Practice economy · RCM

Collect what the rail already proved you earned.

Because the claim, the remittance, and the payout live on one ledger, denials, underpayments, and left-behind dollars show up as postings you can work — not a report you reconstruct.

Automation proposes the recovery; a human disposes every appeal and every dollar.

See how it fits the loop Read the reconciliation waterfall

Engines verified-green at HEAD; running on a live practice's real remittances is gated on client zero — see the register below.

Encounter
Code
Claim
Remittance
Payout

The four engines

Four engines on one ledger.

Each reads real postings and proposes; a person disposes.

Read the remittance.

Posts every 835 reason and remark code into the ledger
Groups denials by payer, code pair, and root cause
Ranks what is recoverable — no invented win rates

Read the waterfall

Draft the appeal; a human signs.

Assembles denial reason, exam documentation, and the payer's own coverage rule
Stops before filing — propose, never dispose
Saves the hours; the clinician keeps the authority

Read the doctrine

Prove the underpayment.

Compares contracted rates to remitted amounts, line by line
Surfaces silent fee-schedule drift as ledger evidence
Your own postings — not a benchmark we made up

Recover the found money.

Scans for timely-filing misses, unbilled secondaries, unposted balances
Routes each item to a person to work or dispose
Recovers what is provably owed — no conjured slide number

Compliance is a condition of payment

Pre-payout checks that sit inside the money path.

Duplicate claims and invalid code pairs are caught before money moves, not after a takeback. A 276/277 duplicate-claim inquiry and NCCI validation are two of the six gate conditions — either failure halts the instruction.

See the six-condition gate

The six-condition gate

Verified in code

1. Ledger balancedDouble-entry debits equal credits; the hash chain is intact.
2. Scrubber clearanceThe claim has passed edits with no blocking findings.
3. Coding / NCCI validProcedure and diagnosis coding survives NCCI validation.
4. Signature immutableThe signed encounter has not changed since attestation.
5. 276 / 277 dup-claim clearA pre-payout duplicate-claim check finds no prior submission.
6. Provider screenedLive OIG-LEIE + NPPES screen plus the credentialing composite.

The register

Real recovery logic — no recovered-dollar figure we can't stand behind.

The engines are verified-green code, tested at HEAD against the ledger. What is gated is a live practice's real remittances — that waits on client zero.

Verified-green

Denial, appeal, rate, and found-money enginesTested at HEAD against the ledger

Gated

Running on a live practice's real remittancesWaits on client zero + live payer connectivity

Be client zero.

The engines are built and tested. What they need next is a live practice's real remittances to run against. If that could be yours, talk to us.

Talk to us about client zero