REVENUE CYCLE MANAGEMENT
Stop leaving revenue on the table
Specialty-aware revenue cycle management that gets you paid - accurately, compliantly, and faster. Deepest in behavioral health, built for procedure-heavy specialties too.
≥ 95%
First-pass clean claims*
≤ 45
Days in A/R*
% of revenue
Aligned pricing
90837 · Individual therapy
Carve-out · Optum payer ID confirmed
90834 · 45-min session
Time-based code matched to minutes
96127 · Telehealth · POS 10
Modifier FQ validated · 835 auto-posted
The challenge
Every specialty has its own billing traps
Generic vendors don't even know what they're missing - and the cost lands on your practice. Behavioral health shows just how deep the traps can run.
Carve-out denials
Magellan, Optum and Carelon route differently - claims sent to the wrong plan deny on arrival.
Time-based coding risk
90832 vs 90837 is decided by documented minutes. One slip invites an OIG upcoding audit.
Telehealth rejections
Modifiers 95/GT/FQ and POS 02/10 change constantly - a mismatch means a denial.
“Pajama-time” admin
Providers and staff burn nights on billing while Days in A/R quietly climb.
One platform, every specialty
Configured to the way your specialty bills
Behavioral health · deepest build
Carve-out routing, time-based coding, telehealth modifiers, and measure-based documentation. Our most optimized configuration.
Cardiology, vascular and vein
Professional and technical component billing, global surgical periods, and prior-authorization-heavy procedure families, with the conservative-therapy documentation that Medicare contractor coverage rules require built before the claim goes out.
Your specialty
Primary care, GI, orthopedics, OB/GYN and beyond: we configure your procedure families, payer edits and prior-authorization workflow, then CQI tightens the build against your real denials.
Human accountability on procedure coding
When a procedure is on the line, automation alone is not enough. AI drafts the codes; a certified human coder reviews, corrects and signs, and accountability never transfers to a machine. A maker-checker step (specialist codes, a second reviews) sits on every procedure claim.
Prior authorization, owned end to end
For procedure-heavy specialties, prior authorization is where revenue goes to die. We detect authorization requirements at eligibility, submit and track through our clearinghouse connections, and our human team owns the medical-necessity documentation payers actually deny on. No claim is submitted against a missing or expired authorization.
The solution
A revenue engine built for your practice
Certified coders
Every claim is touched by a certified - or 100% QA-audited - specialist trained in our Academy.
CQI-driven accuracy
Continuous Quality Improvement engineers the root causes of denials out of the system.
One owner, end-to-end
A single specialist codes, scrubs, submits, posts and appeals - no handoffs.
EMR automation
Real-time eligibility, a BH scrubber and a time-based hard-stop catch errors before payers do.
WATCH
Three minutes inside our revenue engine
HOW IT WORKS
One specialist owns your claim, end to end
Unbilled queue
Signed encounters in priority order.
Code + hard-stop
CPT/ICD validated; minutes enforced.
Eligibility & scrub
Real-time eligibility + BH rules engine.
Submit & post
837P submitted; 835 ERA auto-posted.
A/R & denials
Day 7/14/21 calls; corrected claims.
Reporting
Live dashboards & CQI oversight.
THE NUMBERS
Performance you can take to the bank
≥ 95%
First-pass clean claims
≤ 5%
Claim denial rate
≤ 45
Days in A/R
≥ 97%
Net collection rate
≥ 95%
Coding accuracy
2026 targets, tracked live on your dashboard and our internal CQI scorecard.
THE ENGINE BEHIND THE NUMBERS
Targets we reach by improving the system
These targets are not an AI trick. They come from a Continuous Quality Improvement model embedded in every engagement. Automation helps, but the durable gains come from a team that measures relentlessly, finds the specific bottleneck behind each denial or delay, fixes the root cause, and proves the result, then does it again.
Measure
Every claim, denial and day in A/R tracked in real time on your dashboard.
Diagnose
We trace each problem to its root cause: a payer rule, a coding pattern, a workflow gap.
Improve
We redesign the process so the error cannot recur, not just rework the one claim.
Sustain
The fix is standardized and monitored while we move to the next constraint.
and the cycle repeats, continuously, on your dashboard
A partner, not a vendor
When something is dragging your numbers, finding and fixing it is our job, not a status we hand back to you. We own the outcome and bring support above and beyond the transaction, which is the difference between a vendor and a partner.
SEE YOUR RETURN
Could your recovered revenue pay for us
Estimate the revenue a higher net collection rate could recover - and how it compares to our fee.
Your net collection rate today: 88%
Our fee (share of collections): 6%
Illustrative estimate using our 2026 target net collection rate of 97%. Targets are goals, not guarantees; your actual rate and fee are set in your SLA.
At these numbers, your recovered revenue more than covers our fee.
Why switch
In-house vs. generic vendor vs. NexCQISolutions
| Capability | In-house | Generic vendor | NexCQISolutions |
|---|---|---|---|
| Specialty depth (deepest in behavioral health) | Limited | Rare | Configured per specialty |
| Certified, credentialed coders | Varies | Sometimes | 100% |
| Automated specialty claim scrubbing | Basic | ||
| One end-to-end owner | |||
| Live transparency portal | Limited | ||
| Aligned pricing (% of revenue) | Salaries | Per-claim |
Ready to get paid what you've earned
Pricing is tailored to your practice - book a 30-minute call and we'll show you the numbers.