Platform

Seamless Last-Mile RCM Integration

We leverage our streamlined internal RCM processes automation pipelines to quickly and accurately onboard your RCM processes focusing on the “Last Mile” integrations with EHRs, portals, clearing houses and payer portals. All powered by cutting edge AI integrations offering industry leading accuracy and speed.

Process Automation

Our centralized platform allows us to process eligibilities, claim statuses, payment postings and other RCM processes offering a realtime approach to accounts receivable for all our customers.

From the top down our founders and leaders understand RCM. They merge their decades of engineering knowledge into each and every workflow. Directing the implementation teams in industry practices.

Delivers consistency across all major RCM functions using a unified core

Uses adapters to flexibly integrate with any EHR, payer portal, or clearing house

Delivers compatible with more than 200 healthcare systems and tools

Automates high volume processes while allowing manual control over exceptions

Process Automation

Core engine

Processes major functions like eligibility checks, claim submission, payment posting, and accounts receivable

Adapters

Create MCP servers to map any external system, including Epic, Cerner, CSV exports, payer APIs, clearinghouses like Availity and Waystar, and more.

Data exchange

Managed through reliable, scalable messaging queues that keep workflows synchronized and auditable

Dashboards and reports

Unify all results for real-time tracking, predictive insights, and continuous improvement

01 Claim Status

AI to validate claim accuracy and RPA and API integrations to make status checks quick and consistent

02 Eligibility & Verification

RPA and API integrations with clearinghouses to run complex
eligibility integrations in realtime

03 Prior Authorization

Human in the loop validation of prior authorization checks preventing any costly mistakes and guaranteeing complete accuracy and improved AI model training for all customers

04 Claim Edits

Consistent editing rules and validations make CE a breeze

05 Claim Submission

Against any payer on any portal. With AI augmented workflows making the submission process faster and more streamlined

06 Denial Management

Handling any denial reason and code with accuracy and AI lookups for next steps and follow ups

07 Accounts Receivable

Full comprehensive accounts receivable reducing payment cycle time by up to 35%

08 Payment Posting

Consistent and accurate payments leveraging our internal payment posting pipelines

09 Reporting

Out of the box reporting provided to customers with every product or customizable to any given need

AI and RCM: Smarter Together

Artificial Intelligence is transforming Revenue Cycle Management by taking the complexity out of billing and claim submissions. Instead of relying solely on manual processes, AI algorithms analyze patient and payer data in real time, flagging errors before they happen and ensuring claims are accurate the first time. This reduces denials, shortens payment cycles, and maximizes cash flow.

But AI doesn’t replace people—it empowers them. By automating repetitive tasks, RCM specialists can focus on high-value work like resolving edge cases and optimizing workflows. The result is a seamless blend of automation and human expertise that delivers precision, compliance, and efficiency from end to end.

Custom Processes

Our focus is providing a standardized RCM experience to all our clients but we understand that for your billing needs there can be processes that are outside of the standard scope. Our industry leading team can provide consulting services to create and build any process your organization may need. Our consulting team can breakdown any process into discrete, automatable steps and create a plan of action to accomplish your goals with measurable results. Your team will always be at the helm of the project making sure we’re following your vision and delivering the perfect final product.

Start Optimizing Your Revenue Cycle Today

Let our AI-powered solutions simplify your billing, reduce denials, and boost your revenue. Partner with OptipayRCM and see measurable results—fast.