How we work
Agree the work. Know how it will run.
Choose enrollment, billing support or a written review. Your proposal sets out the deliverables, responsibilities, fee and schedule before you decide.
- Health Revenue Intelligence, LLC
- A business associate agreement before any patient record
- Printed fees
- Status, next action and owner
Start with the service your practice needs.
You can engage HRI Med for payer enrollment, ongoing billing, a paid billing review or a service-line review. Tell us the problem and we confirm the scope before quoting.
The written proposal names the work, who is responsible, the fee, the information we need and the schedule. You approve it before the work begins.
- Enrollment
- Applications and follow-up, priced per application. You can buy enrollment on its own.
- Ongoing billing
- Responsibilities and fees agreed from your practice's claim mix and volume.
- Paid billing review
- A written assessment of enrollment, claim totals and billing workflows, followed by a meeting to review the findings. Implementation is a separate decision. See the report format.
- Service-line review
- A written answer on coverage, coding requirements and enrollment for one proposed service.
What happens after you sign.
For enrollment work, we confirm the payer list and collect the documents needed to file. Enrollment is invoiced once, when you sign.
The documents needed to start
We identify the practice and provider documents needed for the agreed applications. Later payer requests are recorded with the next action and responsible person.
The records payers read first
We check each provider's NPPES record and set up or update the CAQH profile that most commercial payers pull from. CAQH must be re-attested on a set cycle, so we note when each profile comes due.
Filing, in the order your schedule needs
Medicare goes through PECOS and Medicaid through your state's program. Commercial panels follow in the agreed order, led by the plans most of your patients carry.
Your status record
The status record lists each application, the latest update, the next action and who is responsible. We agree how your practice receives it before work starts.
Moving billing from another team?
Agree the start date, open claims and division of work before the handover. The plan should make clear which responsibilities transfer and which stay with your team.
See the billing handover checklistEach application, its status and the next action.
Each row names the payer, its status, the next action and whose move it is. When the move is yours, the row asks for one specific thing, such as a signature. When a payer goes quiet, we call and write, and the row records what we tried.
- Preparing
- We have what we need and are completing the application.
- Submitted
- Filed. The payer has not acknowledged it yet.
- In review
- The payer is working on it, and we are checking in.
- Needs you
- The payer asked for something only the practice can give.
- Panel closed
- The payer says it is not adding providers. We ask for an exception in writing.
- Effective
- The payer has confirmed an effective date in writing.
One row, followed as the work progresses.
Illustration of a status record as work progresses. It is not a live client dashboard.
Preparing Commercial plan A
The CAQH profile is attested and the application is complete. Next move: ours, to file it.
Submitted The next update
Filed, and the payer's reference number is logged on the row. Next move: the payer's. We confirm it was received.
In review A later update
A credentialing analyst has the file. We call and write on a set rhythm, and each attempt is recorded on the row.
Needs you When the payer asks
The payer wants a signed attestation page. The row names that one page and nothing else. Once it is back, the move is ours again.
Effective When confirmation arrives
The payer confirms a date in writing. The date goes on the row and into your enrollment file, with a page on what to bill under it.
The effective-date column stays blank until a payer commits to one in writing.
Once a payer gives an effective date, we send you what to bill under it.
The payer's effective date confirms when the enrollment applies. It does not guarantee payment for every claim. We record the written confirmation and explain what to check before relying on that enrollment.
When a payer confirms, you receive its letter and a page from us on billing that payer: which provider and location the enrollment covers, how claims should go out, and what to check on the first few.
When the last payer answers, you keep the enrollment file, with every application, reference number and letter in it. The next provider who joins starts from that file.
Billing support, when it is part of your scope.
We can handle agreed parts of the revenue cycle or take on ongoing billing. The agreement names the claims and responsibilities included, what your staff keeps, and how status is shared.
For work in scope, we record payer responses, unresolved items and the next action. The format and reporting arrangements are agreed with your practice.
A practice can start with enrollment, with billing, or with both.
Enrollment runs on practice information, never patient records.
Enrollment needs details about the practice and its providers, such as licenses, NPIs, ownership and malpractice coverage.
Keep patient names, dates of birth, member IDs and claims out of the form and out of email. If the work involves patient information, such as the on-screen walk-through in the billing review or billing itself, we sign a business associate agreement with your practice before any of it changes hands.
Provider documents go only where an application sends them: CAQH, PECOS, your state's Medicaid program and the payers you chose.
Fees agreed before work begins.
| Item | What it covers | Fee |
|---|---|---|
| Billing review, one to three providers | Each provider's enrollment, your claims and a walk-through with your staff, ending in a written report. | $7,500 |
| Billing review, four to ten providers | The same review for a practice with more providers. | $12,500 |
| Organization application | One per payer, for the practice itself. | $450 |
| Practitioner application | One per provider, per payer. | $350 |
| CAQH setup | For each provider whose profile needs setting up. | $300 |
| Solo practice | One fee per payer, whatever forms that payer needs, with no practitioner fee. | $450per payer |
| Service Line Made Billable | One written answer for one service. | $2,500 |
| Billing and revenue cycle | Claims, posting, denials, appeals, underpayments and reporting. Set from your numbers, in the agreement. | By agreement |
Enrollment is priced per application. Billing is priced from the practice's own payer mix and volume. Hourly consulting and the other consulting projects are on the consulting page.
We follow every application until its payer answers.
Medicare usually answers first. Medicaid depends on the state. Commercial plans publish a month to two months or more, before contract loading. We check every application against a written checklist before filing it. A complete, consistent file removes the most common reason a payer sends one back: missing or mismatched information.
A closed panel is not always final. We ask for an exception in writing, and our note on closed panels covers the other routes.
Common questions about the day-to-day.
Who will I be dealing with?
Your proposal identifies who is responsible for the engagement. The same firm can handle enrollment, billing and separately scoped reviews.
We are already enrolled. Can you add one new provider?
Yes. With the practice already enrolled, no organization application is needed. Each payer takes one practitioner application at $350, plus $300 if the provider needs a CAQH profile set up.
We have more than one location. Does that change the work?
It adds to it. Each payer has to hold every address where the practice sees its members, and each clinician has to be linked to the sites where they work. We check every location against every payer, so nothing is filed for one site and missed at another.
What if our address, tax ID or an NPI changes partway through?
Tell us as early as you can, ideally before it happens. A change like that reaches every application still open. We update the NPPES record, the CAQH profile and each pending file, so no payer approves details the practice no longer uses.
A provider is leaving before their applications finish. What happens?
We withdraw that provider's open applications with each payer, so no plan links them to the practice after they go. The rest of the Sprint carries on, and the status record shows each withdrawal.
What does the status record show?
Each application, its latest update, the next action and the responsible person. Billing status is included when it is part of the agreed service. The format and reporting arrangements are agreed before work begins.
How does billing end if we want to stop?
The agreement sets a term and a monthly minimum, and billing runs for the term. Stopping early carries an exit fee, which the agreement sets from that minimum and the length of the term. Either way, the claim history and files stay with the practice.
Who owns the enrollment file?
The practice. Each application, the payer's reference number, every letter and each effective date go into a file that is yours, whether or not you keep working with us.
When will the work be delivered?
Your proposal sets the delivery schedule for the work HRI controls and identifies information needed from your practice. Payers control their own review and decision dates.
What if the work changes after we start?
We identify the additional work and agree its scope and price before carrying it out. The original agreement continues to govern the work already included.