For Independent medical billing and outsourced revenue cycle companies serving small practices
Track provider enrollment and revalidation dates across client practices
A client hires a new provider and starts seeing patients before payer enrollment is approved, or a revalidation date or CAQH attestation lapses. Claims deny for credentialing reasons, and they look like ordinary denials until someone traces them back.
What it can cost you
Example: 1 new provider seeing 60 patients before enrollment clears x $110 = $6,600 in claims held or denied.An illustration, not a promise. Your Opportunity Scan puts a real number on it.
What the system checks overnight
- Tracks enrollment status by provider and payer for every client.
- Flags providers with visits scheduled under a payer where enrollment is still pending.
- Flags revalidation and recredentialing dates inside your set lead time.
- Flags CAQH ProView attestations coming due.
- Ties credentialing denials back to the provider and payer behind them.
Where it reads from
- CAQH ProView
- athenahealth
- AdvancedMD
- Tebra
- eClinicalWorks
- Availity
What happens when it fires
Your credentialing team gets dated reminders, and the account manager gets a drafted note to the client about visits booked before enrollment clears.
Autonomy level: Draft for approval. The system prepares the message or task, and you approve it before anything goes out.
What we guarantee
Every provider's enrollment and attestation dates are checked nightly against your lead times. We agree on the metric before the Sprint starts and measure it over the first 20 business days after go-live. If we miss it, you get half your Sprint fee back. Dollar savings are tracked in your monthly saves log, reported rather than promised.
Questions
We do not offer credentialing. Is this still useful?
Yes, because enrollment gaps show up as your denials. Even if the client handles enrollment, knowing about a gap before claims go out saves rework.
Does it submit applications?
No. It tracks dates and statuses that you or the client record.
Do I need new software for this?
No. The system reads from the tools you already use, with read-only access by default. A guardrail layer controls exactly which data the AI can see.
What does it cost?
A 3-week Sprint is $6,000 fixed and includes the morning brief plus one automation tied to an agreed metric. Ongoing support is $1,500 a month, or $500 a month to keep it running without new automations. If the agreed metric is missed over the first 20 business days after go-live, half the Sprint fee is refunded.
How is this different from a dashboard app or a free AI kit?
A dashboard app shows numbers when you go look. A free AI kit gives you the parts, and you do the setup, the upkeep, and the checking. Here the alarms are built for your kind of business, they watch outside data like market rates and rule changes alongside yours, and on Run or Keep-Running, the person who built them keeps them working and logs what they caught.
More alarms for medical billing companies
Seven more things worth watching.
- Client A/R aging creepTrack days in A/R and aging buckets for every client and payer nightly, and flag the client whose older A/R is growing before they notice it first.
- A client stopped sending chargesCompare each client's charge volume with its schedule and normal pace, and flag lag-to-bill growing toward payer timely filing limits.
- Denial spikes by client and payerGroup denials by payer, reason, and CPT code across every client nightly, and catch one payer change hitting several clients at once.
- Clearinghouse rejections nobody workedCount open clearinghouse rejections by client and reason, flag queues nobody touched, and catch claims the payer never acknowledged.
- Payments not posted or posted shortMatch deposits with ERAs and posted payments for every client, flag ERAs not posted, and catch payers paying below the client's fee schedule.
- Work queues aging by billerAge open claims and denials by assigned biller, flag backlogs that are growing, and suggest how to rebalance work before follow-up stops.
- Client accounts at riskCompare each client's fee revenue with staff hours, flag falling collections, late fee payments, and renewals coming up across your book.
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