Cross-industry engineering experience across regulated and high-growth sectors.
All Industries
“Hospitals and health systems spent an estimated $19.7 billion in one year trying to overturn denied claims.” — American Hospital Association
Check coverage in real time through 270 and 271 transactions before a claim is ever built.
Assign and validate ICD-10, CPT, and HCPCS codes, with AI coding that reduces billing errors.
Scrub CMS1500 and UB-04 claims against payer rules so clean claims go out the first time.
Track every medical claim from submission to remittance, with adjudication logic for payers and TPAs.
Route denials into structured appeals and predict them before claims to insurance companies go out.
Post 835 remittance and patient billing automatically, so billing data reconciles without manual entry.
Generate and track authorizations through the 278 transaction and FHIR-based automation.
Manage provider enrollment and credentialing so claims are not denied on eligibility technicalities.
Surface clean claim rate, AR days, and denial rate through connected dashboards. Read more
Give patients clear statements and healthcare payment options that improve collections.
“Physicians complete an average of 39 prior authorizations per week, spending about 13 hours on the process.” — American Medical Association
USA
PL
UA
MX
TR
Medical billing software manages getting healthcare providers paid: it verifies eligibility, assigns codes, scrubs and submits claims, works denials, and posts payments. It exchanges data with payers through EDI X12 and, increasingly, FHIR.
Medical billing is the core process of creating, submitting, and collecting on claims, while revenue cycle management is the broader end-to-end process around it. Billing is one step inside RCM, so buyers should set scope before they build.
The main X12 transactions are the 837 for claims, the 835 for remittance, the 270 and 271 for eligibility, and the 278 for prior authorization. Modern systems increasingly add FHIR APIs alongside X12.
Traditionally it uses the X12 278 transaction, which the software generates and tracks automatically. Newer systems add FHIR automation through the Da Vinci guides, and because payer support varies, systems usually handle both pathways.
It verifies eligibility up front and scrubs claims against payer and coding rules so errors are fixed before submission. Machine learning can also predict likely denials from historical data, so teams work the riskiest claims first.
Yes. Medical billing software can integrate with EHR and EMR systems, practice management software, patient portals, clearinghouses, and payer systems using HL7, FHIR, and EDI X12, so billing does not require duplicate entry.
Cost depends on scope: a focused billing module costs far less than a full RCM platform with payer-side adjudication. The main drivers are the number of EDI and payer integrations, prior-authorization automation, and AI, and a precise estimate follows discovery.
Outsourcing handles the work but gives little control over software or data, and buying the best medical billing software product still constrains workflows. Building custom makes sense when billing is core to your business, such as for billing companies, healthtech, or payers.
