Solutions
Insurance Verification and Eligibility
Prior Authorization
Using humans as an integral part of our automation validation processes we guarantee accurate prior authorization submissions and allow customized prior authorization workflows for any customer process, clearinghouse, payer portal or EMR flow.
Eligibility
We are a premiere provider of eligibility automation leveraging clearing house APIs, MCP (AI) integrations and payer portal access to make sure your procedures have been approved long before any patient arrives adding simplicity and peace of mind to any practice. Allowing our provider partners to do what they do best and focus on their patients and leave the back office to us.
Charge Capture
Claim Edits
Our processing can remove the need for manual claim editing based on insurance provider ERA feedback and make sure your claims are organized in exactly the way any individual payer requires for a given submission.Â
Claim Scrubbing
Our presubmission claim scrubbing AI tools can detect and correct common coding errors and reduce first pass denials by up to 63%..
Claims Processing
Claim Submission
We tailor our submission processing to match any customer process, timeline or payer requirements and generate a continual feedback loop from the second the claim is ready to be submitted until it’s fully resolved.
Claim Status
Our extensive process automation workflow allows us to guarantee accurate claim statuses up to 50x faster than human processing. Providing you with the ability to have claim statuses always up to date and accurate. Â
Denial Management
Denial Management
We understand the hurdles insurance companies put in the way of getting providers compensated for the critical work they provide. We focus on understanding payers denial practices and adjusting our submission and resubmission practices to lower first pass denials by up to 63%. We take every denial seriously and focus our staff, AI and procedures on ways to prevent denials and guarantee a consistent and secure cash flow for all of our customers.
Claim Correction
Payers can have interesting ways of requiring claims to be submitted. We make sure to understand their requirements and adapt processes to follow. Tying our claim statusing processes to our rejection handling allows us to correct claims as soon as we know they’re rejected and fix issues before our customers even notice.
Appeals
Not every denial is the end. We investigate all denied claims and push back against payers that unfairly or incorrectly denied a claim. Leveraging our database of claim denial processes and AI tooling we can identify claims that should have been covered and provide the necessary documentation and follow up with all payers.
Payment Posting
Payment Posting
Consistent and streamlined payment cycle time is critical to bottom line revenue. Our focus is to speed up payment remittances and guarantee timely and consistent payment processing. Reducing aging payments and putting AI automation to work where it can best be utilized in capturing not just the large claims but all claims.
AR Follow-Up
Accounts Receivable
We offer a complete accounts receivable workflow that matches any customer process with any system. Our focus is the “Last Mile” adapting our tooling to your workflow with seamless integration. We can handle any CPT code thrown at us and then some! Leveraging our decades of experience, advanced AI and process tooling to make any adjustment not just based on the payer feedback but on our customers expectations and procedures.
Claim Adjustments
All claims regardless of outcome require some adjustments; it’s just part of the RCM process. We bake that into our AR processing and make sure to include any and all relevant adjustments crafted exactly to your specifications.
Account follow ups
Oftentimes getting a payer to cover a payment in a timely fashion requires a nudge in the right direction. Our processes allow us to provide that little bit of extra help to get the payments posted and providers paid on time.
Reporting and Benchmarking
Statements and Inquiries
Measuring the success of a project is the most important step to long term success. If we can’t determine where we stand, how can we know if we’re succeeding? As a data driven organization, reporting and metrics is at our core. Continual feedback is the cornerstone of any process. We build customer visible reporting into every process we do.
Other
Claim Recapture* (coming soon)
Our wealth of procedural and claim information has allowed us to build customized AI agents that can look at encounter information and recognize if a procedure or claim was missed during the coding stage. Allowing customers to recapture claim revenue that would have been lost to billing and coding errors otherwise.
We’re also taking this innovation to the next level, helping our customers and their patients by analyzing encounter information to see if there were any more potential procedures that could have been provided. Our extensive RCM expertise allows us to leverage AI to compare every encounter to similar ones and make recommendations that can improve patient outcomes and potentially save lives.

At OptiPayRCM we’re focused not just on bottom line revenue but on patient outcomes as well!
Healthcare Automation Consulting Services
While the main focus is Revenue Cycle Management (RCM), we understand that an organization may have unique processes outside the standard RCM scope. Our automation, AI and process automation expertise can be an invaluable asset when exploring opportunities for improving customer processes. Let us know how we can help.
Contact Us
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.
Contact Us
