce turnaround time by correcting rejected claims quickly and accurately.
After acceptance, insurance payers review claims to determine coverage, medical necessity, contractual adjustments, and reimbursement eligibility.
The payer either approves the claim, partially pays the claim, denies the claim, or requests additional information each outcome requiring a specific follow-up action.
Proactively manage payer adjudication outcomes to maximize reimbursement.
Once claims are processed, insurance companies send Electronic Remittance Advice (ERA ANSI 835 files) containing payment details, adjustments, denials, and patient responsibility information.
ERA files provide detailed explanations for paid amounts, contractual adjustments, deductibles and co-insurance, denials and remark codes essential for accurate reconciliation.
Streamline ERA processing for complete visibility into every payment decision.
Payments received through ERA or paper EOBs are posted into the billing system. Each payment is reconciled against submitted claims and patient accounts.
Payment posting ensures proper allocation of insurance payments, patient responsibility amounts, contractual adjustments, and write-offs maintaining financial integrity across the revenue cycle.
Ensure complete and accurate financial reconciliation across all payment channels.