Medical Billing & RCM Services

Our flagship medical billing service covers every step of the revenue cycle from charge capture through final payment posting. When you outsource medical billing to Healix RCM, you get a dedicated billing team that understands not just how to submit claims, but how to maximize reimbursement for every service your providers deliver.

Charge capture begins at the clinical documentation level. Our billers review provider notes before coding to catch underdocumented services that would otherwise result in downcoding or outright rejection. We assign ICD-10 diagnosis codes, CPT procedure codes, and HCPCS supply codes with precision, applying appropriate modifiers based on your specialty's coding conventions and payer-specific rules. Every claim passes through our proprietary scrubbing process — checking NCCI edits, LCD/NCD compliance, bundling conflicts, and payer-specific rules that commonly trigger rejections. Claims that fail our internal review are corrected before submission, not after denial. This pre-submission accuracy is how we maintain a 98%+ first-pass acceptance rate. After submission, we track every claim through adjudication, appeal underpayments based on your contracted fee schedule, and post every payment daily. Practices that switch to Healix RCM average a 25–35% increase in net collections within the first six months.

Revenue cycle management is broader than billing. It encompasses every administrative and financial process that generates revenue — from the moment a patient schedules an appointment through the final resolution of their account. Healix RCM's full RCM service covers every touchpoint.

We begin before the patient arrives. Pre-visit eligibility verification confirms active coverage, identifies deductibles and copay obligations, and flags prior authorization requirements before services are rendered. This proactive approach eliminates one of the most common sources of denied claims: billing for services that required pre-approval that was never obtained. Post-visit, we manage the complete cycle: coding, claim submission, payment posting, denial management, AR follow-up, patient billing, and financial reporting. Our platform integrates with 150+ EHR and practice management systems — meaning data flows without manual re-entry and your clinical workflow is never disrupted. The reporting layer of our RCM service gives administrators real-time visibility into clean claim rate, denial rate by payer and code, AR aging, collection rate by payer class, and month-over-month revenue trends. Our clients average 28 AR days — compared to the industry average of 40–45 days — which directly accelerates your cash flow. See our full list of technology integrations on our&nbsp;<Link href='/technology' className='text-blue-600 hover:underline font-medium'>technology page</Link>.

Claim denial is the single most direct source of revenue loss in medical billing. The American Medical Association reports the average practice spends $25 per claim on rework after denial — and many denied claims are never resubmitted at all. Healix RCM&apos;s claims processing service is designed to prevent denials before they occur and resolve them aggressively when they do.

Our claims workflow begins with a pre-submission audit. We verify patient demographics against payer records, confirm modifier usage is compliant, cross-check diagnosis and procedure code pairing for medical necessity, and apply payer-specific edits learned from years of claims experience. Claims that fail any check are corrected before submission — not after. For claims that are denied despite our process, our dedicated denial management team categorizes each denial by root cause, prepares the appropriate appeal, and tracks resolution. We don&apos;t simply refile claims — we analyze denial patterns to identify systemic issues in documentation, coding, or workflow, then work with your clinical team to fix the upstream problem. Our clients achieve a 1.4% denial rate — compared to the industry average of 5–7%. For a practice billing $2M annually, reducing your denial rate from 6% to 1.4% recovers over $92,000 in revenue that was previously being written off.

Prior authorization is one of the most significant operational burdens in modern healthcare. The AMA&apos;s annual survey consistently finds physicians spend an average of 16 hours per week on prior auth — time pulled away from patient care and generating no revenue. When authorizations are missed, procedures get denied and practices face the impossible choice of writing off completed services or billing patients who believed their care was covered.

Healix RCM&apos;s prior authorization management handles the entire process end to end. We track every scheduled procedure against current payer auth requirements, submit requests proactively with complete clinical documentation attached, conduct peer-to-peer reviews when initial requests are denied, and file formal appeals with supporting medical literature when necessary. We maintain a live database of authorization requirements for every major payer across all procedure types and service lines. When payer policies change — and they change frequently and without notice — our team updates its protocols within 24 hours so your practice never submits an unintentionally unauthorized claim. Our 94%+ approval rate means the vast majority of requests are approved on the first attempt. For complex cases requiring appeals, our clinical documentation specialists have deep experience building appeal packages that meet each payer&apos;s specific evidentiary requirements.

No billing matters if your providers are not properly credentialed. An uncredentialed provider cannot bill any payer in their network, and the credentialing process — primary source verification, CAQH profile management, payer application submission, hospital privileging — can take 60–120 days per provider if not managed correctly. Errors in applications or missed deadlines extend that timeline further, leaving revenue uncollected the entire time.

Healix RCM&apos;s credentialing service handles initial credentialing, re-credentialing cycles, CAQH maintenance, payer enrollment, and hospital privileging for all provider types — physicians, NPs, PAs, LCSWs, and facility credentialing for outpatient practices and imaging centers. We manage your entire provider database, monitoring expiration dates on licenses, DEA certificates, malpractice insurance, and board certifications 120 days in advance. When renewal deadlines approach, we handle the renewal process and update all payer records automatically — preventing the coverage gaps that trigger sudden claim denials for services that were fully covered the previous month. Our 95% first-attempt approval rate and 45-day average turnaround time are the benchmark in the industry. For imaging centers and diagnostic facilities requiring IDTF enrollment and ACR accreditation support, our specialized&nbsp;<Link href='/services/imaging-center-credentialing' className='text-blue-600 hover:underline font-medium'>imaging center credentialing service</Link>&nbsp;handles the additional complexity.