The operational core of a practice: billing and revenue cycle management, eligibility and prior authorization, clinical audit, and the staffing behind care management programs — with reporting you can take to a monthly review.
Best for: Practice owners, administrators, RCM directors and finance leaders.
Engage the whole area as a single programme, or start with the one service that is costing you the most time today.
Keep your revenue cycle moving, from scheduling to follow-up.
Carevory Health supports the work behind accurate billing and organized revenue operations. Engage a full-cycle team or address a specific backlog, with responsibilities and reporting matched to your practice.
Best for: Practice owners, administrators, RCM directors and finance leaders.
Engage the full scope or pick the functions you need. Each item below can be included, excluded or phased in your proposal.
- 01Appointment scheduling, confirmations, rescheduling and front-desk workflow support.
- 02Eligibility and benefit verification, deductible/copay review and payer requirement checks.
- 03Prior authorization, pre-certification and referral tracking, including payer follow-up.
- 04Charge entry, documentation completeness checks and coding support within the agreed review model.
- 05Claim preparation, submission, status tracking, corrections and resubmissions.
- 06Denial analysis, appeals, reconsiderations and root-cause reporting.
- 07Payment and adjustment posting, underpayment review and A/R recovery follow-up.
- 08Patient statements, balance inquiries and payment coordination through approved systems.
- 09Provider enrollment, credentialing follow-up, payer participation and contracting coordination.
- 10Operational reporting, account auditing, exception tracking and management review.
- Transition plan
- Responsibility matrix
- Documented work queues
- Exception log
- Service-specific performance reporting
Every metric gets an agreed definition, denominator and reporting period before we compare performance.
- First-pass acceptance
- Denial rate
- Days in A/R
- Aging mix
- Turnaround
- Appeal outcomes
We assess your systems and backlog, agree work queues and sign-off responsibilities, transition access, and begin a controlled rollout. Regular reviews surface unresolved claims and process issues.
- 01Assess systems & backlog
- 02Agree queues & sign-off
- 03Transition access
- 04Controlled rollout
- 05Regular reviews
Know what's covered before the patient walks in.
We verify eligibility and benefits ahead of each visit, flag coverage problems early and start prior authorizations — so front desks collect the right amount and claims start clean.
Best for: Practices, groups and facilities that need dependable eligibility checks and authorization support.
Engage the full scope or pick the functions you need. Each item below can be included, excluded or phased in your proposal.
- 01Eligibility and active-coverage checks ahead of each scheduled visit.
- 02Benefit detail: deductibles, copays, coinsurance, visit limits and network status.
- 03Coordination-of-benefits and secondary-coverage review.
- 04Prior authorization initiation, submission and status tracking.
- 05Referral requirement checks for HMO and managed-care plans.
- 06Patient-estimate inputs and front-desk alerts for coverage issues.
- 07Payer-portal, clearinghouse and phone verification where needed.
- Verification checklist by payer
- Exception queue
- Authorization tracker
- Daily verification log
- Monthly denial-cause review
Every metric gets an agreed definition, denominator and reporting period before we compare performance.
- Visits verified before arrival
- Eligibility-related denials
- Authorization turnaround
- Exceptions resolved before the visit
We connect to your schedule, verify an agreed number of days ahead, record results in your system and escalate exceptions to front-desk and billing owners.
- 01Connect to schedule
- 02Verify ahead of visits
- 03Record in your system
- 04Start authorizations
- 05Escalate exceptions
Stay survey-ready and keep reimbursement aligned with the care you deliver.
Nurse auditors review clinical records for skilled nursing and post-acute facilities — MDS accuracy, PDPM classification, quality measures and survey readiness — and give your team a prioritized list of what to fix.
Best for: Skilled nursing, post-acute and long-term care operators, administrators, DONs and MDS coordinators.
Engage the full scope or pick the functions you need. Each item below can be included, excluded or phased in your proposal.
- 01MDS assessment accuracy and timeliness audits.
- 02PDPM classification review against clinical documentation.
- 03Quality Measure (QM) review and trend analysis.
- 04Mock surveys and survey-readiness checklists.
- 05QAPI and quality-improvement program support.
- 06Clinical documentation audits for skilled-level services.
- 07Staff education on audit findings and documentation practice.
- Audit plan
- Findings report
- Correction priorities
- Education materials
- Re-audit results
Every metric gets an agreed definition, denominator and reporting period before we compare performance.
- MDS accuracy
- On-time assessments
- PDPM documentation support
- QM trends
- Survey-readiness findings closed
We agree the audit scope and sample, review records against current requirements, report findings by risk, support corrections and re-audit.
- 01Agree scope & sample
- 02Record review
- 03Findings by risk
- 04Staff education
- 05Re-audit
Keep patient follow-up connected to the care team.
We help healthcare organizations organize enrollment, outreach, documentation and follow-up across care-management workflows. Each engagement follows your protocols, supervision requirements and escalation paths.
Best for: Clinical operations leaders, practice managers and ACO/VBC program teams.
Engage the full scope or pick the functions you need. Each item below can be included, excluded or phased in your proposal.
- 01Patient identification workflow support, eligibility review and enrollment coordination.
- 02Program consent capture and documentation using approved scripts and systems.
- 03CCM, PCM and RPM operational support, including task tracking and care-plan documentation.
- 04Device onboarding coordination, adherence outreach and routing of reading exceptions.
- 05Appointment, referral, discharge follow-up and care-gap outreach coordination.
- 06Medication-list collection and reconciliation support routed to authorized clinical staff.
- 07Barriers-to-care documentation, community-resource navigation and closed-loop follow-up.
- 08Additional TCM, BHI, APCM and wellness workflows when staffing, supervision and payer requirements are confirmed.
- Program workflow
- Outreach schedule
- Task and escalation records
- Documented handoffs
- Activity reporting
Every metric gets an agreed definition, denominator and reporting period before we compare performance.
- Contactability
- Enrollment conversion
- Task completion
- Referral closure
- Escalation timeliness
- Documentation completeness
We define the program and eligible population, confirm staffing roles, agree scripts and escalation rules, and pilot outreach before scaling.
- 01Define program & population
- 02Confirm staffing roles
- 03Agree scripts & escalation
- 04Pilot outreach
- 05Scale
Organizations that usually start in Revenue & Care Operations.
The questions practices raise most often across Revenue & Care Operations.
Yes. Eligibility, prior authorization, denials or A/R can be scoped separately. Coding and claim sign-off responsibilities are documented; payment and reimbursement are not guaranteed.
Yes. An engagement can address one workflow, a defined project or an ongoing delivery function. Additional services can be scoped as your requirements evolve.
Pricing depends on scope, volume, staffing, coverage, complexity and third-party costs. We provide a proposal that separates implementation, recurring services and optional work.
Yes. Carevory is HIPAA compliant. We sign a Business Associate Agreement before anyone on our team accesses protected health information, work only inside the systems you authorize, and cover subcontractor arrangements too.
No. Verification confirms coverage information at a point in time; payer determinations, policy changes and medical-necessity reviews still apply.
Qualified nurse auditors with post-acute experience. Credential and licensure requirements are confirmed for each engagement before any record access.
No. Clinical assessment, treatment decisions and orders remain with appropriately licensed professionals. Administrative coordinators do not independently diagnose or change treatment.
Tell us what is slowing your organization down. We will help define a focused starting point and the reporting that comes with it.
Business inquiries only. Please don't include patient information.