Your SCALE team does
Your SCALE specialists work only the exceptions: terminated coverage, authorizations stuck at the payer, and the calls that need a person.
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Solutions by functionEach function below arrives tech-enabled — a specialist team with ShieldAI already running behind them. Engage one, or all four under a single accountable owner.
Coverage, benefits, and authorization cleared before the patient arrives — so the claim starts clean instead of being corrected later.
Runs the full pre-visit checklist overnight — eligibility, benefits, plan changes, and authorization status — across every appointment on tomorrow’s schedule.
Your SCALE specialists work only the exceptions: terminated coverage, authorizations stuck at the payer, and the calls that need a person.
Every encounter checked against every charge, so documented work actually reaches a claim and gets paid at the level it was performed.
Reads encounter documentation against submitted charges continuously, surfacing missed charges, under-coding, and modifier gaps by provider and specialty.
Certified coders resolve every flag, close the loop with providers, and keep accuracy above benchmark rather than sampling it quarterly.
Denial management and A/R follow-up, run end to end — prevented where possible, worked and appealed where not.
Scores every claim against how your payers actually behave, corrects what it can before submission, and drafts appeals citing precedent from prior overturns.
Your specialists review and send each appeal, work the aging buckets by payer, and escalate the patterns that need a human relationship to resolve.
Patient billing and balance resolution, handled end to end — with the visibility to know what is outstanding and what has been recovered.
Tracks every outstanding balance across locations and surfaces what is collectible, what is aging, and what has already been recovered — live, not at month-end.
Bilingual patient support handles statements, questions, and payment plans with the tone you would want used with your own patients.
Bring us a month of claims and denials. We'll show you where the money is going and what we'd do about it — before you sign anything.
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