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Our Solutions

Provider Services

Coding/Health Information Management (HIM)

• Remote Coding
• Inpatient (Hospital and Physician)
• Emergency Department (Hospital and Physician)
• Outpatient (Hospital and Physician)
• Clinics (Hospital-Based and Physician)
• Urgent Care
• Ambulatory Surgery/Same Day Surgery (SDS)
• Coding Audits
• Diagnosis Related Groupings (DRG) Validation
• Recovery Audit Contractor (RAC) Audit Support
• Evaluation and Management Coding Audits
• Coding Revenue Integrity Audits
• Clinical Documentation Improvement
• Provider Education
• Revenue Impact Analysis
• Clinical Abstraction
• Healthcare Effectiveness Data and Information Set (HEDIS)
• HCC Coding
• Virtual Scribe
• E/M Auditing & Consulting
• Care Coordination and Chronic Care Management

Revenue Cycle Management

• Patient Access Management
• Scheduling and Pre-Registration
• Eligibility and Benefit Verification
• Referral and Authorization Management
• Provider Credentialing and Enrollment
• Edit Resolution/Claim Submission
• Payment Posting and Reconciliation
• Accounts Receivable and Denial Management
• Credit Balance Review
• Insurance Underpayment Recovery Services
• Advisory and Consulting Services
• Revenue Cycle Gap Analysis
• Resource Utilization and Management
• Boot Camp Training
• Refresher Training
• Process Management Techniques
• IT Development and Analytics
• Analytics and Reporting
• Revenue Cycle Automation
• Sona ProMISe AR Workflow
• Revenue Cycle Consulting/Revenue Recovery

Call Center Services

• Healthcare Customer Service
• Appointment Scheduling
• Early Out Self Pay

Payer Services

Medical Coding Services

• Hierarchical Condition Category (HCC) Coding
• Risk Adjustment Data Validation (RADV) Audit Support
• Risk Adjustment Factor (RAF) Optimization
• Diagnosis Related Groupings (DRG) Validation
• Coding Audits
• Clinical Reviews (Workers Comp, Auto No-Fault)

Claims Management

• Claims Conversion
• Claims Repricing
• Claims Adjudication Support
• EDI 5010
• Pre-Adjudication Support

Member Management

• Eligibility and Enrollment
• Premium Invoice Billing
• Member Mobile App

Provider Network Data Management

• Provider Data Management
• Credentialing

Value Added Services

• Plan Building
• Customer Service Representative Calling
• Analytical Dashboards

Utilization Management

Risk Adjustment

Prospective Risk Review

Concurrent Risk Review

Retrospective Risk Review

Risk Adjustment Optimization

Pharma/Biopharma

Hub Services

• Patient Enrollment
• Reimbursement Support
• Benefit Verification and Re-Verification
• Prior Authorization
• Appeals Management Assistance
• Commercial Co-Pay Assistance
• Care Management

Business Intelligence and Analytics

Clinical Analytics

Revenue Cycle Analytics

Business Office Analytics

Strategy and Consulting

Revenue Cycle Consulting/Revenue Recovery

Care Coordination and Chronic Care Management

CDI Review

• Provider Education
• Revenue Optimization

Inpatient (Hospital and Physician)

Provider Education

E/M Auditing and Consulting