01 / FRONT-END SERVICES
Start clean.
Build the billing foundation before the claim ever moves into the cycle. Click any stage below to explore workflow deliverables.
STAGE 01
Provider Credentialing & Payer Enrollment
Complete provider onboarding and payer credentialing that establishes clean billing foundations with zero revenue hold.
- CAQH Profile setup, attestations, and NPI validation
- Commercial, Medicare & Medicaid payer network contracting
- Expiring license, DEA, and board certification tracking
STAGE 02
Real-Time Benefit & Eligibility Verification
Confirm patient insurance coverage, active policy dates, and cost-share schedules prior to scheduled appointments.
- Real-time EDI 270/271 electronic eligibility confirmation
- Copay, coinsurance & remaining deductible calculation
- Primary & secondary coordination of benefits (COB) check
STAGE 03
Clinical Prior Authorization Clearance
Secure timely payer authorizations and pre-certifications so clinical care proceeds without unapproved service write-offs.
- Medical necessity clinical chart compilation
- Direct payer portal submission & tracking (EDI 278)
- Peer-to-peer physician coordination and reference logging
STAGE 04
Accurate Medical Charge Entry & Coding Audit
Translate clinical documentation into compliant, scrubbed charge entries aligned with payer-specific fee schedules.
- CPT, HCPCS & ICD-10 diagnosis code pointer audit
- Modifier application (25, 59, RT/LT, 51) validation
- Pre-claim automated scrubbing for bundling rules
FOUNDATION / 01
