Before the visit
Specialty benefit checks
Standard eligibility responses rarely say whether a specific service is covered or how many units are left. We confirm the code-level benefit before the visit.
Better RCM for specialty and ancillary clinics.
Authorizations, claims, payment posting and denials for specialty and ancillary clinics, worked by software and a US team inside the systems you already use.
Your claims are not general medical claims.
Drug units and waste, medical necessity rules, technical and professional splits, Medicaid enrollment. General billing services treat these as exceptions. For you they are every claim.
- 35%of prior authorizations are fully electronic. The rest go through portals, fax and phone.CAQH Index 2024
- 24 minfor a specialist's manual eligibility check, three times the 8 minutes a generalist spends.CAQH Index 2024
- 41%of providers had denial rates of 10% or more in 2025, up from 30% in 2022.Experian Health 2025
What we handle
Before the visit
Prior authorization tracking
Request authorizations, track the payer response and flag visits and doses that would go out without one.
Before the visit
Medical necessity checks
Check the diagnosis, documentation and coverage rules a payer needs before the claim goes out.
Claims
Infusion and drug claims
Build claims with the right J-codes, NDCs, units and JW or JZ waste modifiers so drug claims pay in full.
Claims
Hyperbaric and wound care claims
Bill treatment time in the right units and attach the wound documentation payers ask for.
Claims
Diagnostic testing claims
Split technical and professional components with the 26 and TC modifiers for sleep, cardiac, vascular, DEXA and imaging studies.
Claims
Claim status follow-up
Check status electronically, on payer portals or by phone, then log the reference number and next step.
Payments
ERA and deposit matching
Match each bank deposit to its remittance by trace number and chase payments that arrive without one.
Payments
Hard-to-post payments
Post paper EOBs, multi-patient checks, recoupments, reversals and virtual card payments line by line.
Denials
Denial routing and appeals
Sort each denial by what it needs: a corrected claim, records, an authorization or an appeal, then draft the appeal.
Enrollment
Medicaid and payer enrollment
Enroll doulas, midwives and new providers with Medicaid and commercial payers, including EFT and ERA setup.
Continuity
Backup clearinghouse
Keep a second clearinghouse ready so claims and remittances keep moving if your main one goes down.
Your workflow
Your custom workflows
If the work your clinic needs isn't on this list, tell us how you do it today and we'll build it around you.
Tell us about it →Who we work with
Treatment centers
High-dollar claims where one missing authorization costs thousands.
- Infusion centers
- Hyperbaric and wound care
- Pain, ketamine and TMS clinics
Diagnostic and maternal care
High-volume or newly covered services with their own billing rules.
- Sleep, cardiac, vascular, DEXA and imaging centers
- Doulas and midwifery practices
- Billing companies that serve these clinics
FAQ
What kinds of clinics do you work with?
Specialty and ancillary clinics with hard claims: infusion, hyperbaric and wound care, diagnostic testing, pain and TMS, and maternal care. We also work with billing companies that serve them.
Do we have to change our systems?
No. We work inside your practice management system, clearinghouse and payer portals.
Who works our claims?
Software does the repetitive steps. The people who handle exceptions are based in the United States.
How do we start?
We agree on one workflow and one month of claims, then show you what was worked, collected and still open. Pricing is agreed before we start.
How is our patient data protected?
We sign a BAA before we touch any data, and access is limited to the people working your account.
Show us the work you want to stop doing.
Bring a workflow, a spreadsheet, or an idea. We'll work through what Kepler can build and what a first pilot would cover.