End-to-End Revenue Cycle,
Powered by AI

From the moment a patient is seen to the moment payment hits your account — we handle it all with technology no other billing company has.

Core Service

Medical Coding

Our AI reads clinical documentation and suggests the most accurate ICD-10 and CPT codes, complete with confidence scores. Your dedicated coder reviews, confirms, and submits — combining human judgment with machine speed.

AI-suggested ICD-10 diagnosis codes with confidence scoring
CPT/HCPCS procedure code suggestions with charge amounts
CCI edit validation before code assignment
Coding knowledge base that learns from your practice patterns
Full audit trail for every coding decision
See AI Coding in Action
AI Coding Suggestions
98%
F33.1 Major depressive disorder, recurrent, moderate
95%
F41.1 Generalized anxiety disorder
82%
90837 Psychotherapy, 60 min
Core Service

Claims Submission & Follow-Up

Every claim is electronically scrubbed, validated against payer-specific rules, and submitted through our clearinghouse integration. We track every claim from submission to payment posting.

Electronic 837P (CMS-1500) claim generation and submission
Automated 835 remittance processing and payment posting
276/277 claim status inquiry for aging claims
Payer rules engine with timely filing deadline tracking
Prior authorization validation during claim scrubbing
Pre-Submission Scrub
CCI Edits — No conflicts found
Payer Rules — BCBS validated
Timely Filing — 82 days remaining
Prior Auth — AUTH-2024-0847 linked
Claim ready for submission
Core Service

Denial Management & Appeals

Denials aren't just tracked — they're attacked. Our platform identifies denial patterns by payer, generates appeal letters using denial reason codes and patient history, and tracks every appeal through resolution.

AI-generated appeal letters from 12 denial-specific templates
Patient history integration for medical necessity appeals
CARC/RARC reason code analysis and trending
Full appeal lifecycle tracking with recovery measurement
Proactive denial prevention from historical pattern analysis
Appeal Generation
Denial: CARC 50 Medical Necessity
Appeal Letter AI Generated
3 prior encounters cited
Ready to send
Core Service

A/R Follow-Up & Recovery

We don't wait for claims to age out. Our platform surfaces aging claims, tracks filing deadlines, and our team systematically works every outstanding balance with payer-specific follow-up strategies.

A/R aging reports by payer, provider, and date range
Timely filing deadline alerts before claims expire
Reimbursement variance analysis (expected vs. actual)
Fee schedule application and underpayment detection
A/R Aging Summary
0–30 days
$42,150
31–60 days
$12,800
61–90 days
$4,200
90+ days
$1,850
Specialty Service

ASC & Facility Billing

Ambulatory surgical centers have unique billing requirements — dual-format claims, revenue codes, and payer-specific format rules. We handle all of it, automatically determining whether each payer needs an 837P or 837I.

Dual-format billing: 837P (Medicare) and 837I (Commercial)
AI-suggested revenue codes alongside CPT codes
Per-payer format configuration (which payer gets which format)
ASC-specific CPL validation and compliance checks
UB-04 type of bill, condition codes, and occurrence codes
See ASC Billing Demo
Dual Format Claims
Medicare
837P
CMS-1500
POS 24
Same Surgery Two Formats
Commercial
837I
UB-04
Rev 0490
Core Service

Compliance & Audit Support

Every action taken in our platform is logged, auditable, and HIPAA-compliant. We generate scheduled compliance reports and maintain a complete chain of custody for every claim.

HIPAA-compliant data handling with PHI access logging
Scheduled compliance reports (daily, weekly, monthly)
OIG exclusion screening integration
Complete audit trail for coding decisions and claim changes
Compliance Dashboard
HIPAA Audit Logging Active
OIG Screening Current
Monthly Compliance Report Feb 2026
Data Encryption AES-256

Let's Talk About Your Revenue Cycle

Every practice is different. Tell us about your challenges, and we'll show you exactly how Prometheus RCM can help.