Praxis Medservices Request a diagnostic

Clinical revenue operations

Full-service RCM
and healthcare automation.

Certified billing and credentialing specialists, paired with the operating layer in CosmoMS, so clean claims and enrollments stay visible.

Service 01 / Credentialing

Medical Credentialing & Payer Enrollment

Provider enrollment delays cost practices an estimated $7,000 per provider per day in lost collections. We streamline your entire credentialing lifecycle, ensuring timely in-network status across government and commercial payers.

Medicare (PECOS) & State Medicaid Enrollment Complete 855I/855B applications, revalidations, and NPI registry management.
CAQH ProView Profile Management Initial setup, quarterly attestations, document uploads, and automated expiration tracking.
Commercial Insurance Contracting BlueCross BlueShield, UnitedHealthcare, Aetna, Cigna, Humana, and regional IPA contracting.
Enroll Your Providers

Credentialing SLA

Initial Filing Speed < 5 Business Days
Payer Follow-Up Frequency Every 7-10 Days
Average Approval Time 45 - 60 Days (vs 120 industry)
Attestation Compliance 100% Guaranteed Active
Portal Access Real-Time Milestone Tracker
Service 02 / Medical Billing

AI Claims Scrubbing & Daily Billing Operations

Most denials occur before the claim ever leaves the clearinghouse due to avoidable coding mismatches and demographic errors. Our AI scrubbing engine applies over 12,000 continuous payer rules before EDI 837 batch submission.

NCCI & MUE Edit Validation Automated cross-referencing of National Correct Coding Initiative bundling edits and modifier checks (e.g. -25, -59).
LCD & NCD Coverage Verification Validates ICD-10 medical necessity against Local and National Coverage Determinations in real time.
Same-Day Charge Entry & Electronic Filing Direct submission to clearinghouses within 24 hours of encounter finalization in your EHR.
Audit Your Claim Accuracy

Billing Performance

First-Pass Clean Claim Rate 98.4%
Charge Entry Turnaround < 24 Hours
Payer Rule Database 12,000+ Active Rules
EHR Integration Bi-Directional API & SFTP
Clearinghouses Supported Change Healthcare, Waystar, Availity, Office Ally
Service 03 / Denial Management

Automated Denial Classification & Rapid Appeals

Denied claims represent pure lost revenue when neglected. When an electronic remittance (ERA 835) generates a denial, our system parses the CARC/RARC codes, identifies the root deficiency, and compiles an evidence-backed appeal within 48 hours.

Root-Cause Taxonomy Classification Instantly classifies denials by medical necessity, prior auth absence, timely filing, or eligibility.
Automated Clinical Appeal Letters AI agents generate customized appeal packets citing medical guidelines, clinical notes, and payer policy clauses.
Secondary Payer Auto-Crossover Automatic re-billing of secondary and tertiary insurances immediately upon primary ERA receipt.
Recover Denied Revenue

Denial Recovery Metrics

Overall Denial Rate 1.6% (Industry avg 8-12%)
Appeal Filing Speed < 48 Hours
Denial Overturn Rate 86.2%
Days in A/R 24.2 Days
Service 04 / Front-End Operations

Prior Authorization & Eligibility Automation

Prevent front-end rejections before patients walk through the clinic doors. We automate 270/271 real-time benefit checks and interface with payer portals to submit and track prior authorization requests.

Automated 270/271 Eligibility Inquiries Verify co-pays, deductibles, out-of-pocket maximums, and active coverage 48 hours prior to scheduled appointments.
Payer Portal Auth Management Automated submission and tracking via Availity, CoverMyMeds, Navinet, and specialized payer portals.
Automate Prior Authorizations

Front-End Specifications

Pre-Visit Verification 100% of Scheduled Encounters
Auth Approval Lead Time 72 Hours Prior to Procedure
Front-End Denial Reduction 92% Reduction

Ready to modernize your practice's revenue operations?

Schedule a 20-minute consultation with our healthcare RCM specialists to review your practice metrics.

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