Revenue Cycle Management for Pennsylvania Tuned for Pennsylvania Practices
Carevonix's US-based team delivers revenue cycle management for healthcare practices across Pennsylvania, from Philadelphia, Pittsburgh, Allentown. We work inside your EHR and know the payer mix you actually bill: Highmark Blue Shield, Independence Blue Cross, UPMC Health Plan.
Why most RCM is broken
Revenue cycle is a relay race where every dropped baton costs real money. Eligibility skipped at intake. Coding errors at the visit. Claims sent late. Denials never worked. Patient balances forgotten. Most practices have a different person responsible for each leg. Or worse, nobody is. The Highmark / Independence / UPMC split means a single Pennsylvania practice often manages three different in-network workflows under one roof.
- •Net collections rate stuck below 92% with no clear root cause
- •AR over 90 days growing month over month
- •Denial rate above 8% with no systematic follow-up
- •Underpayments by commercial payers going unappealed
- •Patient AR over 60 days sitting in the system with no follow-up
What end-to-end RCM looks like
Carevonix owns the full revenue cycle from front desk through final payment. One accountable team, one set of KPIs, one monthly report.
Front-end eligibility and intake
Eligibility verification, benefits breakdown, copay collection, and prior-auth tracking, completed before every visit so claims aren't denied on day one.
Charge capture and coding review
Coding QA on every encounter against payer-specific rules. We catch missed modifiers, undercoded encounters, and bundling issues before claims go out.
Claims submission and clearinghouse management
Daily claims submission with first-pass scrubbing. Rejections worked the same day. Average first-pass acceptance: 94%.
Denial management and appeals
Every denial worked within 48 hours, corrected, appealed, or documented for write-off. Aging AR doesn't have time to grow.
Payment posting and reconciliation
ERA and manual payment posting with EOB reconciliation. Underpayments flagged and appealed against contracted fee schedules.
Patient AR and collections
Patient statements, balance reminders, payment plans, and pre-bad-debt outreach, all keeping patient AR collected without straining patient relationships.
Monthly KPI reporting
Net collections rate, days in AR, denial rate by payer and CPT, clean claim rate, patient AR aging, all delivered monthly with a named account lead.
What full-cycle RCM with Carevonix delivers
Average outcomes across Carevonix RCM clients within 90 days of go-live.
+6-12%
Net collections rate improvement
67%
Reduction in AR over 90 days
94%
First-pass clean claim rate
< 4%
Denial rate after 60 days
Why practices choose Carevonix for RCM
Most RCM companies sell a software platform with humans bolted on. We sell the humans, backed by tooling rather than replaced by it.
- Dedicated US-based RCM team with a named account lead
- We work in your EHR and PM system with no migrations and no parallel logins
- Single accountable team for the full cycle, so no hand-offs drop the baton
- Flat monthly pricing with no percentage-of-collections fees that punish growth
- Transparent monthly KPI reporting with real benchmarks for your specialty
Built for Pennsylvania practices
Pennsylvania practices contract with three major regional Blues plans, each with different fee schedules and prior-auth requirements. The Highmark / Independence / UPMC split means a single Pennsylvania practice often manages three different in-network workflows under one roof.
Payers we work with daily in Pennsylvania
- Highmark Blue Shield
- Independence Blue Cross
- UPMC Health Plan
- Aetna
- UnitedHealthcare
Pennsylvania metros we serve
- Philadelphia
- Pittsburgh
- Allentown
- Harrisburg
Source: Pennsylvania Insurance Department, 2024
Frequently asked questions
Real questions practice owners ask before they switch.
Ready to see what Carevonix can do for your practice?
Book a 20-minute demo. We'll walk through your current workflows, your numbers, and exactly what would change.