Fourteen services. One revenue cycle.

Medical billing & coding

Accurate claims start with accurate codes. Our coders and billers turn each encounter into a claim that matches the documentation and the payer's rules.

• Charge entry from superbills, encounter forms or EHR charge capture
• CPT, ICD-10-CM and HCPCS Level II coding
• Modifier review (25, 59, XE/XS/XP/XU, 26/TC, 50, 51, 62, 78, 79 and more)
• E/M level review against documentation
• Global-period and bundling (NCCI) checks
• Coding queries to providers when documentation is unclear

End-to-end revenue cycle management

One accountable team from the day a provider is credentialed to the report that shows where revenue stands. Best for practices that want billing off their plate entirely.

• Credentialing, eligibility and prior authorization
• Coding, charge entry and claim scrubbing
• Electronic and paper claim submission
• Rejection, denial and appeal management
• Payment posting and reconciliation
• A/R follow-up, underpayment recovery and patient statements
• Monthly performance reporting and review calls

Credentialing & payer enrollment

No enrollment, no payment. We get providers set up with commercial, Medicare, Medicaid and other payers, and keep them that way.

• CAQH ProView setup, attestation and maintenance
• Medicare (PECOS) and Medicaid enrollment
• Commercial payer applications and contract follow-up
• NPI and taxonomy alignment
• Group and location additions, linkages and changes
• Re-credentialing and revalidation tracking

Eligibility, benefits & prior authorization

Most avoidable denials begin before the visit. We verify coverage and secure authorizations so the claim is payable before it is created.

• Real-time and manual eligibility verification
• Benefit breakdowns: deductible, co-insurance, visit limits
• Prior authorization requests, tracking and extensions
• Referral management for HMO and gatekeeper plans
• Out-of-network benefit checks for OON providers

Claims management

Submission is not the finish line. We scrub, submit and then track every claim until the payer acts on it.

• Clearinghouse edits and payer-specific scrubbing
• Electronic (837P/837I) and paper (CMS-1500/UB-04) claims
• Rejection fixes and same-week resubmission
• Claim status checks by portal, phone and 276/277
• Corrected and replacement claims
• Timely-filing tracking by payer

Denial management & appeals

We find out why a claim was denied, fix it, and fix whatever caused it so the next one is not denied too.

• Denial categorisation by reason (CARC/RARC) and payer
• Corrected claims and reconsiderations
• First and second-level written appeals
• Medical necessity and documentation appeals
• Trend reporting back to your front desk and providers
• Root-cause fixes to templates, workflows and edits

A/R management & underpayment recovery

Old money is still your money. We work aging accounts systematically, oldest and largest first, and catch payers paying less than they owe.

• Aging A/R clean-up projects (60, 90, 120+ days)
• Payer follow-up by phone, portal and correspondence
• Underpayment detection against contracted rates
• Credit balance and refund review
• Write-off review and recommendations
• Hand-off of eligible out-of-network claims to IDR or arbitration

Payment posting & reconciliation

Clean books make every other report trustworthy. We post insurance and patient payments and reconcile them to deposits.

• ERA (835) and manual EOB posting
• Patient payment and copay posting
• Deposit-to-posting reconciliation
• Denial and zero-pay flagging at posting
• Secondary and tertiary claim triggering

Out-of-network billing & negotiation

Out-of-network claims are paid by different rules and often underpaid. We bill them correctly and pursue the gap.

• Out-of-network claim submission and follow-up
• Single-case agreement and negotiation support
• Federal NSA open negotiation and IDR (see the IDR page)
• State surprise-billing arbitration where state law applies
• Patient balance rules under the No Surprises Act

PIP, MVA & no-fault billing

Auto-injury claims follow carrier and state rules, not health-plan rules. We handle the forms, the deadlines and the follow-up.

• Claim setup with carrier, claim number and adjuster details
• State no-fault forms and supporting documentation
• Carrier follow-up and payment tracking
• Denials, IME/peer-review cut-offs and fee-schedule reductions
• PIP A/R management and arbitration referral where applicable

Workers' compensation billing

Workplace injury claims need the right case details, authorizations and state fee schedule from the start.

• Employer, carrier and case number capture
• Authorization requests and tracking
• State fee-schedule billing
• Required report attachments
• Carrier follow-up and bill-dispute support

Patient collections & self-pay

Patients pay more of the bill than ever. We make statements clear, offer simple ways to pay and follow up respectfully.

• Patient statements and reminders
• Payment plans set up to your policy
• Self-pay estimates and Good Faith Estimate support for uninsured patients
• Patient billing questions answered by phone or email
• Hand-off to your chosen collection agency, if you use one

Revenue cycle consulting & reporting

Not ready to outsource? We review where revenue is leaking and show you how to fix it.

• Revenue cycle assessment and leakage review
• Fee schedule and payer contract review
• KPI dashboards: first-pass rate, days in A/R, denial rate
• Workflow and staff process recommendations

Dedicated & remote specialists

Need hands rather than a vendor? A dedicated Ascendix specialist works in your systems, on your processes, as part of your team.

• Billing, coding, A/R, denial or RCM specialist
• Works your queue in your EHR and clearinghouse
• Supervised and quality-checked by Ascendix leads
• Scales up or down with your volume