Screening, diagnostic and therapeutic procedures each carry different coverage rules, often for the same code.
Referring provider and reason captured; history pulled for medical necessity.
Screening versus diagnostic benefit confirmed before the visit is scheduled.
Payer-specific requirements cleared before the procedure hits the schedule.
Technique, findings and add-ons captured at the level actually performed.
Biopsy results matched to the encounter; coding holds for the final read.
Operative note checked for the detail the code set requires.
Modifier and screening-conversion logic applied before submission.
Payer-specific procedure and pathology edits cleared pre-submission.
What actually lands in the account after authorization-aware review.
Six governance modules run on every encounter, from authorization through denial prevention.
Pathology results used to sit in a fax queue. Now they drive the code before the biller even opens the chart.
Our ASC stopped losing screening colonoscopies to authorization delays.
Finally a partner that codes a therapeutic EGD differently than a diagnostic one, consistently.
When a screening colonoscopy becomes diagnostic or therapeutic mid-procedure, we apply the correct modifier (PT for Medicare, 33 for commercial) so the patient's preventive benefit is preserved and the claim reflects what was actually done.
Pathology results are matched to the originating encounter automatically. Coding waits for the final read on biopsies so the diagnosis code reflects the pathology, not just the endoscopic impression.
Yes. Our coders hold GI-specific credentials and code ERCP, EUS, capsule and balloon-assisted procedures to the specific technique and findings, not a generic upper endoscopy code.
Authorization status is tracked from the day a procedure is scheduled, with payer-specific requirements flagged automatically so nothing reaches the schedule unauthorized.
Yes. Site of service changes both the code set and the modifier logic, and we apply the correct set automatically based on where the procedure is performed.
A percentage of net collections with contracted clean-claim and authorization-success targets. No implementation fee, and month-to-month after the first year.
