Skip to Main Practice Content
RCM INFRASTRUCTURE & FINANCIAL ENGINEERING

Engineered To Recover Every

C
O
N
T
E
S
T
E
D
 
D
O
L
L
A
R

In US Healthcare Architecture

Eliminate operational friction, systemic payer underpayments, and locked cash flow with disciplined claim architecture and rapid AR aging liquidation.

0%
Clean Claim Rate
First-Pass Adjudication
< 0 Hrs
Batch Ingestion
Same-Day EDI 837 Submission
0-Hour SLA
Denial Triage
Level 1–3 Direct Appeals
0%
HIPAA BAA Compliant
Zero Local PHI Perimeter
CORE RCM SERVICE ARCHITECTURE CAPABILITIES

SixDedicatedPillarsofHealthcare Revenue Infrastructure

From full cycle medical billing to surgical coding, aged AR recovery, and dedicated virtual assistance step through each specialized operational capability below.

CAPABILITY 1 OF 6
FULL-CYCLE REVENUE CAPTURE

Medical Billing & Claim Transmission

Transform your practice into a high-performing financial entity. We execute audit-proof billing workflows that excel in technical velocity and mathematical accuracy.

Same-Day Electronic Claim Submission (EDI 837)
Automated ERA 835 Payment & Copay Posting
Daily Bank Lockbox Deposit Reconciliation
Line-Item Patient Responsibility Isolation
VERIFIED SLAEDI 837 ANSI X12 Standard
Core Operational Mandate Sovereign Standards

The Four Pillars of Revenue Assurance

Non-negotiable operational standards applied across all provider accounts, surgical centers, and DME pipelines under Medavyn RCM command.

01 / 04
Pillar 01: DENIAL MITIGATION

Denial Management & Root-Cause Appeals

Systematic categorization of CO, PR, and OA adjustment codes. We intercept zero-dollar 835 remittances within 12 hours, overturn medical necessity denials via LCDs, and file certified Level 1–3 redeterminations.

CO-16 / CO-50Level 1-3 Appeals94.8% Overturn
Interactive Operational Telemetry

Claim Resolution Lifecycle Engine

Trace how a denied $14,850.00 specialty claim is scrubbed, appealed, and liquidated through our operational pipeline.

Phase 01: ERROR TRAPPING12-Hour Triage SLA

835 Electronic Remittance Triage & Parsing

Inbound ERA/835 batches are programmatically intercepted to isolate non-zero balance remark codes, categorizing zero-dollar adjudications before they enter dormant buckets.

Protocol Lock:CO-16 / N56 (Missing Clinical Notes)
Automated extraction of Claims Adjustment Reason Codes (CARCs & RARCs)
Cross-referencing EOB line items against active Clearinghouse 277CA acknowledgments
Instant routing to dedicated specialty appeal queues within 12 hours of remittance
ERA 835 Remittance Triage Dashboard
STAGE TELEMETRY835 Remittance Triage
SYNCED
Standard Operating Protocols

Institutional Compliance & Scrutiny

Every workflow adheres strictly to statutory federal billing standards, HIPAA BAA mandates, and ASC X12 EDI transmission protocols.

CLEARINGHOUSE ARCHITECTURE

ASC X12 Standard Transaction Sets

• Direct HIPAA ANSI 5010 Clearinghouse EDI Pipelines

Enterprise EDI connectivity guaranteeing pre-submission syntax validation, zero missing fields, and real-time electronic claim and remittance synchronization.

EDI 837P / 837I (Claims):

Professional and institutional electronic claim batch transmissions with automated NCCI Column 1/2 edit screening prior to payer delivery.

EDI 835 (Electronic Remittance):

Automated ERA parsing extracting line-item CARC/RARC remark codes into active appeal worklists within 12 hours of transmission.

EDI 270 / 271 (Eligibility):

Real-time verification of active insurance coverage, copays, deductibles, and secondary payer coordination of benefits.

EDI 276 / 277 (Status Tracking):

Continuous clearinghouse 277CA telemetry preventing silent claim drop-offs and timely filing forfeitures.

HIPAA ANSI X12 5010 CERTIFIED
AUDITED
WORKFLOW INTEROPERABILITY

Multi-EHR Ecosystem Fluency

• Native Task Queue Command & Zero-Migration Friction

Frictionless plug-and-play capability inside your practice's existing electronic health record and practice management systems. We execute within your native clinical task queues.

AthenaHealth / Collector:

Native unbilled claim bucket management, custom billing rule engine enforcement, and automated patient statement generation.

Kareo / Tebra Architecture:

Electronic super-bill crosswalk validation, denial reason tracking, and patient responsibility isolation.

Epic Resolute & eCW (eClinicalWorks):

Account activity audit logs, guarantor ledger balancing, and hospital-based multi-provider credentialing management.

AdvancedMD & NextGen:

Custom fee-ticket templates, automated payer matrix crosswalks, and high-volume billing batch synchronization.

NATIVE PM / EHR FLUENCY
AUDITED
FINANCIAL ALIGNMENT

Performance-Based Recovery & SLAs

• Incentive-Aligned Engagements with Audited Warranties

Our aged AR recovery engagements operate purely on realized cash collections. We tie our operational compensation directly to your practice's net recovered revenue.

Pure Collections-Based Model:

Zero upfront licensing costs for AR aging projects; fees are calibrated strictly as a percentage of net liquid cash recovered.

24-Hour Charge Drop SLA:

100% of received provider clinical encounter sheets are coded, scrubbed, and batched within 24 business hours of receipt.

12-Hour Denial Triage SLA:

Zero-dollar and partial ERA 835 remittances are categorized and routed to appeal queues within 12 hours of batch arrival.

100% Mathematical Parity:

Daily deposit lockbox reconciliation against posted batches to guarantee $0.00 unapplied cash.

100% CASH-REALIZED ALIGNMENT
AUDITED
Zero Obligation Assessment

Ready to Liquidate Your Unresolved Claims Bucket?

Send us an anonymized aging AR report or sample EOB denial. We will return a line-item recovery feasibility breakdown within 24 hours.