Use Cases
Our Random Yet Important Efforts!
Use Case 1: Rate negotiation for a specialty practice
A specialty practice was busy, but the numbers did not feel right.
Patient volume was steady.
Claims were going out.
Payments were coming in.
But when the practice looked closer, one commercial payer was paying much lower allowed amounts on the CPT codes they performed most often.
The problem was not obvious at first because the payer was not denying everything. They were paying. Just not well.
So the practice had a quiet revenue leak.
We helped review their remittance data, identify the top CPT codes by volume and revenue impact, compare reimbursement patterns, and build a payer-facing rate negotiation packet.
Instead of asking the payer for a general increase, the practice was able to show:
which CPT codes mattered most
how often they were performed
current allowed amounts
why the rates needed review
how the payer relationship could be improved
The goal was simple: stop negotiating with feelings and start negotiating with data.
The payer did not need a long emotional letter.
They needed a clean case.
That is what we helped prepare.
EDI and clearinghouse setup cleanup for a growing practice
A growing practice had providers seeing patients across multiple payers, but the billing workflow was messy.
Some claims were going out electronically.
Some needed manual work.
Some payers were not returning ERAs properly.
Some EFTs were active, but remits were not reaching the billing system.
The clearinghouse setup was half-done, and nobody had a full map of what was connected.
The practice had portal access, payer approvals, and a billing system.
But the pieces were not talking to each other properly.
That created unnecessary follow-up, delayed posting, missing remits, and confusion between the payer, clearinghouse, and billing team.
We helped review the payer list, confirm payer IDs, check which EDI enrollments were active, identify missing ERA/EFT connections, and clean up the clearinghouse routing.
The important part was not just “submitting forms.”
It was connecting the full chain:
Provider → Group → Payer → Clearinghouse → Billing system → ERA/EFT → Payment posting
Once the setup was cleaned up, the billing team had fewer surprises, better visibility, and a much cleaner path from claim submission to payment.
Contact
provider@medrollment.com
1-929-274-4328
US healthcare administrative services company providing payer enrollment, provider credentialing, clearinghouse/EDI enrollment and practice operations support to medical practices.