Coding suggestions and rules support the check. Your team reviews before submission.
Eligibility, coding and claim checks +
Eligibility and prior authorization
EPA runs real-time and automated portal-based eligibility checks. For prior authorization, it supports request tracking and follow-up; the team manages submissions and payer responses.
Coding intelligence · Codi
Codi suggests codes and flags coding, modifier and documentation questions for review. Clinical questions return to the clinician; the billing team reviews the claim.
Rules engine
Check claims against payer requirements and practice billing rules. Flag issues for correction before submission.
Charge capture and submission
Our team prepares and submits claims from documented services, checking the record and billing requirements before submission.
Responsible team Eligibility, coding + billing teams
02 / Follow through
Follow up on denials and unpaid claims.
Navi checks payer status. Billing works denials and reviews Hemi’s appeal drafts before sending them.
From payer response to reviewed appeal
01
Payer responseNavi checks the claim status
02
Supporting recordsHemi prepares an appeal draft
03
Billing reviewReview, send and follow up
Status checks, denials and appeals +
Automated claim-status checks · Navi
Navi checks claim status across supported payer systems, so staff can focus on follow-up rather than repeating the same lookups. Its work also extends across EHR and practice management applications.
Payer portal automation
Portal scrapers retrieve payer information needed for the account. The response stays connected to the claim for billing review and follow-up.
Denial management
Review the denial reason and supporting record, identify the next action and follow the account through correction or appeal.
AI appeal generation
Hemi prepares appeal drafts using the denial and supporting information. The billing team checks the facts, reviews the response and sends it.
Responsible team Billing + accounts receivable
03 / Reconcile
The payment needs to match the record.
Match remittances to claims, post payments and bring differences to billing review.
Reconciliation · illustrative handoff
Claim
↔
Remittance
The payment matches the record.
The matched information supports payment posting.
Matching, posting and open balances +
Remittance and payment matching
Hemi reads remittance information and supports payment matching within the agreed posting workflow.
Payment posting
Our billing team manages posting and reviews differences against the claim and account.
Open balances and exceptions
Unmatched payments and unresolved accounts remain part of the follow-up. Your team can ask questions across claims and practice management data through Hemi.
Responsible team Payment posting + billing review
Ask Hemi
See where the work is getting held up.
Ask Hemi about claims and practice management data in plain language, from an unpaid account to patterns across the practice.
Example questions
Where are claims getting held up?
What has changed across the practice?
Answers depend on the data connected to your practice.
People, technology and your practice
Who handles what.
nCare’s team
Our billing and AR team prepares claims, works denials, reviews appeals and follows payments through.
Your practice
Your clinicians validate the record. Together, we agree who approves coding, posting and appeals.
Supported by Hemi.
Checks claims and payer status, matches payments and drafts appeals for review.
Tools in this workflow +
EPA
Eligibility checks. Prior auth tracking.
Codi
Coding suggestions and claim checks.
Navi
Automated status checks across systems.
Hemi
Drafts appeals. Answers practice-data questions.
HemiConnect
Working with your systems.
HemiConnect links the EHR, practice management, clearinghouse and payer records needed for billing follow-up.
Connection and setup +
We review direct connections and supported application workflows, confirm compatibility and agree access, responsibilities and scope with your practice.
