Six recurring failure points account for the majority of underpayment in primary care. Each one is small. Together they compound across thousands of encounters a year.
Modifier 25 omitted or applied without supporting documentation, so one of the two services is written off.
G0438 and G0439 opportunities missed entirely, or downcoded to a level-3 established patient visit.
Eligible panel identified but time tracking and consent workflows never operationalized.
Product code captured, administration code dropped, or counseling components not billed per component.
25, 59 and 95 applied inconsistently across providers, producing avoidable payer edits.
Medicaid redetermination and plan changes surface after the encounter, at full write-off risk.
Revenue rarely disappears at the payer. It leaks earlier, in the steps nobody owns.
Demographics and coverage captured by hand at the desk.
Eligibility not re-verified; copay and deductible unknown.
Level selection and modifier logic vary by provider.
Payer-specific edits caught after submission, not before.
Denials worked reactively; root cause never fixed upstream.
What actually lands in the account after write-offs.
Certified coders and revenue analysts work inside the same platform your practice does, not in a separate inbox.
A returning patient books a same-week appointment. Clientele checks the panel for open care gaps before the visit is even confirmed.
Demographics validated against the payer record. Mismatches are corrected before they become rejections.
Coverage, deductible status and preventive benefit availability verified in real time, including whether the AWV clock has reset.
Documentation parsed for level of service, preventive components and chronic care time. A certified coder confirms every suggestion.
Payer-specific edit sets run before submission, not after. Anything that would bounce is corrected in the queue.
Batched and transmitted the same day, with acknowledgement tracking down to the clearinghouse level.
Remittance posted automatically, underpayments flagged against contracted rates, patient balance handed to the collection workflow.
They found forty thousand dollars in wellness visits we were already documenting and never billing.
The first vendor that could explain our denials by root cause instead of reading the rejection back to me.
Our front desk stopped guessing at coverage. That alone changed the month.
Yes. Clientele sits as an intelligence layer on top of the system you already use, no migration, no data re-entry. We work in your EHR and practice management system directly, and surface analytics in our platform.
This is the single largest recovery opportunity in Family Medicine. Our coders review documentation for both the preventive and the problem-oriented components, confirm modifier 25 is supportable, and flag notes that need one additional line from the provider before submission.
We identify the eligible panel from your claims and problem lists, build the consent and time-tracking workflow with your clinical staff, and bill the qualifying months. Most practices see enrolled patients within the first 60 days.
Twenty-one days. Week one is access, payer enrollment review and a baseline audit of 90 days of claims. Week two is workflow mapping with your front desk and providers. Week three we run parallel and then take over submission.
A percentage of net collections, with contracted performance targets for clean claim rate and days in A/R. No implementation fee, and month-to-month after the first year.
A named pod: a CPC-certified coder with primary care experience, an A/R analyst, and a revenue lead who reports to you. The AI prioritizes and surfaces; people decide and are accountable.
