Run the revenue cycleas one accountable operation.

Integrations

Connects to the stack you already run.

FAQ

The questions ops leaders ask first.

Don't see yours? Bring it to a 30-minute working session. We'll walk it through with your data.

• What does 'end-to-end RCM' actually include with OptimIQ?

  Eligibility & benefits, prior authorization, medical coding & coding audits, claim scrubbing & submission, payer follow-up, denial management & appeals, payment posting & reconciliation, AR follow-up, patient billing & collections, and revenue analytics. Every stage runs on the same data with the same SLAs, not as separate vendor integrations.

• How fast can we see denial-rate improvement?

  Eligibility-driven denials respond fastest. OptimIQ is built to deliver a 70–85% reduction inside 90 days once real-time re-verification is on. Prior-auth and coding-pattern denials improve over the first two months as payer-specific edits layer in. We publish a 30/60/90 baseline-vs-current dashboard from week one so leadership sees the curve.

• Are your coders specialty-trained?

  Yes. Coders are matched to your specialty (cardiology, internal medicine, behavioral health, ortho, GI, oncology, derm, ASC, and more) and trained on your specialty's payer rules, modifier conventions, and documentation patterns. Every code carries citations to the underlying note for audit defense.

• How do you actually reduce prior-auth denials?

  Auth requirements are determined per payer × CPT × diagnosis at the moment of scheduling. We submit with the clinical evidence each payer expects, poll the payer to approval, and escalate to peer-to-peer when medical necessity is contested. The visit doesn't happen, and the claim doesn't go out, without an active auth on file when the payer requires one.

• Which EHRs and clearinghouses do you integrate with?

  Epic, athenahealth, Oracle Health (Cerner), NextGen, eClinicalWorks, Veradigm (Allscripts), ModMed, MEDITECH, Greenway, Practice Fusion, Tebra, Nextech, Elation, DrChrono, and others. Connections are bidirectional. FHIR R4 where supported, HL7 v2 elsewhere. We connect into Change Healthcare, Availity, Waystar, and direct payer endpoints.

• How do you measure success?

  Initial denial rate, first-pass resolution rate, days in A/R (overall and by aging bucket), net collection rate, denial overturn rate, and revenue leakage detected. Every metric ties back to HFMA MAP Keys and MGMA DataDive benchmarks so the comparison is honest.

• Is this HIPAA-aligned and audit-ready?

  Yes. BAA on file by default, SOC 2 Type II controls, role-based access, encrypted storage and transit, and complete audit trails on every claim. Engineered to pass RAC, ZPIC, and commercial-payer audits — every coded chart carries citations back to the underlying documentation.

• Do we keep our existing tools or replace them?

  Either. We can run inside your current EHR/PMS/clearinghouse stack, or we can consolidate. The recommended path is to layer OptimIQ on top of what you have — if a tool doesn't earn its keep over the first 90 days, it gets retired.