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Healthcare

An RCM platform that took the keystrokes out of claim processing

An RCM company running dozens of practices across eClinicalWorks, athenahealth, PracticeSuite, EHI Connect and ModMed asked us to stop the copy-and-paste. We automated the volume work and gave them one place to run the day.

3.4x
more claims per biller per day
40s
per eligibility check, from 9 minutes
96%
of payments posted straight through
8 days
off days in A/R
The challenge

Where it started

Every client sat on a different practice management system, so the team spent the day switching portals and re-keying the same information.

Eligibility checks for the next day’s schedule, rejection files and payment posting were all manual — and the KPIs the owners managed on were assembled in a spreadsheet, days late.

Client: Revesolv

What we built

The solution, in four parts

One operations ERP

Work queues by task type with an SLA clock, allocation by skill and capacity, QA sampling, and live KPIs — days in A/R, clean claim rate, denial rate, productivity per FTE.

Eligibility automation

Tomorrow’s schedule checked in batch — 270/271 where the payer supports it, portal automation where it does not — with benefits written back to the PM.

Claims, rejections and denials

Claims scrubbed and submitted, rejection files parsed and corrected, denials grouped by CARC/RARC into worklists with the appeal pack assembled.

Posting with balancing checks

ERA posted automatically and scanned EOBs read by document AI, with anything under the confidence threshold routed to a person.

Technology

What it runs on

Mainstream, well-supported technology — chosen so the client’s own team can own it afterwards.

PythonPlaywright RPANode.jsReactAzure Document IntelligencePostgreSQL

The bots do the boring half of the job and our people finally have time for the appeals that actually pay.

Director of Operations, Revesolv

More work

Other outcomes we’re proud of

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