What we measure, and report to you every month.
Claims accepted on the first pass, without rework.
From denials and old A/R that had been written off.
From charge capture to the payer, scrubbed first.
Root cause found, fixed and resubmitted.
Built for hospitals, ERs and large groups.
IOP and PHP credentialing with commercial payers
We get Intensive Outpatient Programs (IOP) and Partial Hospitalization Programs (PHP) approved and credentialed with commercial payers. We do it at the facility level, so the program is approved as a site of care, and at the individual provider level, so each clinician is enrolled.
One team for the whole back office.
Money leaks at six points. We watch all of them.
Coverage checked before the patient arrives.
Eligibility and benefits verified ahead of every scheduled visit, and prior authorizations started at scheduling, so claims are not denied for coverage the front desk could have caught.
Every chart coded to the documentation.
Certified coders assign CPT, ICD-10 and HCPCS codes and modifiers from the provider notes, then check them against payer edits before the claim is built.
Sent within 24 hours, scrubbed first.
Each claim is checked against multiple scrubbing rules and sent to the payer within 24 hours of charge entry. Rejections are fixed and resent.
Every denial worked within 48 hours.
We find the root cause, fix it, and resubmit or appeal. Each denial reason is logged and reported, so the cause can be fixed upstream.
Every payment posted and checked.
ERAs and EOBs are posted, matched to what the payer should have paid, and underpayments are flagged for follow-up.
Followed until every claim is closed.
Unpaid claims are worked by age and value, including out-of-network claims that qualify for No Surprises Act negotiation and IDR.
Recover the revenue insurers underpaid you under the No Surprises Act.
The No Surprises Act protects patients from surprise out-of-network bills. It also gives providers the federal Independent Dispute Resolution (IDR) process to challenge insurers who underpay. That is where we come in: we handle your IDR disputes from the first notice to the final payment, and track every deadline.
Billers who know your specialty's rules.
Certified coders with specialty experience, hospital-based specialties first.
Live in two to four weeks, with no gap in claims.
Talk
A 20-minute call about your payers, volume and current setup.
Proposal
A written scope for your practice before you sign anything.
Onboarding
We log into your EHR, set up access and pick up open claims.
Monthly reporting
One clear report on collections, denials and A/R, every month.
Where your billing is done.
Our team works from offices in Vancouver, Dubai and Islamabad. Our US registered office is in Richmond, Kentucky. You always know who touches your claims.
Richmond, KY 40475
Patient data stays protected.
Before you choose a billing company.
Guide
Guide
GuideCommon questions.
Straight answers about switching, security and No Surprises Act disputes.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01Is it safe to outsource billing to a team outside the US?
Yes, with a signed Business Associate Agreement. HIPAA allows it, and we sign a BAA with every client, train all staff on HIPAA and require NDAs.
02Do you handle No Surprises Act disputes?
Yes. We run open negotiation and federal IDR for out-of-network claims, from the first notice to posting the final payment.
03What is the No Surprises Act?
It is a federal law that protects people with employer, individual and FEHB coverage from most surprise out-of-network bills and caps their cost sharing at in-network levels. It also gives providers and plans a federal dispute process, open negotiation followed by IDR, to settle the out-of-network payment. Ground ambulance services are not covered.
04How can a provider dispute an out-of-network underpayment?
Send an open negotiation notice with your offer within 30 business days of the initial payment or denial. If no rate is agreed within the 30 business day negotiation period, you can start federal IDR, and a certified IDR entity picks one of the two offers.
05What does IOP and PHP credentialing mean?
It means getting an intensive outpatient program or partial hospitalization program approved by a payer so its services can be billed in network. It can happen at two levels: the program or facility itself as a site of care, and each clinician who treats the plan's members. Nucleus Align handles both with commercial payers.
06What is the difference between facility-level and individual-level credentialing?
Facility-level credentialing approves the program or facility as a site of care. Individual-level credentialing enrolls each clinician who treats the plan's members. They are separate applications, and Nucleus Align works on both.
07Can Nucleus Align credential our IOP or PHP with commercial payers?
Yes. We get IOPs and PHPs approved and credentialed with commercial payers, at the facility level and at the individual provider level. Payers set their own timelines, so we go through your program and payers on a call.
08How long does it take to switch billing companies?
Two to four weeks from the first call to live claims, with no gap in claims while we take over.
09Do I have to change my EHR?
No. We work inside the EHR you already use.
10What will I see each month?
One clear report on collections, denials and A/R.
Talk to a billing lead.
Pick a 20-minute slot or send your details. Monday to Friday, 9am to 5pm Eastern.
With a billing lead