Charge entry and claim submission happen daily. Each claim is scrubbed against Alabama Medicaid and BCBS of Alabama edits first, so fewer come back for avoidable errors.
Certified coders assign ICD-10, CPT, and HCPCS codes from the documentation. E/M levels matter more than usual here, since ACHN participation rates widen the dollar gap between a 99213 and a 99214. .
We verify coverage before every visit through the Alabama Medicaid web portal and payer portals. Dual-eligible patients in Medicare Advantage plans get checked against the right plan, which isn't always obvious from their cards.
Alabama Medicaid and commercial payers keep their own authorization lists, and Medicaid added prior authorization requirements for new 2026 radiology CPT codes. Our team submits requests and follows up daily so imaging stays on schedule.
Every denial is categorized by root cause and payer. Within the first month, you'll know whether the real issue is coding or enrollment.
Aging claims get worked weekly. Balances are resolved well before Alabama Medicaid and commercial filing deadlines run out.
Clear statements and a friendly support line help Alabama patients understand what they owe. Fewer confused calls mean faster payments.
We handle Alabama Medicaid enrollment and revalidation, ACHN participation agreements, Medicare enrollment through PECOS, and BCBS of Alabama applications. If your practice gets an off-cycle revalidation notice this year, we'll take it from there.
One team owns everything from scheduling to final payment. No more guessing which person dropped which claim.
Every remittance is posted and reconciled against expected rates, ACHN participation rates included. Underpayments get flagged and appealed.
Huntsville and Birmingham draw patients from Tennessee and Mississippi, and the Florida Panhandle sends plenty to Mobile. When a claim falls out of network, we build a fair-market case and negotiate directly, including federal independent dispute resolution where the No Surprises Act applies.
Monthly reports show collections and denial rates by provider and payer. ACHN bonus payments get tracked separately, so you can see what participation is actually worth.
All work runs on secure, HIPAA-compliant systems with role-based access. A signed business associate agreement is in place from day one.
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Years of Experience
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Medical Specialties
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Happy Clients
Most Alabama practices pay a percentage of monthly collections, so our fee grows only when your revenue does. Your rate depends on specialty, volume, and services. We quote it after a free audit.
Not in the usual sense. ACHN entities coordinate care, but they don't pay claims. Claims go to Alabama Medicaid and are processed through Gainwell Technologies.
It depends on whether your practice actively participates with its ACHN and has the right agreements on file. Our free audit checks your remittances against the ACHN rate schedule so you'll know for sure.
Yes. We gather the documents and complete the revalidation, then track it until it's approved.
We work inside most EHR and practice management systems used across Alabama, so your team keeps its current software.
Most practices transition within a few weeks. We set up payer connections, review open AR, and run alongside your current process so claims never stop.
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