Eligibility and Benefits Verification
Coverage, deductibles, copays and authorization requirements confirmed with the payer before the visit.
From 2.29%of collections. No setup fee, no long-term contract.
Medical billing services and RCM for US healthcare providers
ClainetRCM is a boutique virtual medical billing company helping physicians, clinics and group practices in all 50 states get paid faster. AAPC and AHIMA certified coders file clean claims within 24 to 48 hours, work every denial and review your AR every 14 days, starting at 2.29% of monthly collections.
- HIPAA compliant, BAA signed
- AAPC / AHIMA certified coders
- Go live in 7-14 business days
Claims and enrollments with Medicare, Medicaid and commercial payers
MedicareMedicaidUnitedHealthcareAetnaCignaBlue Cross Blue ShieldHumanaTRICARE
Our services
Medical billing and healthcare RCM services, end to end
Certified billers, coders and RCM specialists who maximize your reimbursement, reduce claim denials and keep your practice financially healthy. Take the full revenue cycle, or only the stage you need.
Select a panel to see how each service works.
Medical Billing
Full-service medical billing starting at just 2.29% of collections. Our billers submit clean claims electronically, track payments, post EOBs, manage patient statements and follow up on every unpaid claim.
Clean claims filed within 24-48 hours of receiving your encounter data.
Explore medical billing servicesRevenue Cycle Management
Complete revenue cycle management from patient registration and eligibility verification through coding, billing, payment posting, denial management and financial reporting.
One RCM partner from the first appointment to the final payment.
Explore revenue cycle managementMedical Coding
AAPC and AHIMA certified coders deliver accurate ICD-10-CM, CPT and HCPCS coding across all specialties, so claims get approved and audits stay clean.
Certified coders review every chart before it becomes a claim.
Explore medical coding servicesDenial Management
We work every denial, not just the easy ones. Specialists find the root cause, correct the coding, file the appeal with the documentation the payer requires, then fix the upstream process.
Denials corrected and refiled within 24-48 hours, not written off.
Explore denial managementAccounts Receivable Management
Focused AR management that analyzes aging reports, prioritizes high-value claims and follows up until payers pay, so days in AR come down and cash flow steadies.
Every AR bucket reviewed on a 14-day cycle.
Explore AR managementProvider Credentialing
Provider credentialing and payer enrollment, including CAQH profiles, insurance enrollments and re-credentialing, so new providers get paid from day one. Our assigned payer representatives help expedite enrollment.
Typical Medicare enrollment: 30 to 45 days. Medicaid and MCOs: 30 to 60 days.
Explore provider credentialingPrior Authorization
Payer criteria checked, clinical documentation packaged, and every request followed to a decision.
Medical Scribing
Virtual medical scribes who document visits in your EHR in real time, so charts can be closed the same day.
Medical Virtual Assistant
HIPAA-trained remote assistants for scheduling, patient calls, intake and referrals.
Practice Management
Front-office and back-office operations managed inside the software you already use.
Provider Licensing
State medical licenses, DEA and controlled substance registrations filed, tracked and renewed on time.
Healthcare Business Registrations
Entity formation, EIN, organizational NPI, CLIA and state registrations filed in the order each depends on.
Dental Billing
Dental billing and revenue cycle support for US dental practices, from eligibility checks to claim follow-up.
Why outsource billing
Key benefits of outsourcing your medical billing to ClainetRCM
Practices that partner with ClainetRCM get faster payments, fewer denials, lower overhead and more time for patient care.
Faster insurance reimbursements
Clean claims go out electronically within 24-48 hours of receiving your encounter data, scrubbed before submission and followed up until paid. AR is reviewed every 14 days, so nothing sits and ages unnoticed.
Fewer claim denials
Every claim is coded by AAPC/AHIMA certified staff, checked against real-time eligibility and measured against current payer policy. Denials are worked, not written off.
Predictable monthly cash flow
A structured billing cycle removes payment surprises, so you can plan staffing, investment and growth with confidence.
More time for patient care
Billing tasks, prior authorizations and denial follow-ups stop landing on your desk and your front desk. Our free audit shows what billing is actually costing you today.
Compliance and HIPAA security
Every claim follows HIPAA, CMS and payer-specific rules. A BAA is signed before any PHI moves, and data is encrypted and access-controlled.
