From credentialing through collections, everything below runs through the same Dedicated Specialty Pod. No hand-offs between vendors, no re-explaining your practice to someone new, and no service that only gets attention when you ask for it.
Most denials are decided before anyone submits anything — by whether the provider is enrolled and whether the patient's coverage was confirmed. This stage is where the cheapest fixes live.
We handle provider and group enrollment end to end: Medicare via PECOS and the 855 forms, state Medicaid portals, commercial and IPA contracts, CAQH profile creation and the re-attestation due every 120 days, NPI registration, DEA and state licensure, hospital affiliations, revalidations and re-credentialing cycles.
Why it matters more than practices expect: a provider who isn't enrolled can't bill, and payers almost never pay retroactively for services rendered before the effective date. Commercial enrollment routinely takes 90 to 120 days. A new hire who starts before their file clears draws full salary against unbillable encounters for a quarter.
The work that decides your timeline isn't the application — it's the follow-up. We track every payer file on a schedule rather than waiting for the payer to come back to us.
Included at no extra charge for full-service billing clients. Practices that want credentialing on its own can buy it standalone. See credentialing and build a quote
Medicare & PECOS
State Medicaid
Commercial & IPA
CAQH build + maintenance
NPI Type I & II
DEA & licensure
Revalidation
Hospital affiliation
Part of full service
We confirm coverage, plan status, benefit detail, deductible and out-of-pocket position, and prior-authorization requirements ahead of the visit — not after the claim comes back denied.
The failure this prevents is expensive twice over. A claim denied for terminated coverage or a missing authorization costs staff time to rework and pushes payment out 30 to 60 days. Worse, it becomes a patient balance nobody expected, which is the most common source of billing complaints at the front desk.
Verification also gives your staff something to work with: patients told their responsibility before the visit pay at materially higher rates than patients who receive a statement six weeks later.
Getting it right the first time. Every claim that goes out clean is a claim nobody has to rework, appeal, or write off.
Part of full service
Specialty-trained coders review documentation and assign CPT, ICD-10-CM, HCPCS and modifiers against current guidelines and your specific payers' rules — before the claim is submitted, not after it's rejected.
This is where specialty training earns its keep. A generalist biller has seen your payer's modifier rules occasionally. A coder working your specialty daily knows which plan bundles a code others pay separately, which modifier combination triggers an automatic rejection, and which documentation phrase the payer's edit is looking for.
Coding accuracy cuts both ways: under-coding quietly gives away revenue you earned, and over-coding creates audit exposure. Both are avoidable with review by someone who reads charts in your specialty every day.
CPT / ICD-10-CM / HCPCS
Modifier review
Documentation gaps
Pre-submission scrub
Specialty edits
Part of full service
The daily operating work of the revenue cycle: charge entry, claim scrubbing and submission, clearinghouse management, ERA and EOB payment posting, secondary and tertiary billing, patient statements, and reconciliation against contracted rates.
Underpayment catching is the part most practices never audit. Payers don't always pay their own contracted rate, and a claim paid at 80% of the fee schedule looks identical to a paid claim on a report.
We work in your existing practice management and EHR system in most cases — no data migration required — so your clinical workflow doesn't change when your billing does.
Charge entry
Claim scrubbing
Submission & clearinghouse
ERA/EOB posting
Secondary billing
Patient statements
Underpayment recovery
Recovering revenue that's been denied, delayed, or left to age past the point most billers bother to chase it.
Part of full service
Every denial gets worked to resolution, not filed. We categorize by root cause, correct and resubmit what's correctable, and appeal what's appealable with the documentation and language that specific payer actually responds to.
The part that compounds is the root-cause loop. A billing company that only reworks denials will rework the same denial next month. We feed denial patterns back into coding and verification, so the reason a claim was denied in March stops producing denials by June.
You'll see denial categories, volumes, overturn rates and dollars recovered in your reporting — so the effect is measurable rather than asserted.
