End-to-End AI Revenue Cycle Management — for 3% of Collections
Automate eligibility, coding, claims, posting, and denial workflows with expert billers and certified coders.
Starts at 3% of net collections. Pass-through fees are billed at cost; minimum monthly fee may apply for micro-practices.
Why Clinics Choose Us
Save More, Pay Less
Only 3% of net collections — no lock-ins, no hidden fees. Transparent pricing that aligns with your success.
Smart AI + Expert Human Touch
Automation handles claim scrubbing, eligibility checks, coding QA, denial prediction, and AR follow-up — all under expert oversight.
Faster Payments, Healthier Cash Flow
Clean first-pass claims, fewer reworks, and tight follow-ups mean reduced Days in A/R and faster cash flow.
Insights That Drive Action
Get daily cash snapshots, weekly payer trends, and monthly KPI reviews — complete with actionable playbooks for your practice.
Secure & Compliance-Ready
Secure & Compliance-Ready
BAA and HIPAA-aligned workflows, role-based access, audit trails, and end-to-end encryption keep your data safe.
What's Included in End-to-End AI Revenue Cycle Management at 3%
Front Desk & Pre-Visit
- • Insurance discovery & eligibility checks (270/271) with coverage rules
- • Real-time benefits & patient responsibility estimator
- • Prior-authorization triage & status tracking (option for full PA management)
- • Demographics QA & payer ID hygiene
Charge Capture & Coding
- • Provider-friendly charge capture (mobile/web)
- • AI-assisted E/M, HCC, modifiers, NCCI edits, LCD/NCD checks
- • Certified coder review for exceptions & high-risk encounters
Claim Scrubbing & Submission
- • Automated CCI, MUE, plan-specific rules, and missing attachment detection
- • 837P/837I creation & submission via direct or clearinghouse channels
- • Real-time rejection fixes & resubmission
Payments, Posting & Reconciliation
- • 835 ERA auto-posting with variance checks
- • Paper EOB digitization & quality control
- • Underpayment detection vs. contracted rates
A/R & Denial Management
- • AI-prioritized workqueues by collectability score
- • Root-cause taxonomy (CO/PR codes) & prevention playbooks
- • Appeals with payer guidelines & templated packets
Patient Billing & Collections
- • Clear statements, SMS/email pay links, IVR/voice pay
- • Friendly dunning & hardship workflows
- • Refunds & NSF handling
Analytics & Compliance
- • KPI suite: FPRR, CE %, DSO, denial rate, net collection rate
- • Payer scorecards, code-level leakage, appeal win rates
- • Full audit trails, exportable logs, access governance
Add-Ons (Still Within 3% for Qualifying Clinics)
Credentialing & provider enrollment, Self-pay campaigns, Full-service prior authorization. (Scope and volumes determine eligibility)
How Our AI + Human Model Works
Ingest & Normalize
We connect to your EHR/PM via API, SFTP, or files. All encounters, schedules, charges, and ERAs flow into a unified rules engine.
Pre-Claim QA
AI reviews coverage, plan rules, medical necessity, bundling edits, and flags likely denials before claims are submitted.
Human Validation
Certified coders and billers resolve flagged items, edge cases, and payer-specific quirks for maximum accuracy.
Smart Submission
Clean claims are submitted automatically; rejections are auto-corrected when possible or escalated for expert handling.
Cash Posting & Audits
ERAs are auto-posted with variance alerts; paper EOBs are digitized, reconciled, and audited for accuracy.
A/R Automation
Claims are ranked by probability-to-collect × aging. Automated steps hit portals, calls, and appeals with SLA tracking.
Closed-Loop Prevention
Every denial feeds back as a rule, edit, or provider coaching card to prevent the same issue from recurring.
Proven Performance, Backed by Data
We believe performance should be proven, not promised. Within 60 days, you'll see measurable improvements across the most critical revenue cycle metrics:
Clean acceptance on first pass
Within the first 90 days
With priority-to-collect queues
Via underpayment recovery
Reclaimed from billing work
Our Commitment: We review KPIs with you weekly. If measurable improvements are not achieved within 60 days, you are free to walk away — no lock-in, no penalties.
