Who we serve
Independent practices with one to ten providers. Enrolled, billed and paid by one firm.
Medical practices come first: primary care, internal medicine, pediatrics, OB/GYN, dermatology, orthopedics, podiatry and specialty clinics. We also serve dental practices, therapy clinics, chiropractic, optometry and the medical side of aesthetics practices. Behavioral-health facilities are served by Health Revenue Intelligence directly.
Pick the one that sounds like yours.
Four moments that bring a practice to us.
Three of them come before a payer will pay: a payer pays in-network only after it has enrolled the practice and the clinician who saw the patient. The fourth comes after, when claims go out and the money that comes back is short.
No payer has a record of the practice yet. We build it in order: a CAQH profile for each provider, Medicare through PECOS, your state's Medicaid program, then the commercial plans. Most commercial payers read from CAQH, so that profile comes first.
- First step
- A free review of your payers and what already exists.
- What it costs
- $350 per payer for the practice, $250 per payer for each provider, $150 per CAQH profile. A solo practice files once per payer, at $350.
- What you receive
- Each payer's effective date or written answer, then a page on what it pays for.
The practice already bills, and a new physician, nurse practitioner or physician assistant starts soon. Each payer has to link that person to your group first. Missed links tend to surface as denials, well after the visit. We file with every payer you bill and follow each one until it is done.
- First step
- Tell us who is joining and which payers you bill.
- What it costs
- $250 per payer for the new clinician, plus $150 if they need a CAQH profile set up.
- What you receive
- Each payer's effective date for that clinician, tracked on the Friday board.
You are weighing a service your payers may or may not cover, such as medical weight management or hormone therapy. The equipment costs money before the first claim goes out, so the answer on whether it pays should come first.
- First step
- Name the service and the payers that matter.
- What it costs
- $2,500, fixed, for one written answer on one service.
- What you receive
- Coverage, codes, documentation, missing contracts and expected payment, payer by payer.
The practice is enrolled and billing, and the deposits do not match the work. Denials sit unworked, payments post without anyone checking them against the contract, and nobody can say which payer is underpaying. We run the whole revenue cycle: benefits and eligibility, authorizations, claim build and follow-up, payment posting and reconciliation, denials and appeals, underpayment detection and reporting.
- First step
- A free review of what the practice bills and what comes back.
- What it costs
- Set from the practice's own numbers and written into the agreement before we start.
- What you receive
- Every claim followed until it is paid or answered, and a report that says where the money went.
The steps repeat. The payer list does not.
Medical practices come first.
Enrollment and billing follow the same steps in every specialty. The payer mix changes, and so does what each payer asks to see, pays for and denies. An independent practice runs this itself or hands it to a firm. We are that firm, from the first application to the last appeal.
Independent practice is the smaller share of medicine, and payers treat it that way.
| Practice | Usual starting point | What we watch |
|---|---|---|
| Primary care, family and internal medicine | Opening, or a nurse practitioner or physician assistant joining | A long payer list, filed in the order your patients need. |
| Pediatrics | Opening, or a new pediatrician joining | Whether each Medicaid managed-care plan needs its own application. |
| OB/GYN | A new provider, or adding hormone therapy | Hormone therapy coverage, which turns on product, diagnosis and payer. |
| Dermatology | Medical work beside cosmetic work | Covered work that looks cosmetic, such as hyperhidrosis treatment under CPT 64650 or 64653. |
| Orthopedics and sports medicine | A new surgeon, a physician assistant or a new location | Each clinician tied to the right group and location. |
| Podiatry | Opening, or adding a location | Medicare through PECOS, then each commercial plan. |
| Psychiatry and mental-health prescribers inside medical groups | A prescriber joining the group | Whether a plan sends behavioral health to a separate company. |
| Specialty clinics adding a location | A second site | Each payer's record updated for the new address. |
Not listed? Describe the practice in your request. If we are the wrong fit, we will say so.
Same payers, same full service.
Five neighbors who bill the same payers.
These practices sit outside general medicine and still live on medical plans, or on a medical side of the work. They get the same service a medical practice gets: enrollment, billing, denials and the reporting that shows where the money went.
Dental practices, including dental-to-medical work
An oral appliance for sleep apnea is billed to the medical plan under HCPCS E0486. For Medicare, the dentist must first be enrolled as a DMEPOS supplier, Medicare's category for medical equipment.
- What we do
- Enroll the practice and the dentist with medical plans, build the medical claims and follow them to payment. We check the Medicare supplier rules against your practice in the review, before you pay anything.
For dental practices Dentists and medical insurance, in more detail
Physical, occupational and speech therapy clinics
The clinic and each therapist are enrolled separately, and a plan can pay the clinic while it still has no record of the therapist who saw the patient. Authorizations and visit limits decide what gets paid after that.
- What we do
- Enroll the clinic and every therapist, track authorizations where a plan requires them, bill the visits and work the denials.
Chiropractic practices
Each plan draws its own line around what it covers for chiropractic care, and the documentation has to show the reason for every visit.
- What we do
- Enroll the practice and each chiropractor, build claims to each plan's rules and follow every denial to an answer.
Optometry practices
A medical eye visit bills to the patient's medical plan, apart from the vision plan. That side needs its own enrollment and its own claims.
- What we do
- Enroll the practice and each optometrist with medical plans, and run the medical billing from claim to payment.
Medical aesthetics practices under a medical director
Some aesthetics treatments are medical, and a payer can cover them when a medical director oversees the care and the record shows the diagnosis. Medical weight management is one, with a catch: most employer and Marketplace plans exclude GLP-1 drugs for weight loss, so the visit may pay while the drug does not.
- What we do
- Enroll the medical director and the practice, tell you which services can be billed, then bill them.
- What we leave alone
- Cosmetic treatments. We will not bill them to insurance.
For aesthetics practices Services that look cosmetic and are covered
Where we are the wrong call.
Better to say so now than after a fee.
What owners ask before they write to us.
We are a solo practice. Are we too small?
No. A solo practice files one application per payer, at $350, plus $150 for a CAQH profile if you need one. Four payers comes to $1,550.
We have not opened yet. Is it too early to start?
It rarely is. Commercial payers take months to answer. Medicare is usually faster, and Medicaid varies by state. Start once you have an address, a tax ID and each provider's NPI.
Do you only enroll, or do you bill too?
We do both. Enrollment gets the practice paid in-network. Billing keeps it paid: claims, posting, denials and appeals, underpayments and reporting. The billing fee is set from the practice's own numbers and written into the agreement.
Do you enroll nurse practitioners and physician assistants?
Yes, at $250 per payer, the same as a physician.
Tell us what kind of practice you run.
A few lines on your specialty, your payers and where billing stands are enough. Leave patient information out.
We get back to you as quickly as possible.