Full-Cycle Revenue Management

Billing & Revenue Cycle
Built to Maximize Collections

From eligibility verification to ERA posting, denial management, and patient payments — every step of the revenue cycle in one integrated platform.

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Practice Performance Dashboard Live
98.2%
Clean Claim Rate
14d
Days in A/R
2.8%
Denial Rate
96.4%
Collection Rate
Claim Lifecycle

From Visit to Payment — Every Step Automated

Claims flow automatically from documentation through submission, posting, and follow-up. No manual steps, no dropped claims.

Draft Auto-generated from note
Scrubbed CPT/ICD-10 validation
Submitted EDI 837P to payer
Accepted 999/277 acknowledgment
ERA Posted Auto-posted, patient balance set
Denied → Appeal Auto-routed with AI appeal letter
Claim Scrubbing

98%+ Clean Claim Rate
Out the Door

Every claim runs through multi-layered validation before submission. CPT/ICD-10 compatibility, modifier logic, payer-specific rules, and NPI validation — caught before they reach the payer and get denied.

  • CPT and ICD-10 compatibility validation
  • Modifier logic and unbundling checks
  • Payer-specific editing rules
  • EDI 837P submission via clearinghouse
  • ERA 835 auto-posting to patient accounts
  • Secondary claim generation after primary EOB
  • NPI and taxonomy validation
  • Real-time eligibility at scrub time
Claims Queue — Today

Nguyen, T. — Aetna PPO

17000 (Destruction actinic keratosis) × 3, 99213

$387.00 ✓ Ready to Submit

Patel, M. — UnitedHealth

11102 (Shave biopsy), 99214-25

$512.00 ✓ Ready to Submit

Martinez, L. — BCBS

17110 — missing modifier for bilateral procedure

$295.00 ⚠ Needs Review
Claim scrubber caught modifier error before submission — preventing likely denial and 3-week delay.
Denial Management

Work Denials Faster with CARC/RARC Decoding

Automated denial reason decoding, appeal template generation, root cause trending, and rework tracking — so nothing slips through.

<3%
Denial Rate
94%
Appeal Success Rate
4.2d
Avg. Days to Rework
CARC 97 Payment adjusted because the benefit for this service is included in the payment/allowance

Suggested action: Resubmit with RARC M144 — check for duplicate billing or bundling conflict with primary CPT. Appeal template generated.

CARC 4 Service inconsistent with modifier or service is excluded

Suggested action: Add 25 modifier for E&M on same day as procedure, or correct to appropriate E&M level. One-click correction available.

Prior Authorization

AI-Powered Prior Auth Approvals

Automatic PA requirement detection, clinical documentation assembly, and AI-generated payer-specific medical necessity letters. Approvals in days, not weeks.

1

PA Requirement Detection

System automatically detects when a procedure or medication requires prior authorization based on payer and policy ID.

2

Clinical Documentation Assembly

Pulls relevant notes, diagnosis history, prior treatments, labs, and photos from the chart — exactly what the payer needs.

3

AI Medical Necessity Letter AI

Claude AI generates a complete, payer-specific medical necessity letter using the assembled clinical evidence. Provider reviews and approves in minutes.

4

Payer Submission

Submitted electronically via the payer portal or fax. Status tracked automatically with follow-up reminders.

5

Approval & Expiration Tracking

Approval stored in patient chart with auth number. Alerts fire 30 days before expiration so renewals are never missed.

Eligibility Verification

Real-Time 270/271
Eligibility Checks

Automated eligibility checks via HIPAA 270/271 transactions. Deductible, copay, coinsurance, and out-of-pocket balances displayed at check-in — so there are no payment surprises.

  • Real-time 270/271 eligibility transactions
  • Deductible, copay, and coinsurance display
  • Out-of-pocket maximum tracking
  • Auto-check 72 hours before appointment
  • Secondary insurance coordination
  • Coverage effective date validation
  • Network status (in/out of network)
  • Medicare & Medicaid benefits lookup
Insurance Eligibility Active
Patient Johnson, Karen M.
Payer Blue Cross Blue Shield PPO
Member ID XYZ8847291
Individual Deductible $1,500 / Met: $1,200
Remaining Deductible $300.00
Copay (Specialist) $40.00
Coinsurance 20% after deductible
Out-of-Pocket Max $5,000 / Met: $2,100
Network Status In-Network ✓
Verified Today 7:45 AM (auto)
A/R Aging

Accounts Receivable Aging Dashboard

Color-coded aging buckets so your billing team always knows where to focus attention. Industry benchmark: under 15 days in A/R.

Bucket Claims Amount % of A/R Visual
0–30 days 142 $48,220 54%
31–60 days 48 $18,450 21%
61–90 days 21 $9,870 11%
91–120 days 14 $6,340 7%
120+ days 9 $6,120 7%
$89,000
Total Outstanding
14d
Days in A/R (benchmark: <30)
75%
Collected within 30 days
Patient Payments

Modern Patient Payment Experience

Card on file, text-to-pay, payment plans, and automated statements. Reduce collection friction and get paid faster.

Card on File

Securely store payment method for seamless post-visit collections.

Text-to-Pay

Send SMS payment link — patients pay from any device in seconds.

Payment Plans

Offer flexible installment plans for larger balances, auto-charged.

Auto-Statements

Automated patient statements by email, SMS, or paper — on a schedule.

Cost Estimator

Show patients an accurate cost estimate before their visit — no surprises.

Patient Portal Pay

Patients view and pay balances anytime from the patient portal.

Revenue Analytics

Revenue Analytics by Provider,
Payer & Procedure

Slice and dice your revenue data by any dimension. See exactly where your money comes from and where it's slipping away.

$48.2k
17000 Destruction AK
$36.1k
99213 Office Visit L3
$27.4k
11102 Shave Biopsy
$21.3k
17110 Wart Destruction
96.4%
Collection Rate
$133k
Revenue MTD
+14%
vs. Last Month
Ready to Optimize Your Revenue

Stop Leaving Money on the Table

See how Nuvora Health's billing tools can increase collections, reduce denials, and save your team hours every week.

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