Healthcare RCM Software
Revenue cycle software connecting eligibility verification, claims submission, medical coding, and denial prevention - built on real production clearinghouse integration experience, not theoretical billing workflows.
The problem
Where healthcare organizations get stuck
Eligibility and claims live in disconnected systems
Without a connected view, coverage issues surface as denials after service instead of being caught at scheduling or check-in.
Claim rejections trace back to preventable structural errors
Missing NPIs, invalid diagnosis pointers, and mismatched identifiers cause rejections that have nothing to do with medical necessity.
Coding accuracy depends entirely on manual review capacity
As claim volume grows, manually coding every chart to the specificity payers require becomes a bottleneck and a source of inconsistency.
What we build
Capabilities
Eligibility & benefits verification (270/271)
Real-time or batch eligibility checks with cost-sharing and prior-auth signals, not just active/inactive status.
Claims generation & submission (837P/837I)
Correctly structured professional and institutional claims, validated before submission to catch structural errors early.
Clearinghouse integration
Production experience integrating Claim.MD for eligibility and claims submission, extensible to other major clearinghouses.
Claim status & remittance tracking (277/835)
Track a claim through acknowledgment, status, and remittance - not just fire-and-forget submission.
AI-assisted medical coding
ICD-10-CM and CPT code suggestions with source justification, reviewed and finalized by a certified coder.
Pre-submission claim review & denial prediction
Catch diagnosis-procedure mismatches, missing authorization, and documentation gaps before claims go out.
Coordination of benefits & multi-payer support
Ordered, multi-payer insurance data modeling so claims route to the correct primary and secondary payers.
Revenue cycle reporting & analytics
Visibility into first-pass acceptance, denial rates, and days-in-AR to guide where to focus next.
EHR & practice management integration
Claims and eligibility data stays in sync with your source-of-truth clinical and scheduling systems.
How we work
Our process
Audit your current eligibility, claims, and coding workflow for gaps
Integrate clearinghouse connectivity for eligibility and claims submission
Build AI-assisted coding and pre-submission review into the workflow
Connect claim status and remittance tracking back into billing operations
Monitor first-pass acceptance and denial rates, iterating as payer rules evolve
Related services
How we deliver this
FAQ
Common questions
Related solutions
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