Six modules that hand each other clean data.
Revora covers the revenue cycle from the first phone call to the final patient balance. Each module is useful on its own, and together they stop problems where they start.
Patients book themselves, any hour.
Publish each doctor's calendar to an online booking page, and let the AI voice agent pick up the phone. Both book into the same real schedule your front desk uses.
- Online booking with real open slots, visit types and languages per doctor
- AI voice agent that books, reschedules and cancels, and answers hours, location, insurance and balance questions
- Callers are identified by name and date of birth, and every booking is read back for a yes
- Coverage is checked and a cost estimate is sent the moment a visit is booked
- FHIR Slot and Appointment APIs for partner apps and marketplaces
Insurance problems found before the visit.
Patients check in from their phone: insurance, intake questions and consents with a typed signature. Eligibility runs at booking, two days before the visit and at check-in.
- X12 270/271 with copay, deductible, coinsurance and out-of-pocket left, in under a second
- Inactive coverage or a wrong member ID goes to the front desk the moment it is found
- A corrected insurance card re-verifies and releases every claim that was waiting on it
- Good-faith cost estimate shown to the patient before they arrive
- Procedures that need prior authorization are requested when they are booked
Signed notes become claims.
The doctor writes the note as usual. Revora proposes ICD-10-CM and CPT/HCPCS codes as they type, and shows why: the phrase behind each diagnosis and the medical-decision-making elements behind the visit level.
- Office visit level from the 2021 AMA medical decision making rules (two of three elements)
- Diagnoses to the highest specificity the note supports, with negations ignored
- Modifiers 25, 95, RT/LT; vaccine administration; drug units from the dose; venipuncture with drawn labs
- Orders that need prior authorization are flagged and requested automatically
- Documentation tips that keep a code from being denied
Clean claims, sent on their own.
Every claim passes more than 25 edits before it leaves. Fixes that are certain are applied automatically; the rest arrive in a work queue with the reason and the fix. A denial-risk score holds anything a person should look at.
- Required data, NPI check digits, ZIP+4, ICD-10 format and pointer checks for 5010
- Modifier 25, medical necessity, vaccine administration, preventive age bands, unit limits, duplicates
- Payer rules: prior authorization, timely filing, Medicare preventive coverage
- Learned rules: payer bundling and coverage policies picked up from past remittances
- 837P, 999 and 277CA tracked automatically; 276/277 status checks for claims that go quiet
Posted, checked, and recovered.
835 remittances are balanced and posted line by line. Each payment is checked against your contract. Denials are categorized from their reason codes and, when the fix is certain, corrected and resent without a person.
- Balance checks on every ERA: line, claim and payment totals
- Underpayments found against the fee schedule, with appeal letters drafted and batched by payer
- Touchless recovery: authorization on file, diagnosis already on the claim, missing modifier
- Patient statements by text and email with a pay link; reminders when overdue
- Payer scorecards: denial rate, days to pay, first-pass acceptance, underpayments
The other side of the claim, on the same platform.
Insurers and TPAs connected to Revora receive eligibility requests and claims, adjudicate with their own rules, review prior authorizations and appeals, and send 835s, all in standard X12 and FHIR.
- Front-end edits with 277CA acknowledgments
- Adjudication from the contract: fee schedule, bundling, coverage policies, authorization, duplicates, timely filing
- Copay, deductible and coinsurance from each member's accumulators
- Prior authorization approved automatically when criteria are met; pended for a clinician otherwise
- Appeals reprocessed as a reversal and a new payment on the next remittance
See it on your own claims.
Bring a week of your 835s and we will show what Revora would have caught, fixed and recovered.