i.
A denial sweep done entirely for you
You export 90 days of remittance files. That is the whole ask. Every denial, partial payment, and silent write-off gets pulled, parsed, and sorted without anyone on your staff touching it.
I help Iowa group home and NEMT owners recover the Medicaid revenue they already earned, by auditing 90 days of their own remittance files, without adding audit risk.
$3,500 flat · three founding providers at this rate
We know we lose money on denials. I couldn't tell you how much, and nobody here has time to go find out."
This is for owners and administrators of Iowa group homes and NEMT operations, one location or twenty, who are writing off denied claims because chasing them costs more attention than anyone has to spare. You are not disorganized. You are busy, and the denials are quiet.
You export 90 days of remittance files. That is the whole ask. Every denial, partial payment, and silent write-off gets pulled, parsed, and sorted without anyone on your staff touching it.
One document. Every denial with its dollar amount, its reason in plain language, and whether it is still inside the window to act on. Sorted by what it is worth, with the total at the top. You stop guessing.
Nothing is submitted. No payer is contacted on your behalf. No claim is touched. This is a review of your own files, and every finding traces back to a document you already hold. You end with a stronger record than you started with.
Nothing in the report is grouped by who touched a claim. Your biller receives a tool, not a performance review. Most of what surfaces is payer behaviour and system gaps, and the report says so plainly.
A single number agreed up front that does not move with what I find. Federal rule 42 CFR 447.10(f)(2) bars paying a billing agent a percentage of what is billed or collected. If you were pitched a percentage before, that is the model worth questioning.
A business associate agreement before a single file moves. You are told where the data sits and who touches it, and it is destroyed on your word when the engagement closes.
Everything above is included.
The guarantee: if the ledger does not identify at least 25 specific denials with the reason each one failed, you do not pay. Three founding providers at this rate, then it rises. Two engagements run at a time, because it is me doing the work.
No, because nothing leaves your building. I do not submit claims, contact payers, or touch anything in your system. I read files you already have and hand back what I found. When this is over you hold a clearer record of your own billing than you did before, which is the opposite of exposure.
Because the percentage model is restricted here. 42 CFR 447.10(f) allows paying a business agent only where the compensation is not tied to a percentage of what is billed or collected, and is not dependent on collection. So the number is fixed, said out loud before I start, and unaffected by what I find.
Export 90 days of remittance files. Roughly twenty minutes of your billing person's day. No meetings, no software to learn, no change to your process, and no access to your systems.
A business associate agreement is signed before anything moves. You are told where the files sit and who has access, and everything is destroyed on your word when the engagement closes.
Not yet, and I would rather say so than dress it up. What I have done is build and deliver a $12,000 plan consolidation system for an Iowa HCBS provider that is still running on a maintenance contract, and I worked direct care before that. Reading remittance files is the same problem as reconciling service plans, which is work I have already shipped for a provider in this state. The founding rate and the guarantee exist because this specific engagement is new.