Lower cost than an in-house team
An in-house billing department can cost $50,000 to $100,000+ a year in salaries, benefits, training and software. ClainetRCM starts at 2.29% of collections with no setup fee.
How it works
Three steps from your first call to paid claims
1
Free revenue audit
Share 90 days of remittance data or a recent aging report under a signed BAA. We show you, line by line, where revenue is leaking.
2
Onboarding in 7-14 days
We sign the BAA, set up secure access to your EHR and payer portals, map your payer mix and fee schedule, and run alongside your current process.
3
Go live and get paid
Claims go out within 24-48 hours, every denial is worked, AR is reviewed every 14 days and you get a monthly close report.
EHR and PM compatibility
We work inside the EHR you already use
No migration and no new software to buy. We log in to your system and work your claims there.
- Epic
- athenahealth
- eClinicalWorks
- NextGen
- AdvancedMD
- Kareo
- DrChrono
- Practice Fusion
- ModMed
- Greenway
- CareCloud
- CureMD
- Elation Health
- Nextech
- Compulink
- ChartLogic
- Office Ally
- CollaborateMD
- Sevocity
- Praxis EMR
- Amazing Charts
- RXNT
- CharmHealth
- Office Practicum
- ChiroTouch
- Cerner
- Meditech
- Allscripts
- McKesson
- GE Healthcare
- MEDHOST
- Altera Health
- PointClickCare
- MatrixCare
- WellSky
- HCHB
- Axxess
- Netsmart
- Qualifacts
- Kipu Health
- Valant
- TherapyNotes
- SimplePractice
- ICANotes
- TheraNest
- WebPT
- Raintree
- Dentrix
- Open Dental
- Curve Dental
24-48 hrsFrom encounter to claim submission
14 daysAR review cycle on every bucket
2.29%Starting rate, of monthly collections
50 statesPractices served nationwide
Medical specialties
Specialty-specific billing and coding for your clinical discipline
Every specialty carries its own CPT codes, modifiers, payer policies and authorization rules that generalist billers get wrong. Our specialty-trained teams know yours, from cardiology and behavioral health to orthopedic surgery and emergency medicine.
Primary and General Care
Behavioral and Mental Health
Cardiovascular and Pulmonary Care
Musculoskeletal and Physical Medicine
Specialized Medicine
Sensory and Neurological Care
Women's and Men's Health
Dental and Oral Health
Surgical Specialties
Diagnostic and Laboratory Services
Other Specialized Practices
Who we work with
Medical billing for every type of US healthcare provider
Customized billing and revenue cycle management built around how your organization actually bills.
Hospitals and Health Systems
Inpatient and outpatient RCM for multi-specialty hospitals, improving coding accuracy, reducing claim backlogs and maximizing DRG-based reimbursement.
Multi-Specialty Clinics
Billing, credentialing and virtual front-desk support that streamline clinic operations and cut the denials that drain revenue.
Individual and Solo Providers
Full-service billing for independent providers who want a large team's expertise without the overhead, from 2.29% of monthly collections.
Private Medical Practices
Scalable RCM for multi-provider groups, with provider-level reporting, multi-location credentialing, payer contract analysis and AR benchmarking.
Diagnostic Laboratories
Lab billing with accurate CPT and HCPCS coding, ABN management and payer-specific compliance for every test ordered.
Urgent Care Centers
High-volume urgent care billing with rapid claim turnaround, insurance verification at check-in and proactive AR management.
Home Health and Hospice Agencies
Medicare, Medicaid and private payer billing with expertise in OASIS documentation, PDGM compliance and hospice claims.
Specialty Medical Centers
Specialty-specific coding teams for oncology, cardiology, behavioral health and orthopedics, including drug and infusion billing.
Service coverage
Medical billing services across the United States
As a virtual billing company we serve providers in all 50 states, with working knowledge of state Medicaid rules, regional payer networks and local compliance requirements.
California
Medi-Cal billing for Los Angeles, San Francisco, San Diego and every major California market.
Texas
Houston, Dallas, Austin and San Antonio, with Texas Medicaid compliance expertise.
Florida
Miami, Orlando, Tampa and Jacksonville, with Florida Medicaid knowledge.
New York
NYC, Buffalo and Albany providers, with NY Medicaid and Empire BlueCross experience.
