Prior Authorization

We manage authorizations end‑to‑end, emphasizing completeness up front. Requests are built with accurate CPT/HCPCS, ICD‑10 alignment to medical‑necessity criteria, frequency/site‑of‑service rules, and relevant physician notes. We submit through payer‑preferred channels, track to decision against defined turnarounds, escalate early for time‑sensitive cases, and maintain a full audit trail to preserve appeal rights. Outcome: faster approvals, fewer deferrals/cancellations, and reduced downstream denials.

Charge Entry

Charge entry is executed as a controlled, evidence‑based process designed to get claims right the first time. Each encounter is validated against documentation, payer policy, and contract terms before posting. We align CPT/HCPCS with ICD‑10 and modifier logic, apply specialty‑specific edits, and respect bundling, bilateral, frequency, NCCI, and site‑of‑service nuances. High‑risk codes undergo secondary checks or sampling audits; recurring variances trigger feedback to coding/documentation owners. Outcome: cleaner first‑pass claims, fewer avoidable edits, faster cash, and less rework.

Medical Coding & Documentation Support

We support compliant, accurate coding grounded in current guidelines and payer policy. Our approach blends coder expertise, edit engines, and targeted audits to ensure code–diagnosis–modifier coherence and medical‑necessity alignment. Where documentation is ambiguous, we use structured queries and provide succinct guidance to close gaps at the source. Outcome: reinforced revenue integrity, lower audit exposure, fewer post‑payment issues, and stabilized reimbursement.

Denial Management & Appeals

We don’t just chase denials; we eliminate their causes. Our denial program classifies by root cause (front‑end, documentation, coding, eligibility, authorization, medical necessity, COB, timely filing), then builds targeted fixes and evidence‑backed appeals. We monitor overturn rates, payer behaviors, and turnaround times, feeding intelligence back to front‑end teams. Outcome: fewer denials over time, higher appeal success, and tangible leakage reduction.

Patient A/R & Financial Counseling

We safeguard patient relationships while resolving balances. Statements are clear, contact attempts are respectful and compliant, and payment plans are right‑sized to patient circumstances. Where payer errors exist, we correct them first; where responsibility is truly patient, we provide transparent options and closure. Outcome: improved collections without compromising patient experience.

Clinical & Administrative Support

Our back‑office support removes operational burden from clinical teams — referral management, records handling, chart abstraction, and quality‑measure evidence collection — executed with standardized templates, version control, and audit trails. Turnarounds align to clinical need, and documentation hygiene is maintained so downstream teams work with confidence. Outcome: reliable support that preserves clinician time and supports quality measures.

Compliance, Privacy & Security

Security and compliance are built into our operating model: role‑based access and least‑privilege principles, controlled system connections (no local PHI storage), logging and audit trails, and routine training. Incidents follow documented playbooks with prompt remediation and communication. Clients can be confident that operational performance never compromises privacy or compliance.