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RCM Automation

End-to-end automation for revenue cycle companies. One ERP to run the day and watch the KPIs, and bots that do the portal work — eligibility checks, claim processing, rejection and denial files, payment posting — inside the systems your clients already use.

Who this is for

Built for RCM companies, not for a hospital IT department

If you run billing for other people’s practices, your problem is not one system — it is thirty. Every client is on a different PM or EHR, each with its own login, its own quirks, and its own way of handing you rejections.

We automate the repetitive half of that work and give you one place to run the operation: queues, turnaround times, productivity per person and the KPIs your clients ask about on the monthly call.

40s
per eligibility check, from 9 minutes
96%
of postings straight through
1
dashboard instead of a spreadsheet
Sound familiar?

Where the hours actually go

None of this is complicated work. That is exactly the problem — it is repetitive, it is high volume, and it still has to be right.

Twelve portals, forty logins

Every client sits on a different system — ECW here, athenahealth there, PracticeSuite, EHI Connect, ModMed — and your team spends the day switching between them and re-keying the same information.

Eligibility before every visit

EV has to be done for tomorrow’s schedule, for every payer, and a missed terminated policy turns into a denial three weeks later.

Rejections arrive as files

Someone downloads the rejection report, sorts it by reason, fixes what can be fixed, and re-uploads corrected claims — by hand, every day, for every client.

The KPIs are assembled by hand

Days in A/R, clean claim rate and productivity per biller live in a spreadsheet that is finished on Monday and out of date by Tuesday.

01 — The ERP

One system to run the day and prove the numbers

A working platform for your operation — not a reporting layer bolted on afterwards. Work comes in, gets allocated, gets done against an SLA, and the KPIs assemble themselves.

  • Client and practice master: payers, fee schedules, rules and contacts per client
  • Work queues by task type, allocated by skill and capacity, with an SLA clock on every item
  • Productivity and quality per person, per team, per client — including QA audit sampling
  • Live KPIs: days in A/R, A/R over 90, clean claim rate, first-pass resolution, denial rate and overturn, net collection rate, cost to collect
  • Client-facing views and monthly packs that come out of the same data you manage on
  • Shift, attendance and capacity planning, plus invoicing for the work delivered
02 — The automation layer

Bots that work inside the portals you already use

Where a payer or platform offers an API or an EDI transaction, we use it — it is faster and it does not break. Where there is nothing but a screen, a bot logs in and does the work the way your team does, and proves what it did.

  • 270/271 eligibility, 276/277 claim status, 837 submission and 835 remittance wherever they are available
  • Portal automation for everything else, with verification after every step — not blind clicking
  • Credentials held in a vault with least-privilege access; MFA handled, never shared over chat
  • Screenshot and timestamp for every action, so an audit or a client query takes minutes
  • Idempotent by design: a re-run cannot double-submit a claim or double-post a payment
  • Anything the bot cannot complete stops, keeps its state and lands in a human queue with the evidence attached
Process by process

What we automate, and what stays with your people

We start with the highest-volume, lowest-judgement work. Appeals, payer calls and anything that needs a clinical or contractual argument stay with your team — with better queues and better information.

ProcessHow we automate itWhat you get back
Eligibility & benefits (EV) Tomorrow’s schedule pulled from the PM, checked in batch — 270/271 where the payer supports it, portal automation where they do not. Copay, deductible, coinsurance, plan status and effective dates written back, with terminated coverage flagged before the visit.
Prior authorisation Submission where the portal allows it, then automated status chasing on a schedule instead of a person re-checking. An auth status per case, and an alert when one is about to expire.
Charge entry & claim creation Charges built from the EMR extract or superbill, validated against payer rules and your own scrub list before anything is sent. Fewer avoidable rejections, and a clean claim rate you can watch move.
Claim submission & status 837 through the clearinghouse where available; portal submission where it is not. Status checked automatically, not manually. Claims out the same day and a status history you can show the client.
Rejections Rejection reports downloaded, parsed and categorised by reason. Fixable ones corrected and re-uploaded; the rest routed with the reason attached. No file sitting in a shared drive for two days, and a daily count you can trust.
Denials 835 and scanned EOBs read and grouped by CARC/RARC and root cause, then routed into worklists with the appeal pack pre-assembled. Denials worked by value and age, and a root-cause report that stops them repeating.
Payment posting ERA posted automatically with balancing checks; scanned EOBs read by document AI, with anything below your confidence threshold sent to a person. Posting finished before the shift starts, and zero double-posted payments.
A/R follow-up Automated status checks and notes written back to the PM, so callers only pick up the cases that genuinely need a call. A prioritised worklist instead of an ageing report nobody can finish.
Patient balances Statement runs, reminders and payment-plan follow-ups scheduled and tracked. Faster patient cash without your team chasing it manually.
Where it runs

