From claim submission to credentialing, denial management to prior authorization — MedCods delivers end-to-end RCM services backed by AI coding and AAPC-certified specialists.
clean claim rate
Six core service lines — each purpose-built, AI-validated, and backed by certified specialists — working together as one seamless billing operation.
The MAXIMUS AI Engine validates every claim against 3M+ payer-specific rules before submission. ICD-10, CPT, HCPCS, NCCI edits, and modifier validation all run at charge entry — catching errors before they become denials. Paired with real-time analytics, 40+ EHR integrations, and a dedicated AAPC-certified account manager.
Stop revenue leaks before they start. The industry averages an 11.8% denial rate — MedCods clients average 1.5%. MAXIMUS AI catches 87% of potential errors pre-submission. Automated ERA/835 detection, one-click appeal workflows, and root-cause heatmaps by payer and code.
24% of all claim denials trace back to eligibility or prior auth issues caught too late. MedCods runs real-time 270/271 eligibility at the point of scheduling and FHIR-based electronic prior authorization that resolves in minutes — not days. CMS-0057-F compliant, eliminating CO-197 denials entirely.
An uncredentialed provider means zero billing — up to $15,000 per day in unrecoverable revenue for high-billing specialists. MedCods manages CAQH setup, PECOS enrollment, commercial payer applications, and re-credentialing end-to-end. Average completion 40–60 days faster than industry standard.
One platform to manage unlimited client practices, specialties, and tax IDs. White-label reporting portal, portfolio-wide denial heatmaps, batch claim corrections, and AI coding across all clients simultaneously. Built for CBOs, independent billing companies, and multi-location physician groups.
TC/26 component splitting, NCCI edit validation, RBM prior authorization via eviCore/AIM, and automatic modifier application for interventional and teleradiology. Purpose-built for imaging centers, hospital radiology departments, and independent radiologist groups. 98.2% clean claim rate.
Five integrated stages — from patient scheduling to payment posting — working as one connected system, not a patchwork of disconnected tools.
Real-time 270/271 eligibility and prior auth run at the moment of scheduling. Coverage gaps flagged before the appointment — not after denial.
MAXIMUS AI validates every CPT, ICD-10, HCPCS code and modifier against 3M+ payer rules. AI clinical scribe reduces documentation time by 60%.
NCCI edits, LCD/NCD checks, and fee schedule compliance validated. 98.5% of claims submit clean on first pass — no rework, no delays.
Automated ERA/835 detection categorizes every denial instantly. AAPC-certified coders file appeals. Root-cause analytics prevent recurrence.
Automated ERA payment posting, payer benchmarking, A/R aging drill-downs, and predictive collection forecasting — all in your live dashboard.
MedCods serves 30+ specialties with purpose-built billing modules, each carrying specialty-specific CPT code sets, payer contract rules, and denial workflows.
MedCods supports 30+ specialties with purpose-built billing modules, including cardiology, radiology, orthopedics, oncology, mental and behavioral health, OB/GYN, anesthesiology, pathology, dermatology, family practice, emergency medicine, and more. Each module includes specialty-specific CPT code sets, payer contract rules, and denial workflows.
Yes. MedCods Enterprise supports unlimited providers, locations, and tax IDs from a single management dashboard. Billing companies can manage multiple client practices — each with white-label reporting — from one platform. CBOs and large physician groups get portfolio-level analytics with drill-down to individual provider and claim level.
MedCods manages the full credentialing lifecycle — CAQH profile setup, primary source verification, PECOS Medicare enrollment, Medicaid enrollment, commercial payer applications, and re-credentialing — with proactive status tracking and deadline management. We complete credentialing 40–60 days faster than the industry standard 120-day average, directly reducing uncollectable revenue during the enrollment gap.
The moment a denial is received via ERA/835, MedCods automatically detects it, categorizes it by reason code, and fires a dashboard alert. The claim is routed to the correct appeal workflow based on denial type and payer. High-dollar or clinically complex denials are escalated to AAPC-certified coders who prepare and file the appeal on your behalf. Every deadline is tracked and every status is visible in your dashboard in real time.
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.
