Structured RCM Operations From Front-End to Revenue Recovery
Provixion provides structured Revenue Cycle operations across Front-End, Mid-Cycle, and Back-End workflows — with quality controls integrated throughout the delivery process.
Build a Cleaner Billing Foundation
Front-End operations focus on the accuracy of information before records move downstream into billing.
Demographic Entry & Validation
Accurate entry and validation of patient, guarantor, subscriber, and demographic information based on available source data.
Eligibility Verification
Verification of active coverage and available benefit information, including copay, deductible, and coinsurance details.
Insurance Validation
Validation of payer, member ID, group number, primary and secondary coverage, and coordination of benefits information.
Verification Pipeline
Patient, guarantor, and subscriber information entered and validated.
Active coverage, copay, deductible, and benefit details verified.
Payer, member ID, group number, and COB information validated.
Two-level review before the record moves forward.
Record validated at every stage, ready for billing.
Claim Submission Pipeline
Billable services captured from the clinical encounter.
Services entered according to the established client workflow.
Claim prepared with required fields, codes, and modifiers.
Claim submitted through electronic billing workflow.
Clearinghouse edits reviewed, corrected, and resubmitted.
Clean claim moves to payer for adjudication.
Billable services captured from the clinical encounter.
Services entered according to the established client workflow.
Claim prepared with required fields, codes, and modifiers.
Claim submitted through electronic billing workflow.
Clearinghouse edits reviewed, corrected, and resubmitted.
Clean claim moves to payer for adjudication.
Keep Claims Moving With Structured Billing Operations
Mid-Cycle operations support accurate charge capture, claim preparation, submission, and clearinghouse edit resolution.
Charge Entry
Accurate capture and entry of billable services according to the established client workflow.
Claim Submission
Claims prepared and submitted through the appropriate electronic billing workflow.
Clearinghouse Edit Resolution
Review, correction, and resubmission of claims affected by clearinghouse edits.
Turn Payments and Denials Into Structured Revenue Recovery
Back-End operations support payment posting, denial management, credit balance review, and refund processing.
Payment Posting
ERA/EOB payment and adjustment posting with appropriate account review.
Denial Management
Structured review and follow-up of denied claims based on the applicable workflow and payer requirements.
Credit Balance Review
Identification and review of overpayments and credit balances.
Refund Processing
Structured processing of eligible refunds according to applicable client and compliance requirements.
Quality Is Built Into Every Workflow
Every applicable deliverable passes through a structured two-level review process before client delivery.
QA Covers
Quality Assurance runs across all RCM functions — Front-End, Mid-Cycle, and Back-End. It is not a separate service add-on; it is integrated into every workflow.
Verification Pipeline
Task processed per applicable workflow and SOP.
Specialist reviews output against SOP, workflow requirements, and quality checklist.
A second reviewer independently verifies the work before client delivery.
Verified against defined quality requirements. Ready for the client.
How the Services Connect
Front-End, Mid-Cycle, and Back-End are not separate unrelated services — they are stages within one continuous Revenue Cycle operating model.
Front-End RCM
- Demographic Entry & Validation
- Eligibility Verification
- Insurance Validation
Mid-Cycle RCM
- Charge Entry
- Claim Submission
- Clearinghouse Edit Resolution
Back-End RCM
- Payment Posting
- Denial Management
- Credit Balance Review
- Refund Processing
Quality Assurance runs across all three stages
Every deliverable — Front-End, Mid-Cycle, or Back-End — passes through Level 1 (Self Audit) and Level 2 (Independent QA) before client delivery.
How We Work With Your Existing Operations
Three structured stages from first conversation to active operations.
We learn your workflow, systems, volume, and operational requirements.
We align our team with your SOPs, workflows, and communication structure.
We execute defined RCM functions with quality review and transparent operational reporting.
Work Within Your Existing Technology Environment
Our team works across commonly used EHR, practice management, and clearinghouse platforms and adapts to established client workflows.
Don't see your system? We adapt to your tech stack →
Let's Discuss Where Provixion Fits Into Your Revenue Cycle
Tell us about your current workflow, operational volume, or areas where additional support is needed. We'll discuss where our RCM operations can fit into your existing model.
No obligation. Discovery calls are 30 minutes.