Pre-Visit Eligibility & Authorization Pipeline
Before surgery or high-cost testing, we verify patient benefits, check for required prior authorizations, and if needed, initiate those with supporting clinical documentation to avoid claim rejections.
Scope & Diagnostic Capture with Accuracy
When you perform nasal endoscopy (e.g. CPT 31231) or flexible laryngoscopy (31575), we ensure laterality, instrumentation detail, and medical necessity are clearly documented all required for audit defense.
Surgical Coding & Global Period Compliance
During the global period, we leverage modifiers like 24 for unrelated services and ensure you never bill prohibited E/Ms. For procedures, we verify global period status and guard against duplicate or inappropriate billing.
Modifier Management & Bundling Intelligence
We apply the right modifiers — 25, 59, 50, 51 — based on surgical complexity, laterality, and payer-specific policies. Our system catches misuse before claims go out to prevent denials.
Post-Op E/M & Split-Visit Logic
If a post-surgical complication or unrelated issue arises during the global period, we guide correct use of modifier 79 or 24 and ensure documentation justifies a separate service.
Diagnostic & Imaging Coordination
CTs, MRIs, allergy panels — we monitor when these require authorizations, ensure linkage with ENT procedures, and prevent double-billing or exclusion.
Denial Triage & Appeals Automation
Our system categorizes denials by reason (e.g. bundling, lack of medical necessity, missing modifier) and routes high-value claims to appeals with templated packets. We track overturn rates and continuously refine the logic.
Empathetic Patient Billing & Recovery
Voice AI and empathetic scripts reach out for balances, provide transparent estimates, and offer patient-friendly payment plans  preserving patient relationships while collecting revenue.