Medical billing services
With MedHeave,
you don't lose control; you gain
MedHeave operates as a HIPAA-compliant, integrated revenue operations department for established US practices. With first-pass rates above 90%, over 97% of claims paid, and AR below 40 days, we bring discipline, visibility, and accountability to your entire revenue cycle.
Our operational footprint
These aren't aspirational targets. These are what we deliver, consistently, across all practices we work with.
90%+
First Pass Rate
<40
AR Days
<10%
Denial Rate
97%+
Net Collection Rate
Your billing setup is no longer in sync with your growing practice.
As your practice grows, billing as a standalone service stops being enough. With end-to-end revenue cycle management, it becomes a coordinated system that drives how consistently and accurately your practice gets paid.
This is how we run and manage your revenue cycle.
Revenue cycle management
MedHeave manages your entire revenue cycle as one integrated system, covering eligibility, charge capture, coding, claim submission, and AR follow-up until fully paid.
Medical billing
We run your complete billing cycle, from charge entry through denial appeals, with a dedicated team accountable at every stage, so you generate revenue on every claim.
Medical coding
We review every diagnosis, procedure, and modifier against your documentation and payer-specific edits, so a coding error is never the reason you lose revenue overall.
Medical credentialing
We manage your credentialing cycle, from primary source verification to CAQH maintenance and PECOS enrollment, so lapsed credentials never cause a claim denial.
Prior authorization
We handle every prior authorization request with the exact documentation each payer needs, follow it through to approval, and appeal every denial so care never stalls.
Worker’s comp & no-fault billing
We verify claims, submit correct codes and documents within 24-48 hours, follow up with adjusters on delays, and manage denials & appeals until you get paid in full.
Denial management
Denial management runs as a dedicated function on our end, with the payer knowledge and the root-cause discipline to recover every dollar that belongs to the practice.
Patient billing
We confirm patient responsibility from EOBs, send up to three statements, make follow-up calls, and coordinate payment plans before escalating accounts to collections.
Trusted by 400+ providers from coast to coast.
MedHeave works with practices across the country, with presence in 35+ states, adapting to each state’s payer rules while keeping operations consistent at every location.
Generic billing doesn’t work across specialties.
Ours is built especially for yours.
MedHeave works closely with practices in specialties where we’ve built deep operational familiarity, supporting each field with structured revenue cycle management built around its specific demands.
Behavioral health
In behavioral health, missing eligibility or session tracking can cost several visits, not just one. We stay ahead of authorization limits, benefit caps, telehealth rules, and co-pay terms so billing stays steady through care.
Podiatry
For podiatry billing, we make sure modifiers like 25 and RT/LT are accurate, services align with global periods and payer edits, and orthotics always meet payer-specific authorization and DME requirements before claims go out.
Urgent care
We handle urgent care billing across walk-ins, diagnostics, and procedures. From there, we track payor coding rules, facility contracts, prior authorizations, and eligibility checks so claims never get delayed, cut, or denied.
Orthopedic
We handle orthopedic billing, making sure procedures get authorized upfront and modifiers like LT/RT and bilateral get applied well. Surgical cases with implants are coded and billed the way payers actually expect for payment.
Cardiology
Cardiology billing often triggers NCCI edit denials, bundling issues, and global period violations when E/M services and procedures are billed together. We manage coding and modifier logic to reduce denials and boost payments.
DME
DME billing is handled by aligning orders, documentation, and delivery timelines with payer rules. We apply HCPCS coding, manage capped rentals, and enforce refill limits so claims are never denied for missing paperwork today.
Pediatrics
In pediatrics, we handle well visits and immunizations, making sure vaccine administration and VFC eligibility are correct. Age-based coding stays accurate as well, so nothing gets missed, underbilled, or delayed at any visit.
Anesthesia
The accuracy of anesthesia billing depends on capturing start and stop times correctly. We ensure precise time capture, apply base units and modifiers, and handle medical direction & concurrency so each unit is billed right.
Don’t see your specialty? We likely work in it.
Still looking for a reason? Here's 400+.
Insights from the billing floor.
From denial trends to specialty-specific coding updates, our blog covers insights that actually matter to providers running a practice.
Experienced across 40+ EHRs. We work natively within your system and never route patient data through third-party tools.
FAQs
Questions we often hear from providers like you.
Switching to a different billing setup is not a small decision. These are the operational questions practice owners ask us before making the move, to make sure it’s the right one.
How does MedHeave handle denied claims?
90% of denials are caught through ERAs. 70% are resolved with modifier corrections and resubmitted. The rest are sent to the provider for clinical input. If the corrected claim is denied again, we appeal. Write-offs only happen with provider approval.
What happens to our existing AR when we transition to MedHeave?
We build a full aging sheet and identify claims still within rework windows. Commercial payers allow approximately 90 days; Medicare allows up to 1 year. Claims in the 60 to 120 day bucket are prioritized first. Write-offs are only recommended with your approval.
How do you handle out-of-network billing and the No Surprises Act?
For OON claims, we verify benefits, submit clean claims, and negotiate underpayments through companies like MultiPlan and Zelis. For NSA-eligible claims, we manage open negotiation, IDR filing through the CMS portal, and QPA analysis. Our IDR success rate runs 75 to 85%.
Do you handle prior authorizations or just claims?
We handle both. Auth requirements are verified by specialty and payer, requests are submitted with clinical documentation, and status is tracked centrally. Standard turnaround is 2 to 5 business days. If a claim is denied for missing auth, we check retro auth first, then file a medical necessity appeal.
How do you handle underpayments on in-network claims?
Every EOB is compared against the contracted fee schedule. If the payment is below the contracted rate, we request reprocessing. We bill at 150% of the allowable to prevent charge-level underpayments. Consistent underpayers are flagged to the provider and escalated to credentialing for contract renegotiation.
How quickly do you submit claims after the provider signs the encounter?
Within 24 hours of the signed encounter notes. Missing CPT or diagnosis codes are flagged to the provider the same day. Unsigned notes are flagged weekly. All submissions are tracked through the clearinghouse to confirm successful transmission.
Who works on our account, and what happens if someone leaves?
A dedicated team handles charges, AR, and payment posting, each with a supervisor running daily audits. Resigning staff serve a 30-day notice for SOP handover. Supervisors are a real-time backup on every account.
Do you handle credentialing?
Initial and re-credentialing, including primary source verification and payer follow-ups every 14 business days. Commercial payers take 2 to 4 months; Medicare and Medicaid take 1.5 to 3 months. Expirables are tracked and flagged 60 to 90 days before lapse. CAQH maintenance is included.
How do you handle coordination of benefits with multiple payers?
We determine primary and secondary responsibility. If both plans refuse primary, we contact the patient to update COB with the insurers. Conference calls are arranged when needed. Primary is billed first, remaining balance goes to secondary.
What reporting do we get and how often?
Charge and payment reports weekly. AR reports monthly. Denial trends, underpayment patterns, and payer performance are tracked continuously. Custom reporting is available on request.
How do you protect patient data and stay HIPAA compliant?
Encrypted systems with role-based access controls. ERA and EFT setups are configured during onboarding to minimize manual data handling. Coders hold CPC certifications through AAPC and stay current via CMS, AMA, and continuing education. Coding is based strictly on documentation.
We Run the Revenue. You Run the Practice.
One conversation with our team and you will know where your billing is failing and how fixing it will increase your revenue by 15-25%.
