Run the revenue cycle as one motion.
Eligibility, prior auth, coding, claims, and denials handled as one operation — payer-aware automation on the predictable work, specialty coders on the rest. Every claim observable from intake to payment.
Explore revenue cycleCode what the chart can prove.
Suspected HCCs surfaced from the chart with the evidence attached, RAF computed under CMS-HCC V24 and V28, and every code held until the documentation supports it — audit-ready the moment it's coded.
Explore value-based careSuggesting E11.22 — Diabetes w/ CKD from this sentence. MEAT 4/4 · confidence 91% · RAF +0.302.
Read your practice in print.
A named analyst reads every claim, visit, and payment — and delivers the state of your practice as one traceable monthly report, with peer benchmarks and recommendations sized in dollars. No dashboard to babysit.
Explore practice analytics- CO-97 recoveries posted — $14,820 back in the door
- Clean-claim rate held at 96.4%, best this year
- Clustered Thursdays 2–4pm — 61% of the monthly total
- Fix sized at +$2,300 / mo — recommendation 02, page 4
How it works
One operating layer for everything you've been duct-taping together.
Healthcare operations sprawl across six vendors. EHRs don't talk to clearinghouses, coders work in spreadsheets, and denials pile up in someone's inbox. OptimIQ sits between them — one team, one playbook, one number per week, running on top of the systems your team already uses.
Map
Map the real operation
We shadow intake, auth, coding, AR, and care-gap work — then turn the actual handoffs into a workflow map with systems, SLAs, owners, and exception rules.
Run
Run inside your stack
Operators and agents work in your EHR, PMS, clearinghouse, and payer portals. Repetitive steps move automatically; judgment calls land with the right human.
Measure
Report lift every week
Clean claim rate, denial rate, AR aging, RAF lift, and care-gap closure roll into a single Monday readout, so everyone sees what changed.
EHR Integrations
Built to work with
your EHR.
We work inside the system your team already uses. FHIR R4 where it's supported. HL7 interfaces where it isn't. Live on day one — no rip-and-replace.
- 14+
- EHRs supported
- FHIR
- Native R4
- HL7
- Interface ready
EHR Integrations
Built to work with your EHR.
We work inside the system your team already uses. FHIR R4 where it's supported. HL7 interfaces where it isn't. Live on day one — no rip-and-replace.
- 14+
- EHRs supported
- FHIR
- Native R4
- HL7
- Interface ready
Customer stories
From the people running the work.
What changed, how fast, and what they'd do differently.
OptimIQ replaced four vendors and cut our denial rate by a third in the first quarter. The dashboards alone changed how leadership talks about RCM in our weekly ops review.
Dr. Priya Iyer
Chief Operating Officer · Multi-specialty group · Texas
Our RAF accuracy used to be a guessing game until audits hit. With OptimIQ surfacing suspected conditions and packaging the documentation, we walked into our last audit with a folder, not a panic.
Marcus Hale
VP of Population Health · ACO · Midwest
We hired OptimIQ to staff one workflow. Six months later they're running eligibility, prior auth, and denial follow-up. Our front office stopped quitting.
Renee Coleman
Practice Administrator · Cardiology · Florida
Questions
The questions every operator asks before signing.
If something here isn't clear or your situation is different, we'd rather you ask us directly than guess.
- What does OptimIQ run, and what stays with our team?
- We take on the work end to end on the services you bring us into — eligibility, coding, denial follow-up, prior auth, care gap closure. Your team keeps clinical decisions, vendor approvals, and final sign-off on anything that affects the medical record. We're not a co-pilot tool; we're the team running the workflow.
- Where does our PHI live, and who has access?
- PHI stays in your EHR and clearinghouse. Our team logs in with credentials your security team provisions and revokes. We don't extract or warehouse PHI on our side, and the BAA we sign with you spells out exactly which datasets are touched, by which roles, on which audit trail.
- How do you price engagements?
- Two models. A flat monthly retainer for predictable services like prior auth and care gap work, or a percentage of net collections for revenue cycle engagements (typically 4–8% depending on scope and specialty mix). No per-seat fees, no minimum-volume penalties, no hidden implementation charge.
- Do we have to let our billing or coding staff go?
- No. Most of our customers redeploy their existing billers and coders to higher-leverage work — patient outreach, payer escalations, denial appeals on complex cases. We handle the volume work that's burning them out. If you do want to reduce headcount, we'll help you plan the transition, but it's never a precondition.
- How long until we see results?
- Two weeks of mapping and shadowing, four weeks running in parallel with your team, then we're operating end to end. First reporting cycle lands at day 30. Most metric movement (denial rate, AR aging, RAF lift) shows up by day 60–90. We'll tell you which metrics will move first based on your starting baseline.
- Where are your coders and AR specialists based?
- Our clinical coders, CDI nurses, and AR escalation specialists are US-based and certified (CPC, CCS, RHIA). Routine claim-status and eligibility work is split between US and a small offshore ops team in our owned facility — never a third-party BPO, and never anyone touching PHI without explicit BAA coverage.
- What happens if performance doesn't improve?
- Every engagement has written performance targets — not vague "goals," actual numbers tied to your starting baseline. If we miss them at the 90-day mark, our fee adjusts. If we miss them again at 180 days, you can exit on 30 days' notice, no penalty. We've never had a customer trigger that clause, but it's there.
- Can we end the engagement early?
- Yes. Standard contracts are 12 months with a 30-day notice period after the first 90 days. We'll hand off active queues, documentation, and our playbooks for any service we ran. The whole point is that you can leave without setting your operations back — that's the bar we hold ourselves to.