RCM Foundation provides an AI‑driven back‑office platform that integrates with EHRs, clearinghouses, payer portals, fax systems, and patient communication tools to automate same‑day prior authorizations, denial appeals, claim chasing, and patient balance follow‑ups. The solution is HIPAA‑ready, audit‑logged, and built by physicians, delivering a single operational view of scattered revenue data to reduce manual billing work and prevent revenue leakage.
Funding
Funding not disclosed
Founders
Product
Problem
Medical practices often have revenue cycle data scattered across multiple systems—EHRs, clearinghouses, payer portals, fax lines, and patient communication tools—requiring manual navigation, repetitive data entry, and constant follow‑up to prevent denials, delayed authorizations, and unpaid claims.
Solution
RCM Foundation integrates these disparate sources into a single, HIPAA‑compliant platform and deploys generative AI agents to automate revenue cycle tasks. The agents submit same‑day prior authorizations, appeal denials, chase unpaid claims, and monitor patient balances without human intervention, escalating only when clinical judgment is needed. All actions are audit‑logged and performed under a Business Associate Agreement, ensuring secure handling of protected health information. The system provides a real‑time dashboard that consolidates claim status, authorization progress, and revenue leak alerts into one operational truth. Practices can onboard the solution in under a week, with the first daily revenue brief delivered during the initial rollout.
Target Audience
Primary customers are independent medical practices and small health systems that manage their own revenue cycle and need to reduce manual billing labor while improving cash flow.
Features
- Integration connectors for EHRs, clearinghouses, payer portals, fax inboxes, and patient communication stacks
- Generative AI agents that read claims, reason through payer rules, and execute same‑day prior authorizations
- Automated denial investigation, appeal drafting, and claim resubmission with escalation to human operators when needed
- Continuous monitoring of unpaid claims and patient balances, surfacing potential revenue leaks before they become write‑offs
- HIPAA‑ready architecture with audit‑logged actions and a signed BAA for secure PHI handling
- Real‑time dashboard displaying unified revenue cycle metrics and exception alerts
- Modular rollout starting with fax sorting, then prior authorization, and full billing, all live within 7 days