01Eligibility & Benefits Verification
Verify active coverage, plan details, deductibles, copays, coinsurance, benefit limitations and authorization requirements.
- Eligibility confirmation
- Benefit verification
- Deductible and copay review
- Out-of-network status
- Authorization requirements
02Claim Submission & Charge Entry
Support charge entry, claim preparation, validation, clearinghouse submission and rejection correction.
- Charge entry
- Claim creation
- Claim validation
- Submission workflows
- Rejection correction
03Accounts Receivable Management
Structured insurance follow-up and aging-based workflows designed to move outstanding claims toward resolution.
- Claim status follow-up
- Aging analysis
- Insurance calling
- Outstanding claim resolution
- Follow-up documentation
04Denial Management
Identify denial causes, correct claims, prepare appeals and help reduce recurring denial patterns.
- Denial identification
- Root-cause analysis
- Claim correction
- Appeals
- Resubmission
05Payment Posting & Reconciliation
Process payment information, adjustments, EOBs and ERAs while helping maintain clean account reconciliation.
- ERA posting
- EOB posting
- Insurance payments
- Patient payments
- Adjustments & reconciliation
06Pre-Authorization
Identify authorization requirements and support submission, tracking and follow-up workflows.
- Requirement discovery
- Authorization submission
- Status tracking
- Follow-up
- Documentation
07Credentialing & Enrollment
Support provider enrollment and ongoing credentialing across commercial and government payer environments.
- CAQH support
- Payer enrollment
- Medicare & Medicaid enrollment
- Revalidation
- Credential maintenance
08Revenue Cycle Audits
Review operational workflows to identify gaps, trends and performance improvement opportunities.
- Claims audit
- AR audit
- Payment audit
- Eligibility audit
- Workflow analysis