RCM Software Development

Capture accurate patient demographics and insurance information at the point of registration. Enable automated eligibility and benefits verification to identify coverage status, copay, coinsurance, deductible, remaining benefits, and other payer-specific information before services are delivered.

• Patient registration and intake
• Insurance discovery and verification
• Real-time eligibility checks
• Benefits and coverage verification
• Cost-share information
• Coverage exception detection
• Payer response management
• Eligibility history and audit trails

Automate authorization workflows and reduce delays caused by missing or incomplete approvals. Track authorization requests from submission through payer response while connecting authorization status with scheduling, encounters, and claims.

• Authorization request management
• Payer-specific requirements
• Authorization status tracking
• Expiration alerts
• Documentation management
• Approval and denial workflows
• Authorization-to-claim validation

Connect clinical encounters with billing workflows to ensure services rendered are accurately translated into billable charges. Support coding workflows with ICD-10-CM, CPT, HCPCS, modifiers, diagnosis-to-procedure relationships, and configurable validation rules.

• Automated charge capture
• Charge reconciliation
• ICD-10-CM and CPT support
• HCPCS coding
• Modifier validation
• Coding assistance
• Superbill generation
• Documentation completeness checks
• Coding workflow management

Create, validate, submit, and track claims through their lifecycle while identifying preventable errors before payer submission. Support electronic claims workflows and clearinghouse connectivity for professional and institutional claims.

• Automated claim generation
• Claim scrubbing
• Pre-submission validation
• Payer-specific edits
• Professional and institutional claims
• Electronic claim submission
• Claim acknowledgment tracking
• Claim status monitoring
• Rejection management
• Claim resubmission

Turn denial management from a reactive work queue into a proactive revenue protection workflow. Identify denial trends, classify root causes, prioritize high-value accounts, automate follow-ups, and support appeals and resubmissions.

• Denial categorization
• Root-cause analysis
• Payer-specific denial rules
• Denial work queues
• Appeal workflow management
• Automated resubmission
• Denial prioritization
• Underpayment detection
• Denial trend analytics
• Preventive denial rules

Automate the movement of payer and patient payments into your financial workflows. Process electronic remittance data, reconcile payments against claims, and identify discrepancies between expected and received reimbursement.

• ERA/EOB processing
• Automated payment posting
• Payment reconciliation
• Adjustment management
• Contractual adjustment tracking
• Underpayment detection
• Patient payment posting
• Exception management
• Refund workflows

Give billing and finance teams a complete view of outstanding revenue and the actions required to collect it. Monitor AR aging, payer balances, patient balances, collection activity, and high-risk accounts from a centralized dashboard.

• AR aging analysis
• Payer AR management
• Patient AR management
• Collection work queues
• Follow-up automation
• Aging-based prioritization
• Balance tracking
• Payment plans
• Collection analytics