Core Features

NeuralRev manages the complete revenue cycle through a structured 7-step encounter workflow. Each step is designed to maximize clean claim rates and accelerate reimbursement.

The Encounter Workflow

Every patient visit follows a consistent workflow divided into two phases:

Pre-Appointment Phase

Steps completed before or at the time of the patient visit.

Post-Appointment Phase

Steps completed after the clinical encounter is documented.

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Step 1: Eligibility Verification

Verify patient insurance coverage in real-time before the appointment.

How It Works

1. Select the patient and their insurance plan
2. NeuralRev sends an electronic eligibility inquiry (EDI 270) to the clearinghouse
3. The clearinghouse routes the request to the payer
4. Results are returned within seconds (EDI 271 response)

Information Returned

• Coverage status — Active, inactive, or termed
• Plan details — Plan name, group number, effective dates
• Benefits — Copays, deductibles, coinsurance, out-of-pocket maximums
• Remaining benefits — How much of the deductible has been met
• Authorization requirements — Whether prior auth is needed for specific services

Best Practices

• Run eligibility 24-48 hours before the appointment
• Re-verify if the appointment is rescheduled
• Check both primary and secondary insurance when applicable
• Review authorization requirements before proceeding to Step 2

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Step 2: Prior Authorization

Manage prior authorization requirements for procedures that need payer approval.

Document Upload

Upload supporting documentation for the authorization request:

• Clinical notes and medical records
• Diagnostic imaging reports
• Letters of medical necessity
• Previous authorization letters

Supported formats: PDF and DOCX (up to 250 MB per document).

Status Tracking

Track authorization status throughout the lifecycle:

• Pending — Submitted, awaiting payer review
• Approved — Authorization granted with reference number
• Denied — Authorization denied (with reason)
• Expired — Authorization past its validity period

Verification

Link approved authorizations to encounters before claim submission to reduce denials.

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Step 3: Appointment Details

Confirm the encounter details that will appear on the claim.

• Patient — Demographics and insurance
• Provider — Rendering and referring providers
• Facility — Place of service
• Dates — Service date and admission/discharge dates (if applicable)
• Diagnosis — Primary and secondary ICD-10 codes

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Step 4: Charge Capture

Capture the billable services performed during the encounter. NeuralRev supports three capture modes:

Manual Entry

Direct entry of CPT/ICD codes by certified coders:

• Search and select CPT procedure codes
• Add ICD-10 diagnosis codes with pointer linkage
• Specify units, modifiers, and place of service
• Apply fee schedule pricing

EMR Import

Import codes directly from your electronic medical records system via the Integration API:

• Automated sync of encounter data
• Code mapping and validation
• Duplicate detection
• Manual review and adjustment before submission

AI-Assisted Code Generation

Generate CPT and ICD-10 codes from clinical documentation:

1. Upload or paste clinical notes
2. The AI model analyzes the documentation
3. Suggested codes are presented with confidence scores
4. Coders review, adjust, and approve the suggestions
5. Approved codes are saved to the encounter

The AI assistant considers:

• Procedure descriptions and medical terminology
• Diagnostic indicators in the clinical narrative
• Payer-specific coding guidelines
• Historical coding patterns for similar encounters

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Step 5: Claim Creation & Validation

Build the claim and validate it before submission.

Claim Assembly

NeuralRev automatically assembles the claim from encounter data:

• Patient demographics and insurance
• Provider and facility information
• Diagnosis codes (ICD-10)
• Procedure codes (CPT) with charges
• Modifiers and units
• Prior authorization references

Pre-Submission Validation

The claim validator checks for common errors before submission:

• Missing required fields — NPI, tax ID, subscriber information
• Code validity — Expired or invalid CPT/ICD codes
• Payer rules — Gender/age/diagnosis requirements for specific procedures
• Modifier logic — Correct modifier usage and combinations
• Duplicate detection — Previously submitted claims for the same service

Validation results include:

• Pass — Claim is ready for submission
• Warning — Issues that may cause delays but won't reject
• Error — Must be corrected before submission

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Step 6: Claim Submission

Submit validated claims electronically to the clearinghouse.

Electronic Submission

Claims are submitted as EDI 837 transactions:

1. Claim passes final validation
2. Converted to ANSI X12 837P (professional) or 837I (institutional) format
3. Transmitted to the clearinghouse via secure connection
4. Acknowledgment received (TA1/999)
5. Claim status updated in NeuralRev

Submission Status

Track claims through the submission pipeline:

• Queued — Awaiting transmission
• Submitted — Sent to clearinghouse
• Accepted — Clearinghouse accepted for forwarding to payer
• Rejected — Clearinghouse rejected (formatting or data errors)
• Acknowledged — Payer received the claim

Handling Rejections

When a claim is rejected:

1. Review the rejection reason codes
2. Correct the identified issues
3. Use the AI recommendation chat for guidance on EDI errors
4. Resubmit the corrected claim

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Step 7: Payment Processing

Process payments when remittance arrives from the payer.

ERA Processing

Electronic Remittance Advice (ERA/EDI 835) is processed automatically:

• Parse 835 transactions from the clearinghouse
• Match payments to submitted claims
• Reconcile at the service line level
• Identify adjustments, denials, and partial payments

Payment Details

For each claim payment:

• Allowed amount — What the payer approved
• Paid amount — What was actually paid
• Adjustment codes — Reasons for any difference (contractual, deductible, etc.)
• Patient responsibility — Copay, coinsurance, or deductible balance
• Denial codes — If any service lines were denied

Denial Management

When service lines are denied:

1. Review the denial reason (CARC/RARC codes)
2. Determine if the denial is appealable
3. Gather supporting documentation
4. Submit corrected claims or appeals as appropriate

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Additional Features

Task Management

Automated workflow for handling exceptions and failures:

• Task Buckets — Categorized queues (eligibility failures, claim rejections, payment exceptions)
• Assignment Rules — Automatic routing based on task type, payer, or dollar amount
• Activity Tracking — Comments, status changes, and resolution notes
• SLA Monitoring — Track aging tasks and escalate as needed

Workflow Rules

Automate common actions with configurable rules:

• Triggers — Events that start the rule (claim rejected, payment posted, task created)
• Conditions — Criteria that must be met (specific payer, amount threshold, rejection code)
• Actions — What happens when triggered (create task, reassign, notify)

Dashboard Analytics

Monitor revenue cycle performance with real-time dashboards:

• KPI Cards — Days in A/R, clean claim rate, first-pass resolution rate
• Claims Pipeline — Visual funnel from submission to payment
• Revenue Trends — Monthly collection trends and forecasts
• Status Distribution — Breakdown of claims by current status