Health Revenue Intelligence, for independent practices
The whole revenue cycle, run for your practice, with answers you can act on.
HRI Med is how Health Revenue Intelligence serves independent medical, dental and specialty practices. We run the cycle from eligibility to the final payment: authorizations, claims, posting, denials and appeals, underpayments and the reporting that explains them. When a payer does not know the practice yet, enrollment comes first. It is the fastest way in.
For practices with one to ten providers: opening, adding a provider or a service, or billing today and ready for it to be done properly. Price your enrollment here.
Four places a practice stands with its payers.
Three of them come before the first paid claim: until a payer enrolls the practice and each of its providers, claims to that payer are not paid in-network. The fourth is every week after that, when claims go out and the money has to come back in full.
The lease is signed and the first patients are booked, but no payer knows the practice yet. We set up each provider's CAQH profile, check the NPPES record, enroll you in Medicare through PECOS, file with your state's Medicaid program and open the commercial panels you choose.
- What it costs
- Priced per application. The calculator below prints your total.
- What you receive
- An effective date from each payer, or its answer in writing, and a page on what to bill.
A physician, nurse practitioner or physician assistant starts soon. The practice is enrolled and the new clinician is not, so visits billed under their name too early can come back unpaid. We file their applications with every payer you bill, link them to the group, and tell you what can be billed in the meantime.
- What it costs
- $250 per practitioner application, plus $150 if a CAQH profile needs setting up.
- What you receive
- Each payer's effective date for the new provider, tracked on the Friday board.
You want to add medical weight management, a procedure or hormone therapy, and you need to know whether it will pay before you buy the equipment. That depends on the payer, the codes, the documentation and your contracts. We write the answer down, for one service, at one fixed fee.
- What it costs
- $2,500 for one written answer.
- What you receive
- Which payers cover it, under what codes and documentation, what enrollment or contract is missing, and what it should pay.
The practice is enrolled and claims go out. Some come back denied, some are paid below the contract, and some patients' coverage changed before the visit. We take over the cycle: benefits checked before the visit, authorizations on file, clean claims built and followed, every payment posted against what it should have been, and each denial worked back to its cause and appealed.
- What it costs
- Priced from the practice's own numbers, set in the agreement.
- What you receive
- A weekly claim report in plain words: what was paid, what was denied and why, what was underpaid, and what we are doing about each.
Enrollment is the fastest way in. Billing is the whole cycle after it.
The whole revenue cycle, run by one firm.
We hold every step, so nothing falls between a biller, a credentialing vendor and a consultant.
- Before the visit
- Benefits and eligibility checked, and authorizations requested and tracked until the payer answers.
- The claim
- Built clean against each payer's rules, sent, and followed until it is paid or answered.
- The payment
- Posted and reconciled against what the payer should have paid, with underpayments flagged and pursued.
- Denials and appeals
- Each denial traced to its cause, appealed where the practice is owed, and fixed upstream so it stops recurring.
- Reporting
- A plain weekly account of what came in, what did not and why, drawn from HRI's payer intelligence.
- Enrollment
- Credentialing and payer enrollment for the practice and each provider, followed to an effective date.
- The payers
- Medicare, your state's Medicaid program and each of its managed-care plans, and every commercial plan on your list. We name no payer as a partner; we work each one as its own rulebook.
Everything starts with a free review, a conversation that needs no patient information. If a payer does not know the practice yet, the Enrollment Sprint comes first. If a new service is the question, the written answer follows. Billing runs the cycle from there, priced from your own numbers in the agreement.
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We walk through where the practice stands with each payer and where its claims stand, from a one-page checklist. No patient data.
No charge
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CAQH, Medicare through PECOS, Medicaid and the commercial payers you choose, each followed to an effective date.
$250 to $350per application, plus $150 CAQH setup
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One written answer for one new service.
$2,500fixed, one service
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The whole cycle, every week: eligibility, authorizations, claims, posting, denials, appeals and underpayments.
By agreementset from your numbers
Every fee, with worked examples, is on the pricing page.
No email address asked for.
Price your enrollment before you speak to anyone.
Set your providers and payers. The total uses only our published fees and is invoiced once, at signing. A solo practice files one application per payer at $350, with no practitioner fee.
Enrollment Sprint estimate
Two providers and five payers: $4,550, invoiced once at signing.
- Five organization applications at $350$1,750
- Ten practitioner applications at $250$2,500
- Two CAQH setups at $150$300
Enrollment is the part we can price for you here. Billing and the rest of the cycle are priced from the practice's own numbers and set in the agreement.
