QMTRY’s healthcare revenue cycle management automation

Unifies claims ETL, denials mining, 835/837 reconciliation, and reporting — so finance and clinical teams see the same truth.

Revenue cycle automation in healthcare is no longer optional — it’s PMO-driven and audit-ready, which means faster cash, fewer write-offs, and evidence you can hand to an auditor without breaking a sweat.

Why Revenue Cycle Automation Matters

Revenue cycle automation replaces brittle, manual handoffs with governed pipelines that standardize claims, reconcile remits, and surface the next best financial action. When it’s implemented well, finance, coding, and clinical operations see the same validated truth — shortening the path from encounter to cash while leaving an audit trail your compliance team can defend. The outcome isn’t just speed; it’s provable accuracy with less rework, fewer avoidable denials, and reporting that stands up to scrutiny. For deeper governance detail, see Compliance and examples in our Portfolio.

5 Audit-Ready Capabilities

These capabilities form a cohesive, end-to-end revenue cycle automation stack. Each is measurable, governed, and evidence-producing by default.

QMTRY Powered by Datarobot

Positioned to accelerate outcomes, strengthen compliance, and deliver measurable ROI for federal Health IT programs.

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Audit-Ready AI

Predictive models with explainability, bias testing, and evidence bundles aligned with CMS, NCQA, HIPAA, and HITRUST.

Accelerated Outcomes

AutoML reduces model development time from months to days, accelerating Stars/HEDIS and denial prevention strategies.

Compliance First

Every deployment is validated with Great Expectations and mapped to HITRUST controls for regulator-defensible pipelines.

Federal-Grade Value

Predictive insights drive measurable quality and cost efficiency improvements for federal programs and prime contractors.

Unique Positioning

QMTRY’s healthcare domain expertise + Datarobot’s enterprise AI = unmatched subcontractor advantage in Health IT.

Claims ETL you can trust. Normalize, validate, and enrich 837/835 with deterministic rules and data contracts. Hash incoming files, profile for anomalies, and enforce schema/code-set checks before data lands in the warehouse.

Denials management automation. Classify via CARC/RARC, tag root cause automatically, and generate prioritized work queues by payer, service line, and dollar impact. Playbooks map denial patterns to fixes (coding edits, CDI feedback, or authorization workflows).

835/837 reconciliation. Match line items with tolerance rules, raise variance flags, and track payer behavior over time. Close the loop on what was billed, what was paid, and why variances occur — feeding targeted appeals and contract management.

Reporting that ships itself. Scheduled executive rollups and A/R KPIs with lineage links back to source files and transformations. Leaders can drill from “days in A/R” to the exact rows driving change.

EHR + coding integration. Connect Epic, Cerner, or Meditech for CDI feedback loops, CDM checks, and coding audits. Quality gates land earlier so claims go out clean and denials never show up.

What Improves with Revenue Cycle Automation

Teams see measurable gains within a quarter: ↓ DNFB, ↓ avoidable denials, ↑ clean-claim rate, ↑ first-pass yield, and faster month-end close. Because the pipeline is governed, improvements are sustained — not “lift and fade.” Analysts spend less time reconciling numbers and more time acting on them. For a baseline and roadmap, head over to Contact.

Typical clients see 3–7-day DNFB reduction, 5–15% fewer avoidable denials, and higher first-pass yield as reconciliation and CDI loops mature. Every improvement traces back to source data and policy, making gains defensible and durable.

How QMTRY Delivers

• PMO governance: scope, milestones, RACI, and risk controls aligned to compliance requirements.
• Data quality by design: dbt models with Great Expectations tests, contract checks, and automated alerts.
• Evidence bundles: exportable packs (policies, runbooks, screenshots, CSV extracts) to satisfy auditors quickly.
• Secure pipelines: least-privilege access, encryption in transit/at rest, documented key-rotation.
• Operational handoff: playbooks, SLAs, and ownership transfer so your team runs day two without consultants.
• Outcome reporting: dashboards and executive rollups tied directly to reconciled source data.

HEDIS/NCQA Alignment

• ➤ HEDIS performance measurement integrated across clinical, coding, and billing for transparent quality reporting.
• ➤ Claims ETL pipeline normalizing 837/835 with 999/277CA validation to create reliable, measure-ready data.
• ➤ Denials management with CARC/RARC root-cause and appeals automation that protects quality and revenue.
• ➤ Healthcare reporting automation and executive KPIs for measure compliance and operations.
• ➤ EHR integration (Epic, Cerner, Meditech) with clinical data integration / electronic clinical data systems.
• ➤ Audit-ready HEDIS data for accurate HEDIS reporting, HEDIS data submission, and HEDIS audits.

Want the underlying standards? Review CMS administrative simplification resources for HIPAA transactions (EDI 837/835). CMS guidance on EDI transactions.

QMTRY’s approach to revenue cycle automation in healthcare combines governed pipelines, audit-ready data, and EHR integration. Whether your goal is compliance, faster month-end close, Stars ratings optimization, or scalable healthcare revenue cycle management automation, we deliver.

FAQ

What is revenue cycle automation?
A governed pipeline that standardizes claims, reconciles 835/837, automates denials worklists, and ships audit-ready reporting with traceable lineage.

Will this work with our EHR and clearinghouse?
Yes. We integrate with Epic, Cerner, and Meditech and consume clearinghouse feeds with documented data contracts and quality gates.

How fast can we see measurable impact?
Most clients see fewer avoidable denials and faster cash cycles within 4–8 weeks as playbooks and queues go live, with additional gains as reconciliation and CDI loops mature.