Strategic RCM

Closing the Gaps in Medical Billing

Clinical practices face severe cash-flow leakage due to manual coding mismatches, unvalidated insurance eligibilities, and slow denial tracking. Millennova structures a robust pipeline that streamlines clinical documentation directly into submitted claims, protecting both contracted in-network yields and complex out-of-network reimbursements.

Clean Claim Goal Benchmark

98.2% Clean Claims Rate

In-Network RCM Optimization

Complete oversight of major payer lines (BCBS, UnitedHealth, Cigna, Aetna) and government programs (Medicare, Medicaid). Continuous fee-schedule auditing ensures clinical entities are paid exactly what contracts dictate.

Out-of-Network Settlements

OON strategic collection practices recover revenue from underpaid non-contracted claims. We track regional geographic medical expense averages, prepare comprehensive underpayment packets, and appeal bad claims fast.

ICD-10/CPT Medical Coding

Highly certified AAPC coders perform clean, real-time documentation mapping and code selection. This rigorous system decreases audit risks and drastically limits the initial claim rejection rates at clearinghouses.

Credentialing & Enrollment

Fast-tracked commercial payer enrollment, CAQH profile setups, and Medicare/Medicaid network registrations, protecting practices during new physician hiring or expansion cycles.

Modern Tech-Driven Workflows

Secure Payment Posting & EMR Database Sync

Our teams execute daily payment posting across Electronic Remittance Advice (ERA), Electronic Funds Transfers (EFT), and physical check ledgers. We maintain continuous API and safe file transfer synchronizations with top EMR platforms like Epic, eClinicalWorks, Athenahealth, and AdvancedMD to guarantee perfect ledger alignment without data overlaps.

REAL-TIME ELIGIBILITY Pre-validation of active patient coverage and deductibles before procedures to guarantee eligibility.

DENIAL VELOCITY RECOVERY We isolate and appeal denied claims within 48 hours to minimize days in Accounts Receivable (A/R).

Operational KPIs We Guarantee

Claims Clean Rate (Initial Pass) > 97.5%

Average Days in A/R < 32 Days

Denial Resolution Rate > 92.0%

Help Desk

Frequently Asked Questions

Get fast answers to standard procedural queries regarding our RCM models.

We compile regional geographic cost metrics and clinical necessity documentation to appeal OON claims underpayments. When insurers pay claims below reasonable out-of-network schedules, our specialized auditors submit structured administrative appeals that hold payers accountable to fair market pricing.

Our infrastructure supports continuous dual-synchronizations with almost all modern EMR platforms, including Epic, eClinicalWorks, Athenahealth, AdvancedMD, DrChrono, and Kareo. We utilize secure file transfer protocols and custom APIs to seamlessly move data without interrupting your clinical staff.

Our clean claim rate of over 98% is maintained through daily claims scrubbing and real-time coding validation engines. When patient billing information is posted, it runs through automated clearinghouse rules that isolate error factors (e.g., typos, invalid insurance codes, wrong CPT/ICD mappings) before physical dispatch.

Medical Billing & RCM Solutions