Diabetes diagnosis specificity, CGM interpretation, thyroid and hormone therapy documentation, injectable J-code and NDC validation, and imaging authorization. Clientele automates endocrinology revenue cycle management as one continuously measured system.
Select a domain to see how it flows into documentation, coding, authorization and claims.
Glycemic control, complications and insulin regimen captured at every visit.
E11.9 to E11.69 combination codes selected by documented complication, not defaulted.
Insulin pump and CGM device orders checked against payer coverage criteria.
Diagnosis specificity validated before the claim leaves the queue.
Each module scores compliance, flags risk and surfaces the recommendation behind it, before the claim is built.
Auto-suggests combination codes (E11.21, E11.40) from documented complications instead of defaulting every encounter to E11.9.
Splits technical and interpretation components automatically and blocks duplicate 95251 billing within the same monitoring period.
Flags hormone therapy visits missing baseline labs before the claim is built.
Matches injectable J-codes to documented dose and route before submission.
Confirms NDC-to-J-code pairing against current payer crosswalks.
Checks DEXA interval and pituitary MRI necessity against payer policy before scheduling.
Final scrub across diagnosis, CGM, medication and authorization checks before the batch submits.
Visit captured with glycemic, thyroid or hormone panel context attached.
Combination ICD-10 codes selected from documented complications, not defaulted.
95250/95251 components split and checked against the monitoring period.
Injectable dose and route matched to J-code and NDC before billing.
MRI, DEXA and device orders checked against payer policy pre-submission.
Diagnosis, CGM, medication and authorization checks reconciled in one pass.
Batched same day with clearinghouse acknowledgement tracked.
Reimbursement tracked against the original claim, denial-free.
Average time in pipeline: 29 seconds.
CGM billing finally matches how the visit was actually documented. 95250 and 95251 stopped getting bundled by mistake.
J-code and NDC mismatches on injectable therapy used to be our top denial reason. That queue is nearly empty now.
DEXA authorization tracking means we stopped scheduling scans that were going to be denied on the interval rule.
Combination ICD-10 codes are suggested directly from documented complications (nephropathy, neuropathy, retinopathy) instead of defaulting every encounter to E11.9, and every suggestion is checked against the note before it is accepted.
95250 and 95251 are tracked separately, matched to device data span and interpreting clinician, and checked against the payer’s monitoring-period rule so the same period isn’t billed twice.
J-codes are matched to documented dose and route, NDC pairing is confirmed against current payer crosswalks, and therapy visits missing baseline labs are flagged before the claim is built.
DEXA frequency is checked against the payer’s coverage interval and pituitary or adrenal MRI orders are matched to supporting hormone data before the authorization request goes out.
CGM interpretation and chronic care management minutes are logged per encounter and reconciled against the code billed, so time-based claims are supported the same way every time.
A percentage of net collections with contracted clean-claim and coding-accuracy targets. No implementation fee, and month-to-month after the first year.
Send us 90 days of endocrinology claims data. We will show you exactly where CGM billing, J-code mismatches and imaging authorization gaps are costing your practice, before you sign anything.