Transparent, Performance-Based Pricing
Flat Fee: 3% of net collections (includes payer and patient payments posted)
No Setup Fee: Standard integrations at no additional cost
Flexible Commitment: Month-to-month after 90-day onboarding; 30-day notice to cancel
Micro-Practice Consideration: Minimum monthly fee may apply for smaller practices to cover team and tooling
Pass-Through Costs: Clearinghouse fees, payer portal fees, and merchant fees billed at cost
Advanced Scope: Heavy prior-auth volume or complex hospital claims may require an addendum — still anchored at 3% for qualifying clinics
Service-level commitments (SLAs)
Eligibility & PA triage
same-day
Charge review & claim submission
< 24 business hours
Rejection fix & resubmission
< 24 business hours
Denial touch cadence
every 7–10 days (payer-dependent)
Payment posting
within 24 business hours of ERA/EOB receipt
Monthly executive review
with CFO-ready deck
Onboarding timeline (typical)
Week 0–1: Discover & Connect
Data access (BAA), payer mix, fee schedules, baselines, sandbox hookup.
Week 2–3: Parallel Run
We run your live claims in parallel, benchmark edits/denials, tune rules.
Week 4: Go-Live
Switch over submissions, start A/R workdown.
Weeks 5–8: Optimization
Provider coaching tips, payer playbooks, dashboard fine-tuning.
Comparison Table (In-House vs Typical RCM vs Us @ 3%)
| Capability | In-House | Typical 6–8% RCM | Us @ 3% |
|---|---|---|---|
| AI-assisted edits & denial prediction | × Limited | × Rare | ✓ AI-prioritized |
| Certified coder oversight | ○ Staff-dependent | ✓ Included | ✓ Certified oversight |
| Transparent KPIs & payer playbooks | ○ Manual reporting | ○ Summary dashboards | ✓ KPI reviews + playbooks |
| Prior auth management | Front desk burden | ○ Add-on | ✓ Included when eligible |
| Underpayment detection | Ad-hoc | ○ Contract-dependent | ✓ Underpayment radar |
| Fee alignment | Salary overhead | 6–8% | 3% flat |
What makes us different from typical 6–8% vendors
Automation first
ML-driven edits & denial prediction before payers see the claim.
Coder-supervised AI
Humans own the edge cases and quality.
Outcome dashboards a doctor can actually read
Clear, actionable insights designed for healthcare providers.
Prevention > heroics
Each denial becomes a rule, not recurring work.
Aligned incentives
Lower fee, higher collections, clear SLAs.
Results snapshot (typical 90-day cohort)
First-Pass Resolution Rate (FPRR) uplift within 60–90 days
avoidable denials from edit prevention & coaching
in A/R with priority-to-collect queues
net collections from underpayment detection & appeals
Every practice is different; we baseline your current metrics and agree on targets up front.
Who we're a great fit for
Outpatient specialties
Primary Care, Pediatrics, Internal Med, Cardio, Ortho, GI, Derm, ENT, Ophthalmology, Pain, Behavioral
Group practices & MSOs
Consolidating revenue ops
New practices
Needing credentialing + RCM foundation
Clinics with challenges
High denial/rework or poor visibility
What you'll see in the dashboard
Cash Today, Weekly Collections, Net Collection Rate
Denials by Root Cause, Appeal Win Rate, FPRR
A/R Aging Heatmap, Payer Scorecards, Underpayment Radar
Provider coaching cards
(e.g., modifier usage, bundling conflicts)
Compliance & Security Highlights
BAA executed; HIPAA-aligned SOPs
PHI minimization, role-based access, SSO/MFA
Encrypted transit/at rest; payor portal credential vaulting
Audit logs, incident response drills, quarterly reviews
Daily OIG/SAM.gov screening
Active providers and staff are checked against OIG LEIE and SAM.gov sources, with scored matches routed for compliance review and claim submission blocked for confirmed exclusions.
Good Faith Estimate (NSA) compliance
Self-pay and uninsured visits can generate line-item GFEs, track delivery and acknowledgment, and preserve proof for No Surprises Act audit response.
Coordination of Benefits workflow
COB rules help determine payer order, document the reason, build secondary claims from posted primary remittances, and write the order back to the EHR.
ADR / RAC documentation handling
ADR queues track request intake, due dates, document assembly, submission confirmation, payer outcomes, and recovery dollars for RAC and payer documentation reviews.
FAQs
Get answers to common questions about our 3% RCM services and how they can transform your healthcare revenue cycle management.
Simple, honest next steps
Share read-only access (or upload sample reports)
Get your free audit & savings plan
Parallel run to prove impact
Go live at 3% of collections