Carenox runs provider-side RCM and clinical operations for clinics, ASCs, and health systems — eligibility & benefits, prior auth, coding QA, claims & rejections, AR/denials, HIM, and patient access. HIPAA/BAA, least-privilege access, SOPs, QA, SLAs, and dashboards included.
RCM success is payer policy + operational discipline. We align pods to your EMR/PM and payer mix, lock definitions next to dashboards, and keep QA objective with defect classes and AQL targets.
Front-end RCM, claims & rejections, AR/denials, and coding QA with clean-claim lift.
Patient access, auths, revenue integrity, HIM, and complex payer programs.
Case build, prior auth, benefits, coding QA, and day-of-surgery risk reduction.
Eligibility nuances, auth renewals, documentation QA, and payer-specific edits.
Order checks, medical necessity (LCD/NCD), auth, and representment workflows.
Eligibility/home services rules, documentation QA, billing & appeal templates.
Sliding fee, UDS reporting alignment, eligibility & enrollment coordination.
Virtual-care coding, place-of-service nuances, payer policy change control.
Predeterminations, auths, EOB reconciliation, and patient responsibility clarity.
Cardiology, Ortho, GI, Neuro — specialty payer rules, modifiers, and edits.
Charge capture, edits, audit readiness, documentation integrity, and HIM.
eTMF QC lanes with defect classes, checklist gates, and inspection-ready dashboards.
Clean-claim rate +11.8 pts; first-pass yield +9.1 pts via payer edit playbooks & rejection SWAT.
Median prior-auth TAT −32%; approval rate +7.4 pts; day-of-surgery cancels −41%.
Aging >90d −19.6%; collections yield +13.3%; touch rate +22% with stable adherence.
We’ll scope lanes, set SLAs & QA, and show dashboard tiles before go-live.