Available Standalone
A focused project to recover aged and legacy receivables — typically claims inherited from a previous billing company, left behind during a system migration, or aged past 90 days while the team handled current work.
This is different from ongoing A/R management. Ongoing A/R keeps current claims from aging. A/R Recovery is a dedicated cleanup of a backlog that already exists: we inventory outstanding claims, separate what's still within timely filing from what isn't, identify which balances are genuinely collectible, and work them in order of recoverable value rather than easiest first.
Old claims get worked last by in-house teams for a reason — they're hardest, documentation is stale, and the staff who filed them may be gone. But the balance doesn't disappear; it becomes a write-off nobody decided to make. We'll tell you what's recoverable and what isn't before the work starts.
Available as a standalone engagement, and a common first step for practices leaving another vendor.
Legacy A/R cleanup
Post-vendor transition
Timely-filing triage
Aged claim appeals
Collectibility analysis
Part of full service
The ongoing discipline that keeps A/R from becoming a recovery project. We monitor aging buckets continuously, follow up on unpaid claims on a schedule rather than when someone notices, manage patient balances and payment plans, and keep payables organized alongside them.
The 90-day line is where money starts disappearing. Collection odds fall sharply as balances age, and claims past 90 days get deprioritized precisely because they're hardest to work. Consistent follow-up in the 30- and 60-day buckets is unglamorous and is where most of the recoverable money actually is.
The work that keeps the first three stages accurate as volume grows, providers join, and payer rules change underneath you.
Available Standalone
A structured review of a sample of your claims and documentation, measured against current coding guidelines and your actual payer contracts. We report what we find with dollar figures attached — not a grade, a list of where money is going and what it would take to stop it.
What an audit typically surfaces: under-coded encounters that gave away revenue you documented and earned; over-coded encounters carrying audit and repayment exposure; modifier patterns triggering avoidable denials; claims paid below contracted rates that were never appealed; documentation gaps that would fail a payer audit; and denial categories clustering around a single fixable cause.
The output is a written findings report with prioritized recommendations — quantified revenue impact, compliance exposure ranked by risk, and a specific list of what to change first. Practices use it as a health check on an in-house team, an objective read on a current vendor, or a safeguard ahead of a payer audit.
Coding accuracy review
Under- & over-coding
Documentation sufficiency
Denial root-cause analysis
Underpayment detection
Compliance risk ranking
Written findings report
Part of full service
Ongoing internal auditing of the work your pod produces: claim accuracy sampling, workflow review, and tracking of clean-claim rate, denial rate and A/R days against benchmarks set at onboarding.
This exists so quality doesn't quietly drift as volume grows. The failure mode in outsourced billing isn't a dramatic collapse — it's a slow slide in accuracy nobody catches because the reports still look fine. Continuous sampling catches it while it's a correction rather than a cleanup.
Part of full service
Measure selection, performance tracking through the year, and reporting submission — handled on a schedule rather than assembled in a panic at the deadline.
MIPS is a two-sided number. Strong performance earns a positive payment adjustment; weak or missing reporting produces a negative one applied across your Medicare volume. For practices with meaningful Medicare mix, the swing is real money that has nothing to do with how well you deliver care.
Part of full service
Operational support around the billing engine: workflow design between your front desk and the pod, fee schedule review, payer contract analysis, reporting setup, and — where needed — implementation of practice management software while keeping the existing EHR in place.
Most revenue problems start at the front desk, not in billing. Registration errors, missing insurance updates and incomplete demographics produce denials that look like billing failures. Fixing intake is often worth more than anything downstream of it.
Credentialing — priced from our published fee schedule, and included at no extra charge if you later move to full service. A/R Recovery — a focused cleanup of aged or inherited receivables. Billing & Coding Audit — an objective read on what your current setup is costing you.
Practices often start with one, see how the team works, and decide about billing afterward. Buying one obligates you to nothing.Build a credentialing quote
Twenty minutes is usually enough for us to point at the stage leaking the most revenue — denials, aging A/R, or enrollment.