Services

Full-service revenue cycle management

Expert services across the revenue cycle — from eligibility and claims to denials, appeals, credentialing, coding, and reporting.

Browse the Knowledge Base See how it works

What we do

A connected revenue-cycle service map

Every service belongs to one of three connected pathways — clean claims out, revenue recovered, providers and patients supported.

Claims

Get accurate, clean claims to payers the first time and keep them moving.

Claims management Eligibility & verification Coding support

Revenue recovery

Recover revenue that would otherwise be lost to denials and aging accounts.

Denial management & appeals A/R management Payment posting

Enablement

Keep providers payer-ready and patients clearly informed and supported.

Credentialing & enrollment Patient billing & support

How it works

Follow a claim through the revenue cycle

Select any stage on the route — the path lights up to that point, and its detail appears alongside.

Intake: Encounter created. The revenue cycle begins before care is billed — capturing accurate patient demographics, the responsible insurance, and the reason for the visit. A transposed member ID or a stale plan entered here surfaces much later as a rejection or denial, which is why intake is the cheapest place to prevent them.
Eligibility: Coverage confirmed. Before or at the visit the payer is checked electronically — an X12 270 request and 271 response — to confirm the patient is covered, that the service is a benefit, and what the patient will owe. Verifying eligibility up front removes a large share of avoidable denials.
Coding: Charges coded. The documented encounter is translated into standardized codes — CPT and HCPCS for what was done, ICD-10-CM for why — each supported by the clinical documentation. Accurate, compliant coding is the foundation of a correct claim; it is not where charges are inflated.
Submission: Claim submitted. Coded charges become a claim — an X12 837 — and are transmitted to the payer, usually through a clearinghouse that scrubs it against edits first. A claim that passes these front-door edits and is accepted on the first submission is a clean claim.
Adjudication: Under review. The payer applies the member's benefits and its medical-necessity and coding rules to decide what it will pay. This is the decision point of the cycle: a claim leaves adjudication on one of two paths — paid, in full or in part, or denied.
Payment: Paid. The payer returns an electronic remittance — an X12 835 — with the allowed amount, the paid amount, contractual adjustments, and any patient responsibility. Posting it accurately reconciles the claim, moves any balance to the patient, and reveals underpayments that would otherwise be lost.
Denial: Action required. A denial carries reason and remark codes (CARC/RARC) that explain why. Denials are worked, not written off: the cause is diagnosed, corrected, and the claim is appealed or corrected and resubmitted — which routes it back through submission. The share overturned on appeal is a measure of how recoverable that revenue was.
Reporting: Measured. Every outcome — clean-claim rate, denial rate, days in A/R, collection rates — feeds reporting that shows where revenue leaks and where the process is working. Those measures close the loop back to intake, where the next cycle's problems are cheapest to prevent.
At Adjudication the claim branches to Payment or Denial; a denial is appealed or corrected and resubmitted, routing back to Submission.

Intake

Encounter created

The revenue cycle begins before care is billed — capturing accurate patient demographics, the responsible insurance, and the reason for the visit. A transposed member ID or a stale plan entered here surfaces much later as a rejection or denial, which is why intake is the cheapest place to prevent them.

Stage 1 of 8 · select any stage to follow the claim through the cycle

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