Revenue Protection & Optimization Services

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Claim Care Solutions helps healthcare organizations protect revenue before, during, and after claims are submitted.

Our Revenue Protection & Optimization Services are designed to ensure your systems are configured correctly, payments flow without interruption, and denied revenue is identified, tracked, and recovered — using both expert-led workflows and AI-assisted tools.

This service is ideal for clinics preparing to open, expanding services, or experiencing delayed payments and recurring denials.

We ensure your EHR and billing infrastructure are built correctly before go-live, preventing costly errors that lead to denials, delays, and audit exposure.

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. 

• EHR and practice-management configuration review (any system)
   
• Provider, location, and billing-entity validation
   
• Visit types, charge capture, and billing workflow alignment
   
• Behavioral health vs medical service classification review
   
• Separation of psychotherapy and medication-management services
   
• OMH / Medicaid / payer compliance validation
   
• Prevention of premature billing triggers
   
• System gap identification prior to first patient visit
   

A compliance-safe, audit-ready EHR configuration that supports clean claims and protects revenue at launch.

Getting paid requires more than submitting claims.
We configure the full payment pipeline, so remittances and deposits are not lost or delayed.

• Clearinghouse and EDI readiness review (837 / 835 / 276/277)
   
• ERA routing configuration and validation
   
• EFT enrollment coordination and payment destination verification
   
• Payer-specific ERA/EFT requirement review
   
• Remittance posting workflow setup
   
• Identification of missing or stalled enrollments
   
• Verification of claim response and payment visibility
   

Reliable payment flow with accurate ERA posting and timely EFT deposits.

Denied claims are one of the largest sources of revenue loss in healthcare.

Claim Care Solutions combines expert billing strategy with AI-assisted denial tools to ensure denied revenue is captured, prioritized, and resolved.

• Denial capture from ERAs, clearinghouse, and payer portals
   
• Denial categorization by payer, CPT, provider, and reason
   
• Identification of root-cause patterns
   
• Centralized denial tracking with status visibility
   
• Appeal workflow design and prioritization
   
• Guidance on payer-specific appeal strategies

Our AI tools assist with:

• rapid denial classification
   
• prioritization of high-dollar claims
   
• identification of repeat denial patterns
   
• workflow efficiency for billers and operations teams
   

AI is used to support human decision-making, not replace it — ensuring compliance, accuracy, and accountability.

• New clinics preparing to open
   
• Behavioral health and specialty practices
   
• Multi-provider groups
   
• Clinics missing ERAs or EFT payments
   
• Organizations experiencing recurring denials
   
• Practices preparing to scale billing operations

• 20+ years of real-clinic revenue-cycle experience
   
• Deep understanding of EHR, clearinghouse, and payer behavior
   
• Compliance-driven approach (not shortcuts)
   
• AI-enhanced workflows grounded in real clinic operations. 

We don’t just submit claims - we build revenue systems that hold up under scrutiny

• Fewer denials
   
• Faster payments
   
• Improved cash flow visibility
   
• Reduced rework and write-offs
   
• Stronger audit posture
   
• Scalable revenue operations

Whether you are opening a new clinic or stabilizing existing operations, Claim Care Solutions provides the structure, strategy, and tools needed to protect your income and support sustainable growth.

Contact us to schedule a consultation.