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CARDIOLOGY · PAIN MANAGEMENT · PSYCHIATRY · AND MORE

Insurers Use AI to Deny Your PAs. We Use AI to Approve Them.

eviCore. Evolent. Carelon. UHC. We know every payer, every vendor, every portal — and we know how strong your case is before we submit.

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Our Services

Everything your practice needs.
Under one roof.

Built for cardiology, pain management, and psychiatry practices — every service, every specialty, handled with precision.

"Eligible" doesn't mean "covered." We find the difference before it costs you.

Every day, a dedicated specialist reviews your upcoming schedule — verifying coverage, calculating deductibles, and breaking down copays in plain language. We coordinate referrals directly with PCPs and alert your office if a referral isn't received in time — stopping denials before they start.

We know who actually handles your payer's authorizations — and we go straight to them.

Most insurers outsource PAs to third-party vendors — eviCore, Evolent, Carelon, New Century — each with different portals, rules, and turnaround times. We've mapped every payer-to-vendor route and built custom SOPs for each one. No hold music. No wrong submissions. Full appeal management for every denial.

Every dollar your practice earns should make it to your bank account.

We manage your full revenue cycle — from charge capture to final payment. Claim submission, adjudication, payment posting, denial management, and collections. What separates us is the follow-up: we track every claim until the last cent is accounted for. Weekly and monthly reports show which insurances pay fastest, which CPT codes yield the highest reimbursements, and which denial patterns keep recurring.

HOW IT WORKS

A real team. Smarter tools. Better results.

01
Onboarding
We integrate directly with your practice — access to your system, your workflows, your team. One-time setup, zero ongoing effort from you.
02
We Pull the Order
We access patient info and procedure orders directly from your system. No forms to fill, no data to send — we work like an in-house employee.
03
AI Validation
Every case is cross-referenced against the payer's current clinical guidelines before submission — gaps flagged, documentation strengthened.
04
Direct Submission
Sent to the right vendor, through the right portal, with the right codes. No hold music. No wrong submissions.
05
Approval
Authorization secured and confirmed. You receive the result instantly with full documentation.
06
Denial? We Appeal.
If the payer denies, we don't stop. We build a clinical argument using the payer's own guidelines and fight the denial — until we get a resolution.
01
Onboarding
We connect to your scheduling system and learn your payer mix, plan types, and referral requirements. One-time setup.
02
Daily Schedule Review
Every day, we review your upcoming appointments — verifying coverage, calculating deductibles, copays, and out-of-pocket maximums in advance.
03
Referral Coordination
When a referral is required, we contact the PCP directly and follow up until it's received — no burden on your front desk.
04
Discrepancy Alerts
If coverage doesn't match, a referral is missing, or a visit needs to be rescheduled, we alert your office immediately — before the patient walks in.
05
Full Reporting
Every verification, every referral status, every discrepancy caught — logged in your dedicated dashboard in real time.
01
Onboarding
We integrate with your practice management system and learn your billing workflows, fee schedules, and payer contracts.
02
Charge Capture (Optional)
If your practice needs it, we handle charge capture directly — pulling procedure and diagnosis codes from clinical documentation so nothing falls through the cracks.
03
Clean Claim Submission
Every claim is scrubbed for errors before submission — correct codes, correct modifiers, correct payer requirements. Sent clean the first time.
04
Payment Posting & Tracking
We post payments, track every claim through adjudication, and follow up on anything unpaid, underpaid, or ignored.
05
Denial Management & Appeals
Denied claims don't get written off. We identify the reason, correct the issue, and appeal — recovering revenue that most practices leave on the table.
06
Full AR Reporting
Complete revenue cycle data in your dashboard — collection rates, days in AR, denial trends, and month-over-month performance.

EHR SYSTEMS WE WORK WITH

eClinicalWorks Tebra Athenahealth NextGen Epic Kareo DrChrono AdvancedMD + more

We adapt to your existing workflow — no migrations, no disruptions.

Proprietary Technology

We Don't Guess. We Use the Exact Same Guidelines Your Payer Does.

Insurance companies use AI to find reasons to deny your prior authorizations. We use AI to make sure they can't.

