Solution 03 · Automation
The repetitive work, done by agents that never miss a status check.
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.
- Eligibility (270/271)
- Claim status (276/277)
- ERA posting (835)
- Prior auth follow-up
- Payer portal agents
- Exception routing
What is broken
- 01
Staff are the integration layer
People copy data between the EHR, the clearinghouse, and eleven payer portals. That is not a job. It is a missing API.
- 02
Status checks happen when someone remembers
Claims sit unworked for thirty days because nobody looked. Timely filing windows close quietly.
- 03
RPA that breaks on every portal update
Brittle screen scrapers with no monitoring fail silently for weeks. The backlog is discovered at month end.
What we do
Capabilities, in the order we usually deploy them.
- Eligibility automation
- Batch and real-time verification 48 hours before the visit, with coverage gaps flagged to the front desk by name.
- Claim status
- Every open claim checked on schedule. Responses parsed and routed to the right worklist without a human touch.
- Payment posting
- 835s posted automatically with variance detection. Unmatched and underpaid items go to staff with the contract rate attached.
- Prior authorization
- Submission, follow-up, and status retrieval across payer portals, with the auth number written back to the encounter.
- Monitoring and exceptions
- Every run logged, every failure alerted, every exception assigned within the hour. Nothing fails silently.
- Built on your stack
- EHR and PM integration via API, HL7, FHIR, and SFTP. Portal automation only where no API exists.
What moves
Manual touches per claim
6.21.4
Eligibility verified pre-visit
71%99%
Payment posting lag
4 daysSame day
Staff hours returned per month
0340
Representative targets for a mid-sized physician group with a mixed payer base. Your baseline sets the actual numbers; we agree on them in the diagnostic.
In the portal
Run history, success rates, and exception queues for every automation, in the portal, in real time.
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
Speak to an expert
Let’s find the revenue you’re leaving on the table.
What happens next
- 01
A 30-minute call with an operator
Not a sales rep. Someone who has run a revenue cycle and will ask about yours.
- 02
A scoped diagnostic proposal
Fixed fee, 30 days, with the data we need listed up front.
- 03
Findings with dollars attached
You keep the report whether or not we continue together.