Every RPM & CCM Service Your Revenue Cycle Needs.

Credentialing delays cost practices revenue every day a provider is not yet enrolled with a payer. Our team handles the entire credentialing and re-credentialing lifecycle, from initial CAQH profile setup to payer-specific application submission and follow-up. We track every deadline and renewal so your providers are always actively enrolled.

For RPM, CCM, and Telehealth practices, proper credentialing is particularly critical. Many payers require specific telehealth or remote care endorsements before they will reimburse CCM or RPM codes. We know these requirements payer by payer and ensure your providers meet every one.

Most claim denials trace back to a single root cause: the eligibility was not verified before service. Our proactive eligibility process eliminates that problem entirely. Every enrolled patient is checked each morning through secure, real-time payer connections.

For RPM and CCM practices, eligibility is especially complex. You need to verify not just that a patient has active coverage, but that their plan covers remote monitoring services, what the deductible status is, whether RPM is a covered benefit, and whether a secondary payer exists. We extract all of that, accurately, every day.

Prior authorization requirements have expanded significantly for RPM devices, CCM programs, and specialty telehealth services. Many commercial payers now require PA before RPM device enrollment, and some require re-authorization every 6 to 12 months. Our team handles every submission, status check, and appeal.

We track authorization expiration dates automatically and initiate renewal workflows 30 days before any PA lapses. Your clinical team never has to worry about an interrupted RPM program because of an expired authorization.

Claim submission for RPM and CCM is more complex than standard medical billing. The same patient may require RPM codes (99453, 99454, 99457), CCM codes (99490, 99491), and telehealth E/M codes in the same month, with each requiring different documentation thresholds, modifiers, and time tracking. A single coding error can result in a denial or an audit flag.

Our automated claim scrubbing engine checks every claim against payer-specific rules, CPT code compatibility requirements, and CMS guidelines before submission. Claims that do not pass our internal quality check are held and reviewed by a certified coder before going out the door.

Accounts receivable follow-up and denial management are where most billing companies fall short. Claims sit in AR buckets for weeks without follow-up. Denials are worked sporadically. Patterns that signal systemic payer issues go unnoticed. The result is revenue that erodes quietly over months.

Our AR team works every outstanding claim on a structured follow-up schedule. Denials are flagged, categorized, and appealed the same day they arrive. We track denial patterns by payer and CPT code so we can identify systemic issues and address them at the source before they affect future claims.

For RPM and CCM programs, payment posting requires additional precision. Device supply codes (99454) often have different reimbursement rates than professional services. Patient copays for remote monitoring vary by plan. Our system automatically categorizes these payment types, ensuring accurate revenue attribution and patient balance calculation for every RPM/CCM claim.