Carenox HealthCarenox Health

Multi-Specialty Clinics: Front-to-Back RCM Lanes

We stabilize eligibility & benefits, prior auths, coding QA, claims & rejections, and AR/denials—on your EMR/PM and payer mix.

Talk to an RCM LeadLanes We Run

Why Carenox for Clinics

We align pods to specialties and payer policies. QA is objective (defect classes, AQL), definitions live next to dashboards, and change control keeps macros/SOPs current.

  • Specialty-aware QA (modifiers, NCCI, LCD/NCD, ICD specificity)
  • Eligibility/auth checklists with payer exemplars
  • Rejection SWAT windows (24–48h) tied to edit library
  • AR/denial worklists with appeal templates and evidence

Lanes We Run

  • Eligibility & Benefits (real-time + exceptions)
  • Prior Authorization (payer criteria & renewals)
  • Scheduling & Patient Access macros
  • Up-front estimates & financial counseling
  • Charge Entry & Claim Scrub (edit library)
  • Rejections SWAT (24–48h recovery)
  • Payment Posting & Refunds
  • AR Follow-up & Denials/Appeals
  • Coding QA (AQL, drift checks, exemplars)
  • Revenue Integrity checks
  • HIM coordination
  • Dashboards & definitions catalog

How We Engage

RCM Staffing Pods

Stand up pods on your stack with calibrated QA & dashboards.

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Managed Outcomes

SLAs on clean-claim, auth TAT, AR aging, denial win-rate—with evidence.

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Diagnostic & Playbook

Time-boxed assessment to lock definitions, QA, and a pilot plan.

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Operating Model

  1. Define lanes, SLAs, and QA targets with exemplars
  2. Playbooks & macros; exception paths by payer
  3. Pods & cross-training; calibration cadence
  4. Dashboards with drill-to-evidence
  5. QBRs & continuous improvement

Key KPIs

  • Clean-claim & first-pass yield
  • Auth TAT & approval rate
  • AR aging buckets & denial win-rate
  • Coder QA pass rate & rework

Recent Outcomes

Clean-Claim Lift

+11.8 pts; FPY +9.1 pts via edit playbooks & SWAT windows.

Prior Auth

Median TAT −32%; approvals +7.4 pts; DOS cancels −41%.

AR & Denials

Aging >90d −19.6%; collections +13.3%; touch rate +22%.

Privacy & Security

HIPAA/BAA, least-privilege access, evidence logging, quarterly access reviews.

EMR/PM

We work in your EMR/PM and payer portals; definitions/QA live next to dashboards.

Clinic FAQs

Can we start with one lane?

Yes—many clients start with rejections or AR 60/90+ and expand.

Do you change our EMR?

No. We stabilize on your stack. Edit library & macros are versioned with change control.

Need measurable RCM lift?

We’ll scope lanes, SLAs/QA, and dashboard tiles before go-live.

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