Revenue Cycle

Revenue-Cycle Workflows.

From eligibility to remittance — standards-based claims, ERA/835 posting, and disciplined A/R follow-up, all bound to the same patient, encounter, and documentation your clinical apps already share.

PatientTrac treats the revenue cycle as part of the clinical record, not a separate silo. Charges originate from the same encounter_id the specialty apps write to, claims are generated in standard formats, and follow-up works that same shared data. These are workflow and documentation tools: they support billing operations and do not guarantee reimbursement, payment, or payer acceptance. Founded in 1998, the platform was rebuilt cloud-native around this shared spine.

Revenue-Cycle Workflows Standards-Based Claims (837P/835) ERA/835 Posting A/R & Follow-Up Documentation Completeness Shared Record EN/ES/FR Provider-Facing
Built for

One revenue cycle, across every place you bill.

Whether you bill professional claims for a multi-specialty group, an ambulatory surgery center, or a single clinic, the revenue-cycle workflows run on the same shared record.

Multi-specialty medical groups
Ambulatory surgery centers
Behavioral & neurobehavioral practices
Aesthetic & cosmetic surgery practices
Billing & revenue-cycle teams
Practices leaving a legacy billing system
The Revenue-Cycle Workflows

Seven workflows on one shared record.

Every workflow below reads and writes the same clinical data. Each supports billing and documentation; none guarantees reimbursement or payer acceptance.

01

Standards-based claims (X12 837P)

Professional claims are generated in the standard X12 837P format from the same encounter clinicians documented.

  • Charges flow from the encounter_id every app shares
  • 837P professional-claim generation in standard format
  • Payer-ready output for clearinghouse submission
  • Supports billing workflows; does not guarantee reimbursement, payment, or payer acceptance
02

ERA/835 remittance posting

Electronic remittances post back against the originating claim, so payment status lives with the record.

  • ERA/835 electronic remittance intake
  • Payment, adjustment, and denial reason codes captured
  • Posting reconciled against the submitted claim
  • Supports posting workflows; payment amounts are determined by payers
03

A/R aging & follow-up

Open receivables are organized by age and status, so teams can work the oldest and highest-value balances first.

  • A/R aging buckets by payer and date of service
  • Worklists for outstanding and underpaid balances
  • Status visible on the same shared record
  • Supports follow-up workflows; does not guarantee collection
04

Rejections & appeals

Rejected and denied claims are routed into a structured correction-and-appeal path instead of disappearing.

  • Rejection and denial reasons surfaced from remittances
  • Correction and resubmission workflow
  • Appeal documentation drawn from the shared record
  • Supports appeal workflows; outcomes are decided by payers
05

Secondary claims & COB

Coordination-of-benefits and secondary billing follow the primary remittance automatically in the workflow.

  • Primary, secondary, and tertiary payer sequencing
  • Coordination-of-benefits (COB) handling
  • Secondary claims generated after primary posting
  • Supports COB workflows; does not guarantee reimbursement
06

Pre-authorization tracking

Prior-authorization requirements and status are tracked against the encounter before services are billed.

  • Authorization requirements captured at scheduling
  • Status and reference numbers tied to the encounter
  • Visibility for clinical and billing teams alike
  • Supports authorization workflows; approval rests with payers
07

Proposals & patient financing

For self-pay and elective care, cost proposals and financing options are prepared alongside the clinical plan.

  • Itemized cost proposals for elective and cosmetic care
  • Patient-friendly estimates from the shared record
  • Financing options presented at the point of decision
  • Estimates only; final patient responsibility may vary

PatientTrac supports billing and documentation workflows. It does not guarantee reimbursement, payment, or payer acceptance, and it does not maximize billing. Coverage, coding, and payment decisions rest with payers and the practice's qualified billing staff.

How it connects to the network

The claim starts at the encounter, not a spreadsheet.

Every charge, remittance, and follow-up action is bound to the same encounter_id the clinical apps write to — so billing sees exactly what was documented, and documentation sees where the money is.

Forge

Patient management, scheduling & revenue-cycle hub — where charges, claims, and A/R are worked against the shared record.

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Profiler

Intake & eligibility capture — demographics and coverage collected before the visit feed clean-claim generation.

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Continuum

Perioperative & procedural documentation — the operative record that substantiates procedural charges.

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Companion

Patient engagement & recovery monitoring — RTM-aligned check-ins that document care-management workflows.

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Care-management documentation

Care-management workflows, documented on the shared record.

Several care-management programs depend on consistent documentation over time. PatientTrac helps capture that documentation on the same record — it does not determine eligibility, codes, or payment.

RTM · Patient-Reported Outcomes

RTM-aligned monitoring (Companion)

Companion collects patient-reported outcomes through manual-sync check-ins, aligned with the Remote Therapeutic Monitoring code family (CPT 98975–98981), and documents them against the encounter.

RTM-aligned, not RPM. Supports documentation workflows; does not guarantee reimbursement, payment, or payer acceptance, and does not establish code eligibility.

CCM · PCM · TCM · BHI

Longitudinal care-management documentation

For chronic-care, principal-care, transitional-care, and behavioral-health-integration programs (CCM, PCM, TCM, BHI), the platform helps record the time, activities, and care-plan elements these workflows rely on.

Code families are referenced generically. Supports documentation workflows; eligibility, code selection, and payment are determined by qualified staff and payers.

AI & Compliance Trust

Assistive by design, reviewed by billing staff.

Intelligence and compliance are stated as mechanisms — what the workflows actually do, and where qualified people stay in control.

Server-Side AI · Human Review

How AI helps the revenue cycle

AI-assisted summaries, drafts, alerts, and suggestions for staff review; API keys remain server-side; coding and billing decisions remain with qualified professionals.

AI does not select codes autonomously, determine severity, or guarantee coding. The E/M level is not surfaced to the provider during documentation; the system captures documentation elements relevant to downstream coding review.

Concrete Mechanisms

How billing data is protected

Row-Level Security on every table, a hash-chained PHI audit, TOTP multi-factor authentication, server-side keys, and organization-level tenant isolation protect billing and clinical data alike.

Revenue-cycle workflows support standards-based claim generation (X12 837P), ERA/835 posting, and documentation completeness; they support billing workflows and do not guarantee reimbursement, payment, or payer acceptance.

Why it's different

Billing that shares the clinical record.

Most practices run billing in a system that never truly sees the chart, forcing re-keyed charges and blind follow-up. PatientTrac does the opposite: claims, remittances, A/R, appeals, and care-management documentation all sit on the same clinical spine, bound by one encounter_id, with server-side AI for review and concrete compliance mechanisms throughout. It supports billing and documentation workflows — it does not guarantee reimbursement, payment, or payer acceptance, and it never sets out to maximize billing. Founded in 1998, it was rebuilt cloud-native for exactly this.

See the revenue cycle on your own encounters.

Walk a claim from encounter to remittance across the connected apps, and see billing and documentation share one record.