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Toll Free number:888-988-0605

Overview

We deliver end-to-end Referral & Care Management operations alongside precision AR Payment Posting for enterprise healthcare clients. Our team transforms high-volume financial data into clean, reconciled ledgers while ensuring members receive the right care from the right provider at the right time. By combining referral governance and proactive care coordination with zero-tolerance financial balancing, we help payers strengthen quality outcomes, protect financial integrity, and reduce the total cost of care.

The three pillars of our service offering:

Specialized Account Recovery (RAC & TPL)

  • Focus: Niche Audit Support
  • The Expertise: We provide specialized support to Recovery Audit Contractor (RAC) and Third-Party Liability (TPL) vendors.
  • Recoupment Management: We manage the complex "Recoupment" (Takeback) process, accurately handling funds retracted due to errors or alternative insurer responsibilities.
  • Compliance: We align strictly with State Medicaid and commercial plan requirements.

Payment Posting and Data Logic

Payment Posting & Data Logic

  • Focus: Accuracy & Balancing
  • Zero-Tolerance Balancing: We ensure Total Bank Deposit = Total Posted + Total Adjustments daily.
  • ERA Handling: Expert management for the high-volume automated import of EDI 835 files to minimize manual entry.
  • Lockbox Processing: Utilizing OCR technology to convert image-based EOBs from bank lockboxes into clean, postable data.

Financial Hygiene and Reconciliation

Financial Hygiene & Reconciliation

  • Focus: Clean Ledgers
  • Suspense Account Management: We aggressively research and clear unidentified payments to prevent the aging of unapplied cash.
  • Refund Processing: We identify overpayments (credit balances) during the posting phase and proactively initiate refund processes to return excess funds to the payer or patient.

Our Proprietary Tech

Automated ERA Data Logic: Advanced management for high-volume automated import of EDI 835 (Electronic Remittance Advice) files, ensuring compatibility with industry-leading ERPs and data formats.

BENEFITS

By integrating clinical and financial workflows, we eliminate administrative delays and maintain clean ledgers through proactive research and refund processing.

  • Optimize “Right Care, Provider, Time” through improved coordination.
  • Minimize leakage and reinforce network adherence for savings.
  • Reduce avoidable admissions and ED visits via early intervention.
  • Boost STARs, HEDIS, and NCQA scores and member satisfaction.
  • Lower TCOC to support sustainable, long-term affordability.
  • Ensure zero-tolerance daily balancing of deposits and adjustments.
  • Accelerate care access with faster, first-pass accuracy.

1.3M

Remittances Processed Annually

BENEFITS

By integrating clinical and financial workflows, we eliminate administrative delays and maintain clean ledgers through proactive research and refund processing.

  • Optimize “Right Care, Provider, Time” through improved coordination.
  • Minimize leakage and reinforce network adherence for savings.
  • Reduce avoidable admissions and ED visits via early intervention.
  • Boost STARs, HEDIS, and NCQA scores and member satisfaction.
  • Lower TCOC to support sustainable, long-term affordability.
  • Ensure zero-tolerance daily balancing of deposits and adjustments.
  • Accelerate care access with faster, first-pass accuracy.
1.3M
Remittances Processed Annually

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