Illinois
Chicago-area and statewide billing with Illinois Medicaid managed care expertise.
Pennsylvania
Philadelphia, Pittsburgh and statewide, with Medical Assistance billing specialists.
Ohio
Cleveland, Columbus and Cincinnati providers, with Ohio Medicaid billing compliance.
Georgia
Atlanta metro and statewide billing with Medicaid CMO network expertise.
North Carolina
Charlotte, Raleigh and Durham, with NC Medicaid Transformation billing knowledge.
Michigan
Detroit, Grand Rapids and statewide, with Medicaid Health Plan billing expertise.
New Jersey
Newark, Jersey City and statewide, with NJ FamilyCare and commercial payer billing.
Virginia
Northern Virginia, Richmond and Hampton Roads, with DMAS Virginia Medicaid specialists.
Washington
Seattle, Spokane and Tacoma, with Apple Health (Washington Medicaid) billing expertise.
Arizona
Phoenix, Tucson and Scottsdale, with AHCCCS and major Arizona payer billing.
Massachusetts
Boston, Worcester and Springfield, with MassHealth and BCBS MA compliance.
Tennessee
Nashville, Memphis and Knoxville providers, with TennCare Medicaid billing expertise.
Make the right choice
In-house medical billing vs ClainetRCM
Still managing billing in-house? Here is how the two compare.
| Criteria | In-house billing team | ClainetRCM |
|---|---|---|
| Annual cost | $50,000 - $100,000+ in salaries, benefits and software | Starts at 2.29% of monthly collections |
| Claim accuracy | 75-85%, with errors, gaps and staff turnover | Every claim scrubbed and QA-reviewed before submission |
| Claim submission speed | 3-7 business days on average | Filed within 24-48 hours of receiving encounter data |
| Denials | 15-25% national average denial rate | Denials worked and appealed, AR reviewed every 14 days |
| Staffing and training | Constant hiring, training and turnover | Certified billing team included, zero HR overhead |
| HIPAA compliance | Requires active compliance management | HIPAA compliant by design, BAA signed |
| Specialty coding expertise | Limited to current staff knowledge | AAPC/AHIMA certified coders matched to your specialty |
| Reporting and analytics | Manual, basic, delayed reports | Monthly close report plus a live dashboard |
| Support availability | Business hours only, Mon - Fri | A named account manager, reachable directly |
| Scalability | Slow and costly to scale | Scales with your claim volume |
| Time to launch | 3-6 months to hire, onboard and train | Go live in 7-14 business days |
| Free practice audit | Not available | Complimentary RCM analysis included |
Our competitive advantage
Why healthcare providers choose ClainetRCM
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Questions
Medical billing questions, answered
We run the work that gets you paid: eligibility verification, prior authorization, medical coding, claim submission, payment posting, denial appeals and AR follow-up, plus credentialing and licensing when you need it. You can hand us the full revenue cycle or a single stage, such as denial management or old AR recovery.
Medical billing starts at 2.29% of monthly collections, with no setup fee, no monthly minimum and no long-term contract. Full revenue cycle management is quoted on your data, and fixed-scope work such as credentialing is a flat fee. See the pricing page for what each plan includes.
Claims go out within 24 to 48 hours of receiving your encounter data. Every claim is scrubbed before submission, denials are reworked in the same window, and every AR bucket is reviewed on a 14-day cycle.
Yes, when the billing company acts as your business associate. We sign a Business Associate Agreement with every client before any PHI changes hands, and protect data with encrypted transmission, secure servers, role-based access and ongoing staff training.
Onboarding takes 7 to 14 business days from signed agreement to first claim submission. We sign the BAA, map your payer mix and fee schedule, connect to your existing system and run alongside your current process until the handover is clean.
No. We work inside most major EHR and practice management systems, including Epic, Cerner, athenahealth, eClinicalWorks, NextGen, Kareo and AdvancedMD. You keep your software and your data.
Yes. There is no long-term contract. Give us 30 days' notice and we hand back every file, every open claim and every payer login, and keep working your claims through the notice period.
Free revenue audit
Ready to recover lost revenue and grow your practice?
Talk to a certified medical billing specialist about your denial rate and your days in AR. The RCM analysis is free and carries no obligation: we review your numbers and show you exactly where revenue is leaking.
No setup fee, no long-term contract, onboarding in 7-14 business days.