Revenue cycle management built for specialty medicine.
We take the buy-and-bill billing, starting with rheumatology, so clinicians and office staff can spend more time with their patients.
Benefits, eligibility, and prior authorization
Buy-and-bill revenue is decided before the infusion. We verify benefits, sort medical benefit from pharmacy benefit, and run prior authorization through submission, renewal, step therapy, and peer-to-peer review.
What this looks like for your practice
- Benefits and eligibility verification
- Medical versus pharmacy benefit
- Prior authorization, renewals, and step therapy
- Peer-to-peer review
- Patient assistance and copay programs
Coding, charge capture, and clean claims
Specialty-drug claims need exact J-code units, NDC, weight-based dosing, and waste modifiers. Claims are checked before they are sent.
What this looks like for your practice
- J-code units and NDC
- Weight-based dosing
- JW and JZ waste modifiers
- Claim check before submission
- Site of care
Denial recovery, appeals, and payment integrity
Each denial is reviewed for cause. Appeal drafts are checked by a specialist before they are sent. We also look for underpayments and downcoding.
What this looks like for your practice
- Cause of each denial
- Appeals reviewed by a specialist
- More than one level of appeal
- Underpayment and downcoding review
- Take-back and recoupment response
Analytics, margin, and inventory
In buy-and-bill, the bill and the inventory are the same problem. We match what you purchased, administered, and billed, and report margin by drug and by payer.
What this looks like for your practice
- Purchased, administered, and billed
- Margin by drug and by payer
- Monthly reports
- Quarterly review