Who we serve
Billing and enrollment for medical practices. Support that fits your setting.
Our core offer is designed for practices with one to ten providers. We also consider defined assignments for hospital-affiliated physician groups. We serve medical practices including primary care, internal medicine, pediatrics, OB/GYN, dermatology, orthopedics, podiatry and specialty clinics. We also serve dental practices that bill medical plans, therapy clinics, chiropractic, optometry and the medical side of aesthetics practices.
- Health Revenue Intelligence, LLC
- A business associate agreement before any patient record
- Printed fees
- Status, next action and owner
Four moments that bring a practice to us.
Three come before a payer will pay. The fourth comes after, when the money that comes back is short.
The practice needs to establish its payer enrollments. 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 review of your payers and what already exists.
- What it costs
- $450 per payer for the practice, $350 per payer for each provider, $300 per CAQH profile. A solo practice files once per payer, at $450.
- 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
- $350 per payer for the new clinician, plus $300 if they need a CAQH profile set up.
- What you receive
- Each payer's effective date for that clinician, tracked on the status record.
You are weighing a new service, such as medical weight management or hormone therapy. Know whether your payers cover it before you buy the equipment.
- 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. HRI can handle billing or agreed parts of it alongside your staff. Your proposal identifies the responsibilities, claims and payers included.
- First step
- A 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.
Medical practices.
Enrollment and billing share a common process, with requirements that differ by specialty. The payer mix changes, and so does what each payer asks to see, pays for and denies. Your scope can cover enrollment, billing or both, with appeals agreed in writing.
| 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 | The global surgery period, imaging approvals, workers' compensation and auto claims, and the hospital and surgery-center privileges each facility grants on its own. |
| Cardiology | A new cardiologist, or a new hospital where the group reads | Imaging authorizations, and the read billed apart from the hospital's share of the study. |
| Gastroenterology | A new gastroenterologist, or opening an endoscopy center | Screening colonoscopies that turn diagnostic, and the center enrolled as its own supplier. |
| Podiatry | Opening, or adding a location | Routine foot care claims that carry their proof, and the separate supplier enrollment diabetic shoes need. |
| Sleep medicine and pulmonology | A new sleep lab, or a physician joining | Lab study approvals, the reading billed apart from the recording, and PAP and oxygen rules. |
| 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.
Other practices we serve.
These practices sit outside general medicine and still bill medical plans. They get the same service a medical practice gets: enrollment, billing, denials and reporting.
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 confirm which Medicare supplier requirements apply before preparing the enrollment.
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.
For aesthetics practices Services that look cosmetic and are covered
Common questions before you write to us.
We are a solo practice. Are we too small?
No. A solo practice pays one fee per payer, $450, plus $300 for a CAQH profile if you need one. Four payers comes to $2,100.
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. Medicare sets a limit: it accepts an application up to 60 days before the effective date.
Do you only enroll, or do you bill too?
We do both. Enrollment establishes the payer relationships. Billing manages the claims under those relationships. 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 $350 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.
Professional services within a hospital-affiliated group.
Bring us a defined enrollment, professional billing or review assignment. We confirm the providers, payers, responsibilities and fit before proposing work.