Scheduled Verified Coded Submitted Processed Paid
Platform Solutions AI Engine About Sign in Book a Demo
§ 02 Managed RCM Services Revenue Cycle, Fully Owned

A billing department, not a billing vendor.

Your billing company submits claims. That's not the same as owning your revenue cycle.

Quilven runs the billing department you'd build if you could hire it — coders, claim specialists, credentialing leads, AR analysts. One team. One number to call. Full accountability.

Live · Claims in motion
1,247 processed today
On Ownership

The word vendor is the problem. So we stopped being one.

Most practices outsource billing and still lose money. The billing company submits claims. Posts payments. And everything between the two quietly leaks.

The gap between a billing vendor and a billing department isn't effort. It's ownership.

We take over the full cycle. Denial rates drop below 5%. Days in A/R drop below 30. Aged AR that was being quietly written off re-enters active recovery. Not because we try harder — because the work was structurally ours from day one.

What we cover
Eight functions. One team.
01

Medical Billing

Claims submitted, posted, followed up

02

Coding

Certified ICD-10, CPT, HCPCS accuracy

03

AR Management

Aged claims worked back to zero

04

Credentialing

Providers billable in 90 days

05

Denial Management

Every denial appealed and recovered

06

Prior Auth

Approvals before the service

07

Revenue Optimization

Leaks most practices don't see

08

Reporting & Analytics

Weekly KPIs, monthly deep-dives

On the work

Every function a billing department owns.

Most RCM vendors outsource claim submission. Nothing else. The money leaks everywhere else. We cover the full cycle.

§ 01Medical Billing

Claims submitted clean. The first time.

Filing, posting, and follow-up until every dollar lands.

  • Clean claim submission to Medicare, Medicaid, and commercial payers
  • Electronic remittance posting with adjustment reconciliation
  • Active follow-up on unpaid claims past 30 days
  • Patient statement generation and balance collection
§ 02Coding

Certified coders who know your specialty.

ICD-10, CPT, HCPCS — aligned to your documentation, not guessed.

  • ICD-10 diagnosis coding from clinical documentation
  • CPT and HCPCS procedure coding with modifier accuracy
  • Code audits against payer-specific rules
  • Upcoding and downcoding prevention
§ 03AR Management

Aged AR that actually gets worked.

Most practices have 90+ day claims nobody's touching.

  • AR aging analysis with prioritized recovery queues
  • Active recovery on claims over 30, 60, and 90 days
  • Denial appeals with payer-specific templates
  • Weekly AR reports with recovery rate visibility
§ 04Credentialing

New providers billable in 90 days, not 180.

Credentialing is where revenue quietly dies. We track every application.

  • Provider enrollment with Medicare, Medicaid, and commercial payers
  • Credentialing and re-credentialing cycle management
  • Payer contract review and renegotiation support
  • Live Master Sheet showing every application status
§ 05Denials

Denials investigated, corrected, recovered.

86% of denials are preventable. The rest get appealed and recovered.

  • Root-cause investigation on every denial
  • Claim correction and resubmission
  • Formal appeals with supporting documentation
  • Denial trend reporting to prevent recurrence
§ 06Prior Auth

Approvals before the service, not denials after.

We handle the requests, the follow-ups, the escalations.

  • Prior authorization submission and payer follow-up
  • Retroactive authorization requests where allowed
  • Eligibility verification at point of scheduling
  • Authorization status tracking through to approval
§ 07Optimization

The leaks most practices don't see.

Charge capture gaps. Missed modifiers. ERA mismatches. We find them.

  • Revenue leakage analysis across the cycle
  • Reimbursement maximization through accurate coding
  • Financial benchmarking against industry standards
  • Cash flow optimization via AR day reduction
§ 08Analytics

See everything. Always.

Weekly and monthly reports on the metrics that actually matter.

  • Real-time dashboards on claims, payments, and denials
  • Monthly financial performance reviews with your team
  • Payer-level reporting on approval and denial rates
  • Custom reports built around your specific KPIs
Free · No commitment

The 48-hour billing audit.

Send us 90 days of claims data. In 48 hours, we send back what's recoverable.

If there's revenue to recover, we show you. If everything's clean, you've got outside confirmation. No cost. No obligation. No pitch.
Request your audit

What the audit covers

  • Denial rate and top denial reasons
  • Aged AR breakdown (30 / 60 / 90+ day buckets)
  • Clean claim rate by payer
  • Coding accuracy review (sample-based)
  • Prior auth turnaround analysis
  • Estimated recoverable revenue
On the handoff

From signed to live, in weeks.

You never lose a day of claim submission.

PHASE 01

Audit & scope

Free 48-hour audit. Workflow mapped. Gaps identified.

PHASE 02

Integration

Connect to your EHR — Epic, athena, eClinicalWorks, 40+ others.

PHASE 03

Takeover

We run billing, coding, and AR from day one.

PHASE 04

Optimize

Weekly KPI reviews. Monthly deep-dives. Continuous recovery.

On difference

What you actually get.

Compare Quilven against the two options most practices consider.

Typical RCM Vendor
What most offer
  • Aged AR over 90 days written off
  • Denial appeals stop at 2nd denial
  • Credentialing is a black box
  • Monthly summary reports only
  • Escalations go to a ticket queue
  • 12–24 month contract lock-in
vs
Quilven
What you get
  • Aged AR worked and actively recovered
  • Full appeal cycle pursued on every denial
  • Live Master Sheet shared with you
  • Weekly KPIs plus monthly deep-dive reviews
  • Named account lead as your direct contact
  • Month-to-month after the 90-day ramp
In-House Alone
The reality
  • Your billing team absorbs every payer rule change
  • Denials pile up when someone's out or PTO hits
  • Aged AR gets pushed to next quarter, every quarter
  • No backup for credentialing when one specialist owns it
  • Coding audits happen only when something breaks
  • Late nights and weekends become the norm
vs
With Quilven
With backup
  • We track payer changes so your team doesn't have to
  • Denials worked daily — your team keeps focus on patients
  • Aged AR on a schedule, not when cash gets tight
  • Credentialing coverage across the full team
  • Certified coder audits built into the weekly rhythm
  • Your billing team gets their evenings back
On pricing

Structured around your numbers.

No two practices are the same. Every engagement is priced against your actual volume, payer mix, and scope.

i
Volume-Based

Monthly fee scaled to claim volume. Predictable for high-velocity practices.

ii
Collections-Based

Percentage of collections. We only make money when you do.

iii
Hybrid

Base monthly fee plus a collections component. Predictability with shared upside.

Pricing is confirmed after the free audit — once we've seen your data, we recommend the structure that fits.

Let us find it.

Every practice is losing money it will never see. Most never know how much. Let us find it.

Book a Demo Or request the free audit