Navigate Payor Requirements. Submit With Confidence. Keep Care Moving.
One missed coding, documentation, or payor requirement can delay prior authorizations, claims, and patient care.
Our specialists partner with both in-house and outsourced billing teams, starting with the first submission.
Specialists for Every Provider, Pharmacy, Lab, and Supplier
Our Revenue Cycle Management (RCM) specialists bring experience specific to high-value therapies, partnering with the team submitting the claim, whether a specialty pharmacy, lab, or DME supplier, to support a single product or broader operations.
For buy and bill therapies, virtual Field Reimbursement Managers (vFRMs) partner with the business office, revenue cycle, and procurement teams at each site, providing non-sales education on payor policies and publicly available coding and billing resources as the product is introduced.
A Consultative Approach, Led by Provider Decisions
Our teams combine certified coding professionals, licensed clinicians, and leaders with direct payor, provider, and hospital revenue cycle experience.
Payor expertise: Fluency in payor policies, coding resources, and documentation requirements for high-value therapies.
Claim and denial navigation: Guidance through complete claims, corrected claims, reprocessing requests, and appeals, within applicable deadlines.
Visibility from claim to payment: Clear reporting on claim status and the actions underway at every stage.
Support Across the Product Lifecycle
Reimbursement needs shift as a product moves from launch to established use, reaching new sites, payors, and billing models along the way. Our specialists partner with existing billing teams and patient support programs at each stage, supporting a single product or broader operations through RCM, virtual FRM services, or both.
Patient Access, Built Around Every Patient and Every Case
Do you replace an existing billing team?
No, we partner with in-house and outsourced billing teams, and providers or suppliers can engage us directly.
Can RCM and virtual FRM services operate independently?
Yes, either service can be engaged on its own, together, or alongside your existing partners.
How do RCM and virtual FRM services differ?
vFRMs provide account-level reimbursement education to buy and bill sites, while RCM specialists provide claim-level expertise to the teams submitting claims.
Is the vFRM role a sales role?
No, vFRMs are a non-sales, education-focused resource that does not promote products or discuss clinical use.
Can PRO review claims that have already been denied or underpaid?
Yes, we review claim history and payor correspondence to identify the appropriate next step, such as a corrected claim, reprocessing request, or appeal, within applicable deadlines.
Which providers and places of service do you support?
We support physician offices, infusion centers, hospital outpatient departments, specialty pharmacies, laboratories, and DME suppliers.