We work in the systems your clients already chose

You are not replacing anything. Nothing changes for the practice — the same PM, the same portal, the same logins. The work simply gets done by a bot that leaves a better trail than a person could.

eClinicalWorks (ECW)athenahealthPracticeSuiteEHI ConnectModMedKareo / TebraAdvancedMDNextGenDrChronoCareCloudOffice AllyAvailityWaystarOptum / ChangePayer portals

If your client is on something not listed here, that is normal — most of this work is the same shape whatever the screen looks like. We assess a new portal in a few days and tell you honestly whether it is a good automation candidate or not.

API and EDI first

Where a real interface exists we use it. It is faster, cheaper to run and it does not care if a screen moves.

RPA where there is none

Resilient selectors, a check after every step and a screenshot when something looks wrong.

Credentials handled properly

Vaulted, least-privilege, rotated, with MFA flows designed in rather than worked around.

Everything evidenced

Every action logged with a timestamp and a screenshot, ready for an audit or a client question.

The part your compliance officer asks about

PHI, handled like it matters

HIPAA & BAA

We sign a BAA, work to minimum necessary, and keep PHI out of logs, tickets and screenshots that do not need it.

Runs in your tenancy

Deployed in your cloud account or private environment. Data residency and retention are yours to set.

Access by role

Who can see which client, which bot may touch which portal, and an audit trail on every change.

Offshore-ready

Built for teams split across locations — controls that hold up when your delivery team is in another country.

How we start

One process, one client, thirty days

We do not start with a platform rollout. We pick the process that hurts most — usually eligibility or rejections — measure how it runs today, and automate it for a single client first.

Talk about a pilot

Week 1 — Measure

We sit with your team, count the volumes, time the steps and write down the error rate. That baseline is what everything is judged against later.

Week 2 — Build

The bot is built against a test account, including the awkward payers and the exceptions your team handles quietly today.

Week 3 — Run in parallel

Bot and team do the same work side by side until the output matches. You see every difference, not a summary.

Week 4 — Hand over the volume

The bot takes the queue, your people take the exceptions, and the ERP starts showing what actually changed. Then we pick the next process.

What changes

The numbers we baseline against

These are the targets we set with RCM clients and measure from day one — not a guarantee, and we will tell you early if your process is not going to reach them.

0
less time per eligibility check
0
of payments posted straight through
0
off days in A/R
0
more claims per biller, per day

The bigger change is usually where the people go: chasing fewer files, working more appeals and A/R that actually needs a human argument.

Questions

What RCM owners ask us first

If yours is not here, ask it. We would rather talk you out of automating something than sell you a bot that breaks.

Ask us directly
The bot fails safely rather than doing the wrong thing — it stops, keeps its state, captures a screenshot and raises an exception. We build with resilient selectors and monitor for changes, and portal updates are part of the support arrangement rather than a surprise invoice.
It depends on the platform’s terms and on the credentials being genuinely yours or your client’s, used the way a person would use them. We check this per portal before we build, prefer the vendor’s API or EDI path when one exists, and will tell you where a portal makes automation a bad idea. MFA is handled through supported flows, never by disabling the control.
Yes — eligibility, claims and remittance work is PHI by definition. It runs in your own cloud tenancy under a BAA, with role-based access, encryption in transit and at rest, and PHI kept out of logs and screenshots wherever it is not needed. You set retention.
No. That is the point of this approach. The practice keeps ECW, athenahealth, ModMed or whatever they use, and nothing about their day changes. The automation and the ERP sit on your side.
In practice it changes what they do rather than how many there are. The volume work moves to bots and the team moves to exceptions, appeals and A/R — which is where the money is anyway. We will show you the honest headcount maths for your process before you commit.
Yes, either way round. Most clients start with one automation to prove the model, then add the ERP once several processes are running and they want one view of it all. The two are designed to work together but neither depends on the other.
Discovery and the pilot are fixed price. After that it is usually a build cost plus a monthly run-and-support cost sized to volume — so it scales with the work rather than with your headcount. We put the expected cost per transaction next to the current cost per transaction and let you decide.
What it is built from

The practices behind this offering

Pick the process that hurts most.

Tell us the volumes and which portals your clients live in. We will come back with what we would automate first, what it should cost, and what it should save.