Services

Provider Services
Our India-based team delivers end-to-end Revenue Cycle Management (RCM) support designed to help healthcare providers improve accuracy, reduce administrative burden, and strengthen financial performance. From patient access and medical coding to claim submission, denial management, AR follow-up, and analytics, we ensure every step is handled with transparency, efficiency, and a commitment to quality—so providers can focus on delivering exceptional care.

Payor Services
Our payor services team supports end-to-end administrative and clinical operations to help health plans improve accuracy, reduce operational costs, and enhance member experience. We provide comprehensive solutions including claims adjudication, provider data management, prior authorization processing, eligibility and benefits verification, medical coding reviews, and audit support. With strong expertise in U.S. healthcare regulations and payor workflows, our India-based operations deliver high-quality, scalable, and timely services designed to strengthen compliance, optimize turnaround times, and drive measurable operational efficiency.

Provider Services

Eligibility & Benefits Verification —

We verify patient insurance coverage, benefits, copays, deductibles, and policy requirements before visits. This pre-visit confirmation ensures accurate billing, prevents claim denials, and eliminates surprise balances. Our team coordinates with payors to confirm eligibility, authorizations, and coverage details for seamless revenue cycle start.

Coding —

Our certified coders translate clinical documentation into accurate ICD-10, CPT, and HCPCS codes. We ensure coding compliance, proper modifier usage, and medical necessity documentation to maximize reimbursement. Regular audits and coder training maintain coding accuracy and reduce denials across all service lines.

Charge Entry —

We capture charges from clinical documentation with 100% accuracy. Our charge entry specialists validate CPT/HCPCS codes, units, and modifiers against services rendered. Daily reconciliation ensures complete charge capture, preventing revenue leakage and ensuring claims reflect all billable procedures performed

Billing —

We submit clean claims on first pass using payer-specific rules and scrubbing. Our billing team validates data, applies edits, and ensures compliance with payer guidelines. This minimizes rejections, accelerates payments, and maintains clean AR while maximizing first-pass claim acceptance rates.

Payment Posting —

We post ERA/EOB payments accurately to patient accounts with auto-secondary matching. Our team reconciles payments, identifies underpayments, and flags denials for immediate follow-up. Clear payment visibility enables precise financial reporting and supports effective denial management across all payer types..

Credit Balance Review —

We identify and resolve credit balances through systematic review. Our team processes refunds, corrects posting errors, and reconciles overpayments per payer contracts. Regular credit balance monitoring ensures compliance, optimizes cash flow, and prevents audit findings from improper balance management.

AR Management —

We reduce AR days through systematic aging bucket management. Our team traces claim status, resolves payer issues, appeals denials, and negotiates underpayments. Zero-balance accounts receive final follow-up. This disciplined approach ensures timely cash collection and sustainable revenue cycle performance.

Payor Services

Eligibility Verification -

We verify patient insurance coverage, benefits, copays, deductibles, and policy requirements before services begin. Pre-service eligibility checks prevent claim denials, eliminate surprise billing, and ensure accurate revenue capture from day one. Our team coordinates authorizations and coverage details with all major payors for seamless processing.

Claim Adjudication -

We review incoming claims for coverage eligibility, clinical documentation accuracy, and payment compliance. Our adjudication specialists validate coding, identify coverage gaps, and resolve issues before payment posting. Systematic claim review minimizes payment errors, supports clean processing, and ensures accurate reimbursements across all payer contracts.

Claims Adjustment -

We process payor feedback to correct claims with updated coding, documentation, or patient information. Our adjustment specialists revise CPT/HCPCS codes, modifiers, and units per payer requirements. Accurate adjustments ensure proper reimbursement, reduce AR rework, and resolve discrepancies efficiently while maintaining compliance standards.

Provider Database Management -

We maintain comprehensive provider databases with verified credentials, active contracts, specialties, and payor enrollments. Accurate provider data prevents claim rejections, enables clean submissions, and ensures regulatory compliance. Regular audits and updates support seamless claims processing across all payer relationships and service lines.

PCRS – Provider Call Back Resolution -

We resolve provider inquiries about claim status, payor requirements, and documentation issues within 24-48 hours. Our PCRS specialists provide clear answers, process escalations, and prevent repeat calls. Quick resolutions improve provider satisfaction, strengthen payor relationships, and maintain efficient revenue cycle operations.