Every application on one page, every Friday.
Each Friday you get the board for your practice, one row per application: where it stands, what happens next and who owes the next move. When a payer goes quiet, the row says so and we keep following up. The effective date stays empty until a payer commits to one in writing.
Once billing runs, the same Friday board covers claims: what was paid, what was denied and why, what was underpaid, and what we are doing about each.
Friday board
Changed since last Friday
| Payer | Status | Next action | Expected effective date |
|---|---|---|---|
| Medicare (PECOS) | In review | UsAnswered the contractor's request for a corrected practice address. | Not set yet |
| State Medicaid | Needs you | YouSign the ownership disclosure page we marked. | Not set yet |
| Commercial plan A | Submitted | UsConfirm receipt and log the payer's reference number. | Not set yet |
| Commercial plan B | Effective | UsSend the page on what to bill with this payer. | Set, on the payer's letter |
| Commercial plan C | Panel closed | UsFiled an exception request with the practice's case in writing. | None until the panel answers |
| Commercial plan D | Preparing | UsFile once the CAQH attestation shows as current. | Not set yet |
| Medicare (PECOS) | Submitted | UsWatch for the contractor's first request. | Not set yet |
| State Medicaid | Preparing | UsFinish the application; one page will need your signature. | Not set yet |
| Commercial plan A | Preparing | UsFile after the CAQH profile is attested. | Not set yet |
| Commercial plan B | In review | UsFollow up with the payer on the open application. | Not set yet |
| Commercial plan C | Submitted | UsWait for the payer's network decision. | Not set yet |
| Commercial plan D | Preparing | UsFile once the CAQH attestation shows as current. | Not set yet |
Six status words, used the same way on every board: Preparing, Submitted, In review, Needs you, Panel closed, Effective.
We bring what HRI knows about each payer.
We bring HRI's running notes on how payers behave: the forms they send back, where files stall, what they ask for before they pay. Every medical claim we work adds to them.
That is why a Sprint ends with a page on what to bill, and why a denial gets an answer instead of a resubmission. A form filed on time is half the work. The other half is knowing what the payer accepts after it says yes.
60%
of medical group leaders told an MGMA Stat poll that their claim denial rates had risen on the year before. Denials rarely announce their cause. We trace each one back to it.Source A, listed at the foot of this page.
Run by Health Revenue Intelligence.
HRI Med is part of Health Revenue Intelligence. HRI runs it, and every client gets the same attention HRI gives the facilities it bills for. Prices go in writing before work starts. Status arrives on a set day. When you write, we read it.
- Who we serve
- Independent medical practices first, then dental practices, therapy clinics, chiropractic and optometry, and medical services inside aesthetics practices under a medical director.
- Behavioral health
- Treatment programs and facilities work with Health Revenue Intelligence directly.
Sourced wherever a number appears.
Field notes from the work.
- What "credentialed" means, and why nothing pays before the effective dateEnrollmentThree separate steps, and only the last one gets a claim paid.
- Closed panels: single-case agreements, network adequacy and group contractsPanelsWhen a single-case agreement helps, and when a group contract is the faster door.
- Hyperhidrosis and other services that look cosmetic and are coveredService linesSome treatments sold in aesthetic settings are medical services with coverage rules.
Sources
- MGMA Stat, “Strategic improvements in your RCM to reduce your practice’s claim denials”, a poll of medical group leaders on claim denial rates, 235 applicable responses. A single-question poll of MGMA members.
Each answer links to the full one.
What owners ask first.
What does the free review cover?
Where the practice and each provider stand with every payer, how claims are going, and what we would run first. We work from a one-page checklist and practice facts only. How the review runs
How long does enrollment take?
The payer sets that clock. Medicare tends to answer first, each state runs Medicaid at its own pace, and commercial plans take months. We tell you the day a payer commits to a date in writing. More on timing
Group or individual enrollment?
For most groups, both. The practice goes on file under its tax ID, and each clinician is added and linked to it. A solo owner who is the only clinician files once per payer. The full answer
If we enroll with you, must we bill with you?
No. The Sprint stands on its own and the enrollment file is yours. Billing is a separate agreement for practices that want the whole cycle run. Billing and revenue cycle
Can you take over from our current biller?
Yes. The review looks at what is open and ageing first, and the handover is planned so no claim is dropped between firms. Taking over billing
Start with the free review.
Tell us where the practice stands, which payers matter and how claims are going. Leave out anything about patients; the review never needs it.
We get back to you as quickly as possible.