Module

Medical Billing & RCM

Charge capture from a locked PCR all the way through to the last dollar collected.

Charge capture happens automatically when a crew locks a PCR. Codes surface with evidence citations, modifiers, PCS tracking, and ABN capture. Claims scrub against payer rules before submission. 837P goes out through Change Healthcare / Optum; 835s auto-post. Denials route into a work queue with AI-drafted appeal letters. Patient billing is HIPAA-compliant, multilingual, and integrates Stripe under BAA.

What's inside

Charge capture from locked PCR with HCPCS + ICD-10 + CPT assist
AI coding with evidence citations; upcoding/downcoding risk detector
270/271 eligibility, 837P submission, 835 ERA auto-post
Change Healthcare / Optum (first-class), Availity, Waystar, Trizetto adapters
AI appeal letter generator, denial pattern learner, PCS/ABN gap detector
Patient portal, payment plans, Stripe (BAA), ACH, HSA/FSA
Print-mail statements (OSG / Lob / Billtrust / built-in)
Full RCM analytics: days-in-A/R, cost-per-claim, collections velocity

Feature catalog for this module

28 numbered features · ranges F1200–F1291, F1300–F1319, F1330–F1336, F1340–F1350, F1360–F1362

F1200-F1209

Charge capture from locked PCR, HCPCS ambulance codes, ICD-10 assist, CPT/HCPCS add-ons, O/D modifier pairs, PCS tracking, ABN capture, medical-necessity narrative, claim holds, coder queue

F1210

AI chart-to-code with PCR evidence citations

F1211

AI up/downcoding risk detector

F1212

AI medical-necessity narrative generator

F1213

AI denial pattern learner

F1214

AI PCS / ABN / signature gap detector

F1215

AI payer-rule engine

F1216

AI audit explainer

F1217

AI output carries confidence + model version + human sign-off required

F1220-F1226

Payer directory, per-payer fee schedules, Medicare Part B auto-update, Medicaid auto-update, contracted-rate monitoring, balance billing, self-pay discount

F1230-F1234

Real-time 270/271, batch eligibility, 278 prior auth, COB discovery, broker auth cross-check

F1240-F1246

Scrubber, clean-claim workbench, 837P/837I X12 5010, CMS-1500/UB-04 PDF, two-person release, correction/resubmission, secondary/tertiary claims

F1250

ClearinghouseAdapter interface

F1251

Change Healthcare / Optum (first-class)

F1252

Availity

F1253

Waystar

F1254

Trizetto

F1255

Direct-payer EDI (Medicare MAC DDE/EMC)

F1256

Batching, throttling, idempotent retry

F1257

277CA acknowledgment parsing

F1258

Clearinghouse health dashboard

F1260-F1266

835 ERA auto-post, EOB OCR assist, bank reconciliation, adjustment codes, zero-pay denials, takebacks/refunds, ACH/lockbox

F1270-F1277

Work queue, AI appeal letters, root-cause analytics, timely-filing calendar, A/R aging, write-off with approval tiers, secondary automation, follow-up queue with SLAs

F1285-F1291

Statement engine, print-mail adapter (OSG/Lob/Billtrust/built-in), HIPAA-compliant itemized, multilingual, dunning cadence, pause on appeal, GFE (No Surprises Act)

F1300-F1319

Portal, throttled lookup, pay-by-link, Stripe (BAA), ACH, Apple/Google Pay, alt processors, payment plans, tokenized card-on-file, auto-receipts, refunds, chargebacks, comms preferences, HSA/FSA, auto-post to claim, self-pay discount, collection agency handoff, surcharge compliance, financial-assistance intake, 1099-C

F1330-F1336

HIPAA access logs, OIG compliance, SAM/LEIE screening, break-glass, minimum-necessary, audit export, AI audit trail 10-year retention

F1340-F1350

Daily cash, monthly close, payer mix, denials, A/R, write-off, coder productivity, days-in-A/R, cost-per-claim, collections velocity, AI coding impact

F1360-F1362

Zoll Billing, ImageTrend Billing Bridge, generic HL7/CSV

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