New: the Healacle Portal gives every client a live view of their revenue cycle.
See the platformRevenue cycle · AI · Automation · Operations
Healacle pairs AI-driven automation with operators who have run revenue cycle for health systems and physician groups. Fewer denials, faster cash, and a live view of every dollar, with a team that owns the outcome alongside you.
A clinical story on one side. A payer rulebook that changes every month on the other. Most revenue cycles lose that translation on volume, not on merit.
~15%of claims submitted to commercial payers are denied on the first pass.
Source: Premier, 2024
$19.7Bspent by U.S. providers every year arguing with payers about claims.
Source: Premier, 2024
65%of denied claims are never reworked. That revenue is written off, quietly.
Source: MGMA
Where the dollar leaks
Every claim crosses five handoffs. Errors introduced early are decided late, by a payer whose rules nobody on the floor has read this month. The fix is not more appeals. It is getting the translation right before the claim leaves.
Visit
Clinical story
Codes
ICD-10 · CPT
Claim
837P / 837I
Payer rules
Change monthly
~15% lost here
Verdict
Paid or denied
The Healacle system
Outsourcers give you headcount. Point solutions give you another login. Healacle is one accountable system: operators on top, intelligence in the middle, automation underneath, all reporting into the same portal you look at.
Revenue cycle directors, coders, and A/R analysts who have run the cycle inside health systems and physician groups. They work in your queues and own the KPI with you.
Models trained on claims and remittances that predict denials, suggest codes, draft appeals, and keep payer rules current. Every recommendation is reviewed until it earns autonomy.
Agents that verify eligibility, check claim status, post payments, and chase authorizations on schedule, with every run logged and every exception routed to a person.
Solutions
Start with the part of the cycle that hurts. Every engagement runs on the same operators, models, agents, and portal, so scope can grow without a new vendor.
We take ownership of the full cycle, or the parts that leak: patient access, coding and charge capture, claims, denials, A/R follow-up, and patient balances. Our operators work inside your PM and EHR, with our automation underneath them.
Eligibility
99.2%
verified 48h prior
Coding
1.1d
charge lag
Submission
96.1%
clean claim
Adjudication
5.9%
first-pass denied
Posting
same day
835 posted
Follow-up
33.8d
days in A/R
Not a chatbot. Models trained on claim and remittance data that predict denials before submission, suggest codes from documentation, draft appeals with the right evidence, and keep payer rules current. Every recommendation is reviewed by a person until it earns autonomy.
Reviewed by a coder until the model earns autonomy for this payer and task.
Eligibility checks, claim status, payment posting, prior-auth follow-up, payer portal logins. We build and run the bots, monitor every run, and route exceptions to people. Your team gets the hours back.
Runs today
6,723
Straight-through
98.4%
Hours returned
353
Diagnostics, benchmarks, system selection, and transformation roadmaps from people who have sat in the revenue cycle director’s chair. We tell you what to fix first, and we can stay to fix it.
Diagnostic
Eligibility automation
Denial worklist redesign
Coding assist pilot
Payer escalation program
Each item has an owner, a cost, and the KPI it is supposed to move. Tracked in the portal.
How we engage
We pull your claims, remits, and worklists, sit with your team, and measure every KPI one way. You get a prioritized findings report with the dollars attached to each finding.
DeliverableFindings report and 12-month plan
Workflows are redrawn around the exceptions. Automations are specified against your systems. Roles change so that one person owns each dollar.
DeliverableWorkflow and automation blueprint
Agents go live under supervision. Operators join your queues. Models start in review mode and earn autonomy task by task.
DeliverableLive automations and staffed queues
We run it with you. KPIs are visible daily in the portal, reviewed monthly, and tied to how we are paid.
DeliverableOutcome-based operations
The Healacle Portal
Cash collected, MTD
$21.3M
First-pass denial rate
5.9%
Days in A/R
33.8
Clean claim rate
96.1%
Cash collected
12 months · vs target
Needs attention
56 claims within 7 days of timely filing
$339.2K at stake
CO-197 denials awaiting retro-authorization
$338.4K at stake
Underpayment pattern: BCBS paying 82% of contract on 27447
$128K at stake
One definition per KPI
Denial rate, days in A/R, and clean claim rate measured one way, from your data, daily.
The same worklists we use
Denials sorted by recoverable dollars, with the AI recommendation and who approved it.
Every automation, every run
Success rates and exceptions per agent, so nothing fails silently for a month.
Client and operator in one room
Messages, reports, and the roadmap live next to the numbers they are supposed to move.
Outcomes
Representative targets for a physician group of 100 to 200 providers with a mixed commercial and government payer base. Your baseline and payer mix set the actual numbers, and we agree on them before we start.
| Metric | Baseline | With Healacle | Change |
|---|---|---|---|
| First-pass denial rate | 12% | 6% | Halved |
| Days in A/R | 48 | 34 | 14 days faster |
| Clean claim rate | 87% | 96% | +9 pts |
| Cost to collect | 4.1% | 3.2% | 22% lower |
| Eligibility verified pre-visit | 71% | 99% | +28 pts |
Works inside the systems you already run
API, HL7, FHIR, and SFTP first. Portal automation only where nothing better exists.
A week with Healacle
The CFO · Monday, 7:15am
The number she needs is already on her phone.
Cash collected against target, days in A/R, and the three payers dragging the quarter. No spreadsheet from the billing manager, no reconciliation debate at the Tuesday huddle. When the board asks why denials fell, she can show the curve.
The denials analyst · Tuesday, 9:40am
The queue is sorted by dollars that will actually come back.
Each denial arrives with its root cause, the payer policy it violates, and a drafted appeal with the evidence attached. He reads, edits, sends. Forty appeals before lunch, instead of nine.
The front desk · Wednesday, 7:40am
Every patient on today’s schedule was verified at 6:00.
Two need a new authorization, one has a plan change, and the estimate for the 10:30 procedure is already in the patient’s text messages. The conversation at check-in is about the copay, not the coverage.
Questions
Rarely, and never on day one. We start by taking the work your team should not be doing by hand (status checks, eligibility, posting) and the work it does not have capacity for (aged A/R, appeals). Most clients keep their team and redeploy it toward the exceptions that need judgment.
Epic, Oracle Health, athenahealth, eClinicalWorks, NextGen, MEDITECH, and most clearinghouses including Availity, Waystar, and Change Healthcare. We integrate through APIs, HL7 and FHIR feeds, and SFTP, and use portal automation only where a payer offers nothing better.
The diagnostic is a fixed fee. Ongoing engagements are priced as a percentage of collections or per claim, with an outcome-based component tied to the KPIs we agree on up front. Automation and consulting can be scoped separately.
A Business Associate Agreement on every engagement, least-privilege access provisioned in your systems, encryption in transit and at rest, full audit logging, and a U.S.-based team. Our portal never stores more PHI than it needs to show you a claim.
The diagnostic reports in 30 days. Automations are typically live within 60 to 90 days. Denial rate and days in A/R usually move within the first full quarter, and you watch them move in the portal rather than waiting for a monthly deck.
Physician groups from roughly 20 providers, ambulatory surgery centers, FQHCs, behavioral health organizations, and community hospitals and health systems. If you have a revenue cycle director who is drowning, we are probably a fit.
Speak to an expert
What happens next
A 30-minute call with an operator
Not a sales rep. Someone who has run a revenue cycle and will ask about yours.
A scoped diagnostic proposal
Fixed fee, 30 days, with the data we need listed up front.
Findings with dollars attached
You keep the report whether or not we continue together.