Services
Billing automation
Most billing problems are not hard problems. They are forgotten ones. A claim sits in a queue because nobody checked that queue on Tuesday.
Why things get stuck
Ask a practice where its money is held up and the answer is almost never "this claim is genuinely complicated". It is that a rejection landed in a clearinghouse queue nobody opened, a payer went quiet and no one re-checked the status, an ERA posted but the denial on line three was never routed to anyone, or a claim quietly aged past its filing deadline while sitting in a worklist.
Every one of those is a scheduling failure, not a billing failure. The work was known, the information was available, and nothing happened because a person had to remember to make it happen.
What we automate
We have our own development team, so we are not limited to whatever buttons your practice management system happens to offer. We build against the standard EDI transactions and whatever API your system exposes.
- Eligibility and benefits checked ahead of the visit automatically against the schedule, using the 270/271 transaction, so a coverage problem surfaces before the patient arrives rather than as a denial six weeks later.
- Claim scrubbing against payer-specific edits before submission, with rules we add as your own denial patterns reveal them.
- Submission and rejection handling. The 837 goes out, and front-end rejections come straight back into a worked queue instead of sitting invisibly at the clearinghouse.
- Status polling. Rather than waiting for the payer, we query claim status on a schedule with 276/277 and flag anything that has gone quiet past its normal turnaround.
- ERA auto-posting. 835 remittances post automatically, with exceptions and underpayments split out for a human instead of being buried in a batch.
- Denial routing by reason code. Each denial is classified on arrival and routed to whoever can actually fix it: coding, authorisation, front desk, or appeals.
- Deadline alerts. Timely filing and appeal windows tracked per payer, with warnings well before the cliff rather than a write-off after it.
- Reporting. Your weekly numbers are generated, not assembled by somebody on a Friday afternoon.
What we deliberately do not automate
Appeals need the chart read and medical-necessity language written against the payer's own policy. Coding needs judgement about what the documentation supports. Payer phone calls need a person who can argue. Automation decides what needs attention and who gets it; people still do the part that requires thinking.
Anyone selling you fully automated appeals is selling you a template, and payers deny templates.
You keep your system
None of this means moving onto our platform, because we do not have one and do not want one. The automation sits alongside your existing EHR or practice management system and works through its API or standard EDI files. If you leave, you take your data and your system with you exactly as they are.
Common questions
Do we need to change our software for this?
No. The automation works against your existing system’s API or standard EDI transactions. We do not ask you to migrate, because migrations lose claims and because a vendor who owns your system owns you.
Does automation replace the billing team?
It replaces the part of their job that is remembering things. Eligibility checks, status polls and payment posting run on a schedule; appeals, coding judgement and payer calls stay with a named person. The team spends its time on the claims that actually need a human.
What if our system has no API?
Then we work from the standard EDI files, which every clearinghouse produces. Older systems limit how much can be automated at the front end, and we will tell you honestly what is and is not possible with yours before you commit.
Is this AI making decisions about our claims?
No. These are deterministic rules and scheduled transactions: check eligibility on this date, poll status after this many days, route this reason code to this queue. Nothing guesses, and nothing clinical or financial is decided by a model.
Start with the free audit
Send us ninety days of claims data and we will show you what was left uncollected. No charge, no obligation, and the findings are yours either way.
Request my free audit