Every major payer and vendor — eviCore, Evolent, Carelon, New Century, UHC — publishes the clinical criteria their reviewers use to approve or deny requests. Most practices never read them. We built our entire system around them.

Before we submit a single authorization, our proprietary platform cross-references the procedure against the payer's current guidelines — identifying clinical gaps, flagging weak documentation, and assessing approval likelihood. If the case isn't strong enough on paper, we fix it before it becomes a denial.

The result: stronger submissions, fewer surprises, and medical necessity letters that speak the payer's own language — fully HIPAA compliant at every step.

7+
Years of payer intelligence
125+
Guideline documents indexed
10+
Vendor portals mastered
100%
HIPAA compliant workflows

We Know Their Rules. We Speak Their Language.

Every payer. Every vendor portal. Every guideline document — indexed, mapped, and loaded into every submission we make.

Authorization Vendors
Insurance Payers
eviCore Evolent Carelon New Century Health Availity AuthAI UHC UMR Meritain Ambetter Sunshine Health Wellcare Humana Aetna Cigna Oscar Molina Tricare Horizon BCBS Simply Health Devoted Health

PRACTICE INTELLIGENCE

You shouldn't have to guess how your practice is performing.

Each service has its own dedicated dashboard. Real data, updated continuously — specific to what matters for that workflow. No black boxes. No guessing.

Eligibility & Referrals Live
96%
Referral Completion Rate
99.1%
Eligibility Accuracy
34
Discrepancies Caught
8
Visits Rescheduled
Coverage Issues by Payer
UHC Aetna Cigna Humana Ambetter
Weekly Referral Volume
Wk1 Wk2 Wk3 Wk4 Wk5 Wk6
Prior Authorizations Live
94%
First-Pass Approval Rate
87%
Appeal Overturn Rate
3.2d
Avg. Days to Approval
12
Pending Authorizations
Approval Rate by Payer
eviCore Evolent Carelon UHC New Century
Monthly Approval Trend
Oct Nov Dec Jan Feb Mar
Billing & Revenue Cycle Live
98.2%
Clean Claim Rate
18.4d
Days in AR
96.8%
Collection Rate
$48,320
Appeals Recovered
Revenue by Month
Oct Nov Dec Jan Feb Mar
Denial Reasons
Medical Necessity — 45%
Missing Info — 30%
Coding Error — 25%
Referral Completion Rate Eligibility Discrepancy Rate First-Pass Approval Rate Denial Trends by CPT Code Avg. Days to Approval Clean Claim Rate Days in AR Appeal Overturn Rate Month-over-Month Revenue Auth Expiration Tracking

Every client gets their own dashboard. No extra cost.

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AI-Powered

Insurers use AI to process denials faster than ever. We use AI to fight back just as fast.

AI Appeal Engine dashboard

When a denial lands, our system analyzes the denial letter and clinical documentation to instantly generate a customized medical necessity appeal — tailored to each patient's specific diagnosis, history, and circumstances. Not a template. A real clinical argument built on the payer's own guidelines.

Every letter goes through expert human review before it goes out. Every step happens inside a secure, HIPAA-compliant environment — no protected health information ever leaves controlled systems.

The result: faster responses, lower administrative burden, and significantly fewer denials that stick.

2.4 days
Avg. appeal turnaround
87%
Overturn rate
100%
HIPAA compliant
HIPAA Compliant Human Reviewed Payer-Specific Arguments

Client Results

What Our Clients Say

Real practices. Real results.

BoostingMD specialist team

Our Story

Human Specialists. AI-Powered.

We're not a software platform you manage on your own. We're a dedicated team of prior authorization and billing specialists — people who have spent years inside cardiology, pain management, and psychiatry practices — who use our proprietary AI tools to work faster, smarter, and more accurately than anyone else in the industry.

You get the accountability of a real team with the precision of technology. Every PA submitted, every claim tracked, every denial appealed — by a specialist who knows your practice, backed by a system that knows every payer's guidelines.

Because when the paperwork flows, so does care.

Get Started

Start with a free audit. No commitment.

We'll review your current revenue cycle, prior authorization workflow, and eligibility process — identify what's costing you money, and show you exactly where BoostingMD can make a difference. No pitch. Just a real analysis of your practice.