Automate Revenue Cycle Management from Eligibility to Payment Collection

Yes, our system fully supports CCBHC (Certified Community Behavioral Health Clinic) bundled payment billing. The system automatically captures qualifying services, populates required fields for PPS (Prospective Payment System) and cost-based reimbursement claims, and generates accurate UB04 forms with CCBHC-specific revenue codes. You can track CCBHC metrics and generate reports for federal and state compliance requirements.

Yes, the system supports multiple claim formats including CMS1500 for outpatient services, UB04 for inpatient and institutional billing, and customized invoices for grants and third-party payers. The system can automatically convert CMS1500 claims to UB04 format when needed and submits electronically via 837P (professional) or 837I (institutional) formats through ClaimMD, Office Ally, or Trizetto clearinghouses.

The system automates eligibility verification, charge capture, claim creation, claim submission, payment posting from ERA files, copay charge creation, patient payment collection, and patient statement generation. Automated workflows reduce manual billing tasks by up to 70% while maintaining accuracy and compliance. You can configure automation triggers based on your workflows—such as charge capture at check-in, check-out, or note sign-off.

You can run eligibility checks on-demand from client charts, appointments, or billing windows, or schedule automated verification to run daily, weekly, monthly, or annually across your client population. The system identifies active coverage, verifies benefits, and flags issues like Medicare Advantage or HMO plan requirements. Results display in a centralized window with clear active, inactive, or failed statuses, and the system alerts you if health plan end dates conflict with future scheduled appointments.

Denials and rejections appear in centralized windows with clear reason codes. You can filter by specific denial reasons or payers to prioritize work, assign denials to team members with automatic status tracking, and edit and resubmit claims directly from the window. The system automatically updates statuses when denials are resolved. For zero-payment ERA checks, the system separates them from paid checks so you can review adjustment codes and take appropriate action—resubmit, transfer to client balance, or write off.

The system includes an in-house clearinghouse connection through ClaimMD and also integrates with Office Ally and Trizetto. Claims can be submitted electronically via 837P format for professional claims or 837I format for institutional claims. The system automatically receives Electronic Remittance Advice (ERA) files from clearinghouses for automated payment posting, or you can manually import ERA files from payer portals.

You can enter and track authorizations within the system with low-balance alerts that notify you when authorizations are running low, allowing time to request re-authorizations before service interruptions. Configure when authorization units are deducted—when appointments are scheduled, when clients check in, when clinical notes are signed, or when claims are created—to align with specific payer requirements. Authorization details automatically populate into claims for compliance.

Yes, through Nexio integration, the system accepts credit card, ACH, and POS terminal payments. You can set up automated payment plans for client balances—monthly, bi-weekly, weekly, or one-time—and the system automatically collects payments and sends receipts to clients. Copay charges can be automated and linked to appointments, allowing collection during check-in. The system also tracks credit card on file status and alerts you to declined or failed cards.

The system provides actionable aging reports by buckets showing precisely where each claim sits in its lifecycle, allowing you to track balances through primary, secondary, tertiary, and client responsibility stages. You can close monthly books within the EHR and configure your general ledger so transactions automatically map to GL accounts. Bank reconciliation matches insurance and patient payments posted in the system with actual bank deposits by uploading your bank statements.

Yes, the eligibility verification system specifically identifies Medicare Advantage plans, HMO plans, and other managed care arrangements. This ensures you bill the correct payer and apply appropriate authorization requirements. You can configure service-specific eligibility checks for Mental Health or Substance Use services to surface coverage details relevant to behavioral health. The system also supports multiple authorization tracking for managed care plans with different deduction requirements.

The system applies intelligent automation for payer-specific rules including CPT codes, place of service, and modifiers. Based on payer and service type, it ensures correct modifiers for telehealth, appropriate place of service codes, and payer-preferred CPT codes. This reduces manual errors, minimizes technical rejections, and ensures compliance without staff memorizing payer-specific rules.