Billing & KX Compliance Pre-Flight
Pre-claim validation against your documentation packet. KX modifier rule engine. Pre-submission denial-risk score per claim. Catch the 3–5% of claims that will bounce — before they leave your building.
What this engagement solves
Billers shouldn't be your first line of QA. The denials you catch at billing are the ones you've already paid to create. Pre-flight moves QA upstream — every claim validated against the documentation before it hits the clearinghouse.
Billers learn about a documentation hole when the EOB comes back. By then the equipment is delivered and the takeback risk is real.
KX rules vary by product, payer, and diagnosis. They get keyed wrong, and Medicare takebacks land six months later when the cash is already spent.
The claim says one thing, the documentation packet says another. The mismatch becomes a denial or a downcode.
Every claim is treated the same at submission. The 3–5% that are obviously going to bounce should be flagged before they ever leave.
What you get
Fixed scope. Fixed price range. Delivered on the platform you already run.
Deliverables
- Pre-claim documentation cross-check — every line item validated against the chart
- KX modifier rule engine by product / payer / diagnosis
- Pre-submission denial-risk score per claim (0–100)
- Risky-claim queue — claims scoring above threshold route to a biller for review
- Payer-specific edits baked in (Medicare, Medicaid MCOs, top commercial)
- Reporting: denial-risk trend, top reasons, biller-level performance
- Brightree / WellSky integration — pre-flight runs on the claim before clearinghouse submission
Platforms we sit on top of
Brightree · WellSky · NikoHealth · Bonafide. We add a layer; we don't replace your system of record.
Outcomes
Rounded ranges from real DME engagements. No marketing inflation.
Frequently asked questions
Does this replace our clearinghouse edits?
No — it runs before them. Clearinghouse edits catch format errors. Pre-Flight catches documentation and medical-necessity gaps the clearinghouse doesn't see.
Does it work with our existing biller workflow?
Yes. Pre-Flight surfaces risky claims to your billers; it doesn't replace them. Billers continue to work in Brightree / WellSky.
Will it integrate with Waystar / Availity / Change Healthcare?
Yes. Pre-Flight runs before the claim is handed off to your clearinghouse of choice.
How accurate is the denial-risk score?
The score is calibrated on your historical denial data during weeks 1–2. After tuning, the flagged 3–5% bucket captures the majority of avoidable denials.
Care Plan?
18% of build fee per year — keeps the payer edits and KX rules current as CMS publishes changes.
Start with a free DME leakage audit
30-minute call. Irfan personally maps your intake → setup → resupply cycle and quantifies the leakage in dollars. No deck.
Book the audit Read the case study