Your recoverable revenue, named and quantified — on a timeline scoped to your data, at no cost to you.
Send us your remittance data. We return a specific, defensible figure with your organization's name on it — traced to the claim line. You decide what happens next.
Typical turnaround: five business days for a single site, ten for multi-site or multi-specialty organizations, fifteen for health-system scale — confirmed on your scoping call, never assumed in advance.
Is the diagnostic right for you, right now?
The diagnostic works best for organizations with enough live claim volume to produce a statistically meaningful figure. On your scoping call we confirm fit against three things:
An active OB/GYN, maternal-fetal medicine, behavioral health, or adjacent specialty practice, hospital, or MSO.
Enough ongoing monthly claim volume across payers to support a defensible finding — not a startup practice with no billing history yet.
Twelve to twenty-four months of remittance history available to submit.
If any of these don't fit yet — most commonly, a practice that isn't billing this payer yet — the diagnostic isn't the right starting point. We'll tell you on the call, and point you to Medicaid & payer enrollment instead, which is exactly where that situation belongs.
01
A short scoping call
Twenty minutes to confirm what "recoverable" means for your organization, flag any specialty-specific denial categories up front, and check your claim volume is enough to produce a statistically meaningful figure — free, even if the honest answer is no. This call also confirms your turnaround tier based on the size and complexity of your data. You are assigned a named analyst here.
02
Secure data transfer
Twelve to twenty-four months of remittance data, submitted through an encrypted transfer portal under a BAA — and, for substance-use records protected under 42 CFR Part 2, a Qualified Service Organization Agreement or patient consent as well.
03
Your report, on the confirmed timeline
A defensible, claim-line-traceable figure, delivered by your named analyst within the five-to-fifteen-business-day window confirmed at your scoping call, with time held to walk through it with you.
What you send
Twelve to twenty-four months of remittance data — the 835 files your clearinghouse already produces — submitted through an encrypted, access-controlled transfer portal, never as an email attachment. Optionally, a general ledger extract for a preliminary margin view. No system access, no installation, no disruption to a single workflow.
For bundled global maternity claims, we work from your underlying encounter-level detail wherever your systems retain it, so a finding traces to the specific antepartum or postpartum visit that caused it — not just the global claim.
What you receive, on your confirmed timeline
Your denial rate, decomposed. By payer, by plan, by reason, against comparable organizations — so you can see whether your problem is one payer, one department, or one broken process.
Your authorization exposure. Denials tied to missing or expired prior authorization, isolated from other denial causes — the largest single bucket for many OB/GYN, maternal-fetal medicine and behavioral health practices.
Your authorization turnaround time. Where authorization data is available, the average days from request to determination, and where in the workflow requests are stalling — the operational root cause behind the dollar figure, not just the number itself.
Your recoverable dollars. Denied claims that should have been paid and payments made below contract, quantified, with the underlying claim lines available for you to inspect.
Your rate position. Where your negotiated rates sit against the market on your top ten service lines, drawn from the public transparency data most organizations never mine.
A preliminary margin view. Where you provide ledger data — your contribution margin on your three largest payers, and a first look at cost per visit.
A single named analyst. One point of contact for the full diagnostic window. Every question during the diagnostic goes to that person directly, not a support queue.
How we protect sensitive records
42 CFR Part 2 aware. Substance use and behavioral health records carry protections beyond standard HIPAA. Our review process is built to recognize and preserve those protections from intake to final report.
Sensitive findings, handled as such. Perinatal loss, high-risk maternal-fetal findings, and psychotherapy notes are treated as clinical records deserving discretion — not as billing line items.
Part 2 data, under the right authority. A standard BAA does not on its own authorize us to receive substance-use records protected under 42 CFR Part 2. For that data, we execute a Qualified Service Organization Agreement alongside the BAA, or work under your patients' specific consent — whichever your organization's counsel prefers.
Security documentation on request. We provide our current safeguards documentation — encryption standards, access controls and audit logging — for your vendor risk review before you send anything.
Sample diagnostic output
What your report looks like
Denial Decomposition
SAMPLE
By reason
Eligibility / coverage
24%
Prior auth / no auth on file
26%
Underpaid vs. contract
22%
Missing or invalid info
16%
Recoverable Dollars Ledger
SAMPLE
Aetna
Underpaid vs. contract terms
$4,120
Recoverable
UnitedHealth
Denied — should have been paid
$2,860
Recoverable
Medicare
Rate below market
$3,975
Flagged
Illustrative figures for demonstration only — not actual client data.
Why it is free. Because the number makes our case better than any sales conversation could. Most organizations, having seen the figure, want to know why it is happening — and that is the assessment. But you are under no obligation, and the report is yours regardless.
The honest part. If we find less than you hoped, we will tell you the smaller number. If the right answer is to change nothing, we will say so. Our credibility with finance leaders is the whole of our business.
It stays current for twelve months. Rates, contracts and denial patterns shift. We reach out near the one-year mark to offer a refreshed diagnostic — complimentary if you're an active client, simply scoped if you're not.
Common questions
Do you help with Medicaid provider enrollment?
Yes. For practices that are not yet billing a payer — or adding one — we manage Medicaid and commercial payer enrollment end to end, from the initial application through the first clean claim, for a flat per-provider fee. This is a separate, standalone engagement from the Data Diagnostic below, which is built for organizations with an existing billing history.
What is a healthcare revenue cycle diagnostic?
A free analysis of your remittance data — typically five to fifteen business days depending on size and complexity — that quantifies denied claims that should have been paid, underpayments against contract, and rate gaps versus market, delivered as a defensible, claim-line-traceable figure.
How much does outsourced medical billing cost?
The Data Diagnostic itself is free. Ongoing outsourced billing, coding and denial management is scoped to your organization after the diagnostic shows what is actually recoverable, so pricing reflects your real opportunity rather than a flat rate.
How do you reduce denial rates in OB/GYN and behavioral health practices?
By decomposing denials to their root cause across people, process, technology, data and governance — including authorization-specific denials, typically the largest single category in OB/GYN, maternal-fetal medicine and behavioral health billing.
What is prior authorization outsourcing?
Having a specialized partner manage authorization requests, tracking and appeals on your behalf, so session-limit reviews, level-of-care determinations, and imaging or genetic-testing authorizations do not stall care or revenue.
Do you work with behavioral health practices under 42 CFR Part 2?
Yes. For substance-use records protected under 42 CFR Part 2, we execute a Qualified Service Organization Agreement alongside our standard business associate agreement, or work under patient-specific consent.
How long does the data diagnostic take?
Between five and fifteen business days from the point your data is received through the secure transfer portal, depending on the size and complexity of your data, confirmed during your scoping call.