MedCods was founded by certified billing specialists who watched practices lose millions to billing errors, silent credentialing lapses, and prior auth delays. We built the platform we wished had existed — and it changed everything.
clean claim rate
MedCods was founded by certified billing specialists — people who spent years in the trenches of medical billing, credentialing, and revenue cycle management. We lived the problem firsthand: denial rates creeping past 10% with no clear path to fixing them. Prior authorization queues that consumed 15 hours of staff time every week. Billing vendors who delivered slick dashboards but never answered the phone when claims stalled.
We watched practices lose hundreds of thousands of dollars — not because they saw fewer patients, but because the billing infrastructure around them was broken. A credentialing lapse here. An uncaught modifier error there. Claims denied, never resubmitted, quietly written off forever.
So we built what we wished had existed. A platform designed around how payers actually behave, not how they say they behave in their provider manuals. An AI engine built on 3 million real-world payer rules, not generic coding logic. And an account manager model based on a simple belief: billing expertise cannot be replaced by a ticketing system.
“The average practice loses 15–20% of its earned revenue to billing errors, denials that are never appealed, and credentialing gaps that go undetected for months. We built MedCods to make that number zero.”
MedCods serves 30+ specialties with purpose-built billing modules, each carrying specialty-specific CPT code sets, payer contract rules, and denial workflows.
Every metric your practice produces is visible in real time. Denial rates, A/R aging, coding accuracy, collection forecasts — no surprises, no quarterly reports that are already three months stale.
We price as a percentage of collections, so we only earn when you earn. Every account manager is AAPC-certified and assigned to your practice personally — not rotated through a support queue.
The MAXIMUS AI Engine was trained on how payers actually behave — 3M+ rules derived from real claims, real denials, and real adjudication patterns — not textbook coding guidelines.
Unlike platforms built by software engineers who later hired billers, MedCods was built from the ground up by certified coding specialists. That origin shapes every decision we make.
Not a generic coding engine. MAXIMUS was built on real payer adjudication behavior — modifier rules, bundling edits, LCD/NCD policies, and fee schedules specific to each payer and specialty.
Every MedCods client has a dedicated AAPC-certified specialist who knows your specialty, your payer mix, and your billing history. Reachable by phone — not through a ticketing queue.
Percentage of collections only. No setup fees, no hardware costs, no long-term contracts. Our revenue grows only when your collected revenue grows — full alignment from day one.
MedCods integrates with 40+ EHR systems via HL7, FHIR, and direct API. No rip-and-replace. Most practices are fully live within one week — with their account manager leading every step.
01
Every dollar a provider bills for care they have already delivered is earned revenue. Losing it to preventable billing errors, missed appeals, or credentialing lapses is a failure we take personally. Our goal is a 0% preventable revenue loss rate.
02
Practices deserve full visibility into exactly what is happening with their claims, their denials, thei A/R, and their collections — in real time, not in a monthly PDF delivered two weeks late. Transparency is non-negotiable.
03
AI handles the volume. Humans handle the judgment. AAPC-certified coders review every complex claim, prepare every appeal, and make the calls that require clinical and coding expertise that no algorithm can replace alone.
04
We build AI tools — the MAXIMUS Engine, FHIR prior auth, AI clinical scribe — not for technology's sake, but because faster authorizations and fewer denials mean providers spend more time with patients and less with payers.
05
HIPAA, SOC 2 Type II, CMS certification, AES-256 encryption, and a BAA with every client. Compliance is not a checkbox or a marketing bullet. It is the operating standard below which we will never fall.
06
Percentage of collections pricing was not chosen for convenience — it was chosen because it makes our success inseparable from yours. We have no incentive to bill you for performance we haven't delivered. None.
Every member of the MedCods leadership team has hands-on experience in medical billing, revenue cycle management, or healthcare compliance — before building software.
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The MedCods story is a straight line from a problem that was too costly to ignore to a platform that has now processed billions in healthcare collections.
Our founding team, working inside a multi-specialty billing operation, watches a newly credentialed orthopedic surgeon generate $0 in collections for 4 months due to payer enrollment errors. The cost: $480,000 in unrecoverable revenue. The trigger: MedCods begins.
As practices nationwide face billing disruption from COVID-19 telehealth rule changes, MedCods rapidly deploys telehealth billing modules and POS updates. 50 practices onboarded. Denial rate for clients holds at under 2% through the entire transition.
Every MedCods client has a dedicated AAPC-certified specialist who knows your specialty, your payer mix, and your billing history. Reachable by phone — not through a ticketing queue.
Launch of the multi-client platform for billing companies and CBOs. White-label reporting, portfolio-wide analytics, and role-based access for unlimited clients under one login. First 10 billing company clients onboarded.
Full FHIR-based prior authorization goes live, replacing phone/fax for compliant payers. Credentialing Services division launches with parallel submission model. 200 practices served. MAXIMUS rule set expands to 2M+ entries.
Full FHIR-based prior authorization goes live, replacing phone/fax for compliant payers. Credentialing Services division launches with parallel submission model. 200 practices served. MAXIMUS rule set expands to 2M+ entries.
MedCods serves 30+ specialties with purpose-built billing modules, each carrying specialty-specific CPT code sets, payer contract rules, and denial workflows.
Join 500+ practices that replaced billing headaches with a system that works as hard as they do. No setup fees, no long-term contracts, no risk.
