Claim Care Solutions (CCS) provides executive-level consulting focused on building clinic-real revenue systems that align operations, compliance, and fiscal sustainability. 

What CCS Delivers
• Revenue clarity before risk
• Compliance-aware fiscal planning
• Leadership-ready financial models and other operational documents

Engagements are structured for leadership teams who require clarity, defensible planning, and confidence in decision-making — including Executive Directors, Practice Owners, CFOs, COOs, and clinical leadership.

A strategic advisory designed to help healthcare providers understand what their clinic can realistically earn — before revenue leaks, denials, or compliance risk occur.

This engagement evaluates the full revenue lifecycle, including:

• clinical service structure and billable scope
• CPT and ICD-10 alignment
• provider credentialing and payer participation status
• billing workflow design and charge capture logic
• denial risk and first-pass acceptance trends
• authorization, no-show, and payment lag impact
• payer mix and cash-flow visibility

Using structured review methods and AI-supported analysis, CCS identifies gaps, risks, and missed opportunities — and provides clear, actionable recommendations leadership can implement with confidence.

Designed for Executive Directors, Practice Owners, CFOs, COOs, and clinical leadership teams.
Without this clarity, clinics often overhire, underbill, or rely on projections that do not survive payer or regulatory review. 

Ideal for:
• new or growing clinics
• practices experiencing denials or delayed payments
• organizations preparing to launch, expand, or stabilize operations
• leadership teams evaluating financial risk before investing further resources

Outcome:
A clear, clinic-real understanding of where revenue is working, where it’s breaking, and what must be addressed first.

A comprehensive engagement that delivers a defensible, clinic-real revenue model.

Includes:
• service-to-CPT mapping
• staffing and visit-volume logic
• payer mix and cash-flow modeling
• compliance-aware revenue structure
• leadership- and funder-ready financial framework

Designed for organizations requiring structure that holds up under scrutiny.                  

Particularly valuable in Medicaid-driven, regulated, and multi-service clinical environments. A leadership- and funder-ready financial model grounded in real clinic operations - not assumptions. It is diagnosed into organizations.  

Operational services are provided to support and reinforce the approved revenue strategy — ensuring implementation aligns with the clinic-real model.

Support may include:
• credentialing and payer enrollment
• billing workflow alignment
• EHR and practice management optimization
• denial prevention strategy and reporting
• compliance readiness and documentation support
• staff training aligned to operational goals

These services are delivered as part of, or following, strategic engagements — not as standalone task work.

Certain engagements are offered selectively, based on organizational readiness and strategic alignment.

This is huge for nonprofits.

Purpose:
Determine whether the organization is actually ready to withstand funding scrutiny.

You assess:

• Is revenue logic defensible?
   
• Do services align with allowable funding use?
   
• Does leadership understand sustainability beyond grants?
   
• Is fiscal logic explainable to a board or funder?
   

Can you answer one question:

“If a funder asked how this program sustains itself — could leadership explain it clearly?”

Most cannot.

Output:
✔ Funding readiness gaps
✔ Sustainability red flags
✔ Narrative weaknesses (what funders will question)

Grant-related consulting is provided only when funding directly supports staffing, program sustainability, or approved service expansion.

Support focuses on:
• grant strategy alignment
• budget modeling tied to clinic-real assumptions
• staffing justification connected to service delivery
• sustainability planning beyond the grant term

These engagements are evaluated individually and offered at CCS discretion.

(Pre-Go-Live Revenue Protection & Payment Infrastructure Service)

Claim Care Solutions provides advanced EHR, clearinghouse, and payment infrastructure configuration services designed to ensure clinics are fully prepared to bill, receive payments, and reconcile remittances currently or before live claims are submitted.

We also assist organizations with EHR system selection, helping leadership choose the right platform by evaluating workflow fit, billing functionality, compliance readiness, and long-term growth needs. 

This service supports clinics using any EHR or practice-management system and focuses on clean claim flow, accurate reimbursement, and compliance-safe operations.

(Revenue Protection & Denial Capture Services)

Claim Care Solutions provides structured denial-management and recovery services designed to help providers identify, track, prioritize, and resolve denied claims efficiently, using both human expertise and AI-assisted workflows.

This service ensures denied revenue is not overlooked, delayed, or written off due to lack of visibility or staffing constraints.

Provides revenue-readiness oversight to ensure billing execution partners and internal operations remain aligned with Medicaid, OMH, and payer sequencing requirements.
 

Reviews operational workflows to confirm they do not trigger premature billing or compliance exposure prior to clinic opening or existing clinics.
 

Serves as a revenue and compliance liaison across leadership, clinical operations, and external billing partners.
 

Outcome: Prevents role confusion and protects the organization from misaligned execution during pre-opening phases or existing operational phases.