Clean Claims Pro | Medical Billing & AR Support

What We Focus On

Fewer Preventable Denials

We focus on fixing common front-end and submission issues that cause avoidable denials.

More Predictable Cash Flow

Consistent claim submission and AR follow-up to reduce unnecessary payment delays.

Improved Claim Accuracy

Pre-submission checks to reduce rework and repeated resubmissions.

Clear Operational Visibility

Simple reporting on claim status, AR aging, and follow-up activity.

Partner With Clean Claims Pro

We collaborate with US-based billing consultants, practice managers, and healthcare professionals who want a reliable execution partner.

You retain client ownership and communication
We operate as a white-labeled or behind-the-scenes team
Clear scope, responsibilities, and reporting
Revenue-share or per-account models discussed transparently

This works best for independent consultants or small firms who want to scale without hiring internally.

Our RCM Execution Blueprint

Clean Claims Pro operates on a structured, pillar-based workflow. Each pillar focuses on a specific stage of the revenue cycle, reducing downstream rework and improving operational control.

VERIFY360 — Eligibility & Front-End Accuracy

Objective: Prevent avoidable denials before claims are created.

Insurance eligibility verification
Demographics and subscriber validation
Coverage and effective date checks
Exception identification and reporting

Output: Verified encounter list with clearly flagged coverage or data issues.

CODE ENGINE — Coding Review & Charge Integrity

Objective: Ensure charges are compliant, complete, and defensible.

CPT and ICD alignment review
Modifier logic validation
Unit and bundling checks
Identification of missing or risky charges

Output: Charge-ready encounters with clarification notes where required.

CLAIMS FLOW — Claim Submission & Scrubbing

Objective: Submit clean, first-pass claims with minimal rework.

Claim creation from validated charges
Pre-submission scrubbing for payer rules
Timely EDI or paper submission
Immediate correction of clearinghouse rejections

Output: Accepted claims list and documented rejection corrections.

PAYMENTS AUDIT — Payment Posting & Reconciliation

Objective: Ensure payments are posted accurately and completely.

ERA and EOB posting
Contractual adjustment validation
Identification of underpayments
Accurate patient balance calculation

Output: Reconciled payment records with underpayment flags where applicable.

RECOVERY ENGINE — AR Follow-Up & Denial Resolution

Objective: Recover delayed or denied revenue systematically.

AR segmentation by aging buckets
Priority-based follow-up (timely filing & high value)
Denial root-cause analysis
Resubmissions and appeals with documentation

Output: AR work logs, denial trend summaries, and appeal tracking.

Workflow Flow:
VERIFY360 → CODEENGINE → CLAIMSFLOW → PAYMENTSAUDIT → RECOVERYENGINE

Clinics typically start with one pillar (often AR or denials) and expand as workflows align and trust is established.

Blueprint KPIs & RCM Control Dashboard

Our execution model is supported by a practical KPI framework. These indicators are used to monitor workflow health, identify issues early, and guide corrective action — not to promise fixed outcomes.

VERIFY360 – Front-End Accuracy

Eligibility verification completion rate
Demographic error frequency
Coverage mismatch flags
Front-end related denial patterns

Typical monitoring focus: reducing avoidable front-end errors over time, not achieving zero-error claims.

CODE ENGINE – Charge Integrity

Coding clarification rate
Modifier-related rework frequency
Charge lag (date of service to charge entry)
Documentation gap trends

Benchmarks are evaluated conservatively to balance compliance and revenue integrity.

CLAIMS FLOW – Claim Submission

First-pass claim acceptance rate
Clearinghouse rejection volume
Average claim submission turnaround time
Payer-specific edit recurrence

Focus is placed on trend improvement and submission discipline, not arbitrary percentage targets.

PAYMENTS AUDIT – Posting & Reconciliation

ERA posting turnaround time
Unapplied payment frequency
Underpayment identification rate
Patient balance accuracy checks

These indicators help prevent silent revenue leakage and incorrect patient billing.

RECOVERY ENGINE – AR & Denials

AR aging distribution (0–30 / 31–60 / 61–90 / 90+)
Denial root-cause categories
Appeal submission timeliness
Resolution cycle trends

Performance is evaluated based on disciplined follow-up and controllable process improvements.

KPI visibility allows clinics and partners to understand where processes are improving, where risks exist, and how execution decisions are made — without relying on inflated metrics.

How We Measure Progress

We don’t believe in vague promises or vanity metrics. Progress is measured through clear, observable indicators tied to daily execution.

Reduction in preventable rejections and rework
Improved turnaround time on AR follow-ups
Clear visibility into claim status and aging buckets
Consistency in workflows and communication

These indicators help both sides understand what’s improving, what needs attention, and where to adjust processes.

Is Clean Claims Pro the Right Fit?

This is a good fit if:

You want disciplined billing and AR execution, not shortcuts
You value clear communication and documented workflows
You prefer starting with a defined scope and expanding gradually
You want visibility into work performed, not blind outsourcing

This may not be a good fit if:

You’re looking for instant results without process changes
You want a “set it and forget it” billing vendor
You expect guarantees on outcomes outside operational control
You prefer aggressive tactics over compliant execution

We work best when expectations are aligned upfront and success is measured through consistent execution.

Medical Billing & AR Support for US Clinics