What You Get
- SOPs with version control and change-control tickets
- SLAs (p50/p90) and AQL QA with calibration cadence
- Dashboard tiles with definition locks and drill-to-evidence
- Weekly notes, risk register, and QBR governance
Revenue Cycle Services for Every Clinic
Add capacity in a single lane, or hand off end-to-end billing. Every engagement includes SOPs, SLAs/QA, and dashboards with drill-to-evidence. Built for multi-specialty, urgent care, imaging, and enterprise groups.
Lane Services (Add What You Need)
Target specific steps of your revenue cycle with calibrated pods, AQL QA, and clear playbooks. Start small, expand as results compound.
Claims Submission & Charge Entry
Clean, complete, compliant claims with payer-edit scrubs and 24–48h rejection recovery.
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Denial Management & Appeals
Root-cause Pareto, appeal templates mapped to policy, and overturn tracking by payer/reason.
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Accounts Receivable (AR) Follow-Up
Worklists for 30/60/90+, high-dollar lanes, payer sequencing, and collections yield dashboards.
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Coding QA / HIM Accuracy
AQL sampling, defect classes (NCCI, modifiers, LCD/NCD), reviewer calibration, and audit readiness.
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Provider Credentialing & Enrollment
Payer applications, re-validations, roster maintenance, and aging resolution with SLAs.
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Reporting & Analytics
Clean-claim rate, FPY, denial mix, days in AR, and payer performance — with definition locks to prevent drift.
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Full-Service Billing (Managed RCM)
End-to-end accountability from charge entry through collections. Runbooks, SLAs, QA calibration, and governance included. Near/on/offshore options with follow-the-sun coverage.
Managed RCM
Outcomes across the revenue cycle with immutable evidence tiles and steady-state delivery.
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Pilot / Diagnostic
Time-boxed diagnostic and pilot to prove uplift and stabilize edits before scaling.
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Hybrid QA
Keep production in-house while Carenox runs QA, calibration, and drift checks.
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Security & Compliance
- Least-privilege access (SSO preferred), audit trails, JML reviews
- BAAs where PHI is in scope; incident response mapped
- Evidence attachments and retention policy alignment
Not sure where to start?
Share your payer mix and goals — we’ll recommend a lane or a managed model with a pilot timeline.