Eligibility & benefits
Coverage checked automatically before every visit, and re-checked when a plan changes, with copay and deductible details ready at check-in.
Prevents"coverage terminated" denials
Get paid for the care you already gave
Eligibility checks, prior authorisations, claim scrubbing, denial follow-up and payment posting are repetitive, rule-heavy work, and that's exactly what automation does well. We build the workflows that catch problems before claims go out and chase the ones that come back.
Fewer avoidable denialsFaster prior authsCleaner A/R
Caught pre-submitmissing modifier fixed
Payment postedmatched to ERA automatically
Claim CLM-20481MRI knee · commercial payer
$1,240billed
Eligibility
Prior auth
Scrub
Submitted
Paid
Coverage active · deductible metauto
Auth #PA-7731 approved, attachedportal
Scrubber: missing laterality modifier → fixedrule 14
Submitted via clearinghouse · accepted277CA
Paid $986.40 · posted & reconciledERA 835
What we automate
The billing work between the visit and the deposit.
These are the revenue cycle tasks practices and billing teams most often automate: high-volume, rules-driven, and expensive when they're missed.
Prior authorisations
Orders that need an auth are spotted, the request is assembled from the chart, and status is tracked until approval, with reminders before it expires.
Preventscancelled procedures, unpaid work
Claim scrubbing
Your payer rules and past denials turned into checks that run before submission: missing modifiers, mismatched codes, absent documentation.
Raisesfirst-pass acceptance
Denial management
Denials sorted by reason and value into a worklist, with appeal letters drafted from templates and deadlines tracked so none expire unworked.
Recoversrevenue that's currently written off
Payment posting
Remittances matched to claims and bank deposits automatically. Underpayments against your contracted rates are flagged for follow-up.
Endsmanual ERA keying
A/R follow-up & patient balances
Aging claims chased on a schedule, payer status checked automatically, and patients sent clear statements with a simple way to pay online.
Shrinksdays in A/R
Prior authorisation
Every auth tracked, none forgotten.
Prior auths eat staff hours: portal logins, faxes, phone holds and spreadsheets to track it all. We centralise the queue, automate status checks where payers allow, and alert your team the moment action is needed.
- Auto-detectionOrders that need an auth are spotted from payer rules when they're placed.
- Packet assemblyClinical notes and codes gathered into the request.
- Expiry alertsWarnings before an approved auth lapses or runs out of visits.
Auth queueExample · this week
Patient · servicePayerStatus
J. PikeMRI knee
Commercial AApprovedR. ChenPhysical therapy ×12
Medicare Adv.Pending payerM. AlvarezCT abdomen
Commercial BNeeds notesT. WalshSleep study
Medicaid MCOSubmittedK. OseiInjection series
Commercial AApprovedTop denial reasons
Illustrative breakdown. We build yours from your own remittance data.→ fixed upstream by automated eligibility checks
→ auth tracking and expiry alerts
→ pre-submission scrub rules
→ document checks before submission
→ deadline tracking on every claim
Denials
Prevent the avoidable, chase the rest.
Many denials trace back to a handful of fixable causes. We find yours in your remittance data, add checks earlier in the process so they stop happening, and build a worklist for the ones that still come back.
- Root-cause viewDenials grouped by reason, payer, provider and service.
- Prioritised worklistHighest value and nearest deadline first.
- Appeal templatesLetters pre-filled from the claim and chart, ready for review.
Payment posting
Every dollar matched to the claim it belongs to.
Remittance files, bank deposits and claims reconciled automatically. Payments are posted to the right claim, short-pays against your contracted rates are flagged, and the month-end close stops being a scavenger hunt.
- ERA auto-posting835 files parsed and posted, with exceptions queued for review.
- Underpayment detectionPaid amounts compared with your fee schedules.
- Deposit reconciliationRemittances matched to actual bank deposits.
Remittance (ERA)
CLM-20481$986.40
CLM-20477$212.00
CLM-20470$88.10
Posted to claim
✓ matched$986.40
✓ matched$212.00
! short-payexp. $124.00
⚑ CLM-20470 paid below contract rate, added to the underpayment worklist
A/R agingIllustration · before vs. after automation
0–3031–6061–9090+
BeforeAfter
A/R follow-up
Money moves to the younger buckets.
When claims go out clean, denials are worked quickly and aging claims are chased on a schedule, more revenue is collected in the first 30 days and less drifts past 90.
- Automated status checksClaim status pulled from payers without phone holds, where available.
- Follow-up cadenceEvery unpaid claim has a next action and an owner.
- Patient payment journeysClear statements, text-to-pay and payment plans.
How we work
Start where the money leaks.
We begin with your own data, so the first automation targets your biggest source of lost or delayed revenue.
1
Revenue leak review
We analyse remittances, denials and A/R aging to find where revenue is being lost or delayed.
Discovery2
Workflow design
Rules, checks and worklists designed with your billing lead around your payers and systems.
Blueprint3
Build on secure tools
Automations on BAA-covered infrastructure, connected to your PM system and clearinghouse.
Build4
Monitor & expand
Monthly review of denial rate, first-pass acceptance and days in A/R, then the next workflow.
OptimiseQuestions
Before you ask.
Do you replace our billing team or billing company?
No. We automate the repetitive parts of their work so they can focus on complex claims, appeals and payer issues. Many clients use us alongside an outsourced biller.
Which systems can you connect to?
It depends on your practice management system and clearinghouse: some have APIs, others work through exports, partner integrations or approved portals. We confirm what's possible before quoting.
Do you do medical coding?
No. Coding decisions stay with your certified coders. We build checks that catch common errors and missing information before submission, based on your rules and payer requirements.
How do you handle patient data?
On BAA-covered infrastructure, with minimum-necessary access, encryption and audit logs. We work with your compliance lead and document how data moves; your practice keeps responsibility for its compliance program.
How soon do we see results?
Eligibility checks and denial worklists show results quickly because they act on claims going out now. A/R improvements take longer, as older claims work their way through.
Pairs well with
Related services.
Find out where your revenue is leaking.
Share a recent denial report or A/R aging summary. We'll show you which fixes are likely to recover the most, and how quickly.