Denials, missed charges and slow follow-up drain revenue from hospitals, clinics and billing companies. Agnotic Technologies builds revenue cycle software that checks eligibility, codes, scrubs and tracks every claim, so your team fixes problems before payers reject them.
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Revenue cycle management software development is building the systems that move a patient encounter to a paid claim: eligibility checks, charge capture, coding, claim submission, denial handling and payment posting. Agnotic Technologies builds this software for providers and billing companies, connected to their EHR, clearinghouse and payers through X12 and FHIR interfaces.
Revenue cycle problems look different depending on who sends the claim. These are the patterns we design for.
High claim volume across many departments, service lines and payer contracts.
Small teams that handle scheduling, billing and follow-up together.
Billing for many client practices, often on different EHRs.
Virtual visits billed across many states and payers.
Revenue leakage is money a provider earned but never collected. It rarely shows up as one large loss; it builds up from small gaps at each step of the cycle.
Missed charges: services delivered but never captured as charges, often where clinical and billing systems are not connected.
Underpayments: payers pay less than the contracted rate, and nobody compares the payment with the contract.
Coding errors: wrong or incomplete codes lead to denials or lower payment for the care that was given.
Uncollected balances: patient balances and denied claims that are never followed up before filing deadlines pass.
The same revenue cycle steps, done by hand and with the automation we build.
| Step | Manual process | Automated workflow |
|---|---|---|
| Eligibility | Staff check payer portals or call payers when there is time | X12 270/271 checks run at booking and again before the visit |
| Charge capture | Billers re-key charges from clinical notes | Charges flow from the EHR into billing, with alerts for services that have no charge |
| Coding | Coders review every chart line by line | Coding suggestions and edit checks flag likely errors for the coder to confirm |
| Claim submission | Claims are fixed after the clearinghouse rejects them | Claims are scrubbed against payer rules before X12 837 submission |
| Denials | Denials are worked in the order they arrive | Denials are grouped by cause and ranked by value and appeal deadline |
| Payment posting | Remittances are posted by hand from paper or PDF | X12 835 remittances post automatically, and underpayments are flagged against contract terms |
| Reporting | Monthly spreadsheets that are already out of date | Live dashboards for denials, days in A/R and collections |
AI models trained on your own claim and remittance history learn which claims are likely to be denied, so your team can fix them before submission. People stay in control: the model flags and ranks, and a person decides.
Each claim is checked for missing data, code and modifier mismatches and payer-specific rule breaks before it is sent.
Claims get a risk score based on past denials for the same payer, procedure and diagnosis pattern.
High-risk and high-value claims go to the top of the queue, with the likely reason attached.
Dashboards built on your claim, remittance and payment data, updated as transactions arrive rather than at month end.
Denials by payer, reason code, provider and location, with week-over-week trends.
Average days from claim to payment, broken down by payer and aging bucket.
Collected against expected payment, with underpayments flagged against contract terms.
Every unpaid claim, its age, its status at the payer and who owns the next step.
Share of claims accepted on first submission, by payer and claim type.
Notifications when denials or A/R age cross the limits your team sets.
Revenue cycle data passes through systems owned by different organizations. We build and maintain the connections between them.
Encounters, charges and demographics come from Epic, Oracle Health (Cerner), athenahealth or your practice management system through HL7 v2, FHIR or vendor APIs.
A rules engine builds each claim and checks it against payer and coding rules before it leaves your system.
Claims go out as X12 837. Eligibility (270/271) and claim status (276/277) requests travel the same route.
Payers adjudicate the claim. Prior authorization is moving to FHIR-based APIs under CMS-0057-F.
X12 835 remittances come back, post to the billing platform and update the analytics.
The transactions, code sets and platforms we work with on revenue cycle projects.
Each team owns part of the revenue cycle. The software passes work between them with clear ownership, instead of email and spreadsheets.
| Team | Owns | Hands off to | What the software does |
|---|---|---|---|
| Front desk | Registration, insurance capture, eligibility | Coding, with a verified patient and coverage | Runs eligibility checks and flags missing or invalid insurance data |
| Medical coders | Diagnosis and procedure codes | Billing, with a coded and documented encounter | Suggests codes, runs edit checks and links each code to its documentation |
| Billing team | Claim submission, denials, appeals | Finance, with paid, adjusted or written-off claims | Scrubs claims, tracks status and ranks denials by value and deadline |
| Finance | Payment posting, reconciliation, reporting | Leadership, with cash and A/R reports | Posts remittances, flags underpayments and keeps dashboards current |
These are the measures we build dashboards around. Benchmarks vary by specialty and payer mix, so we track your own baseline and trend.
Claims accepted on first submission with no edits, divided by all claims submitted.
Claims denied by payers, divided by all claims adjudicated.
Total outstanding A/R divided by average daily charges.
Claims paid on first submission without rework or appeal, divided by all claims paid.
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Each specialty has its own coding rules, authorization needs and denial patterns. These are examples of what we build for each.
Prior authorization tracking for imaging and procedures, plus edit checks for complex cardiac coding and modifiers.
Authorization checks before scheduling, and matching professional and technical components on each claim.
Surgical coding with global period tracking, plus authorization for MRI and durable medical equipment.
High-volume claims with level-of-service coding checks and fast follow-up on self-pay and out-of-network balances.
Session-based billing with time-based codes and authorization limits on visit counts.
High test volumes with medical necessity checks between diagnosis and test codes before submission.
Connections we build between EHRs, clearinghouses, payers and billing platforms.
We build secure, scalable products designed for privacy, interoperability, and regulatory readiness from day one across every sector we serve.
Protect PHI with privacy-first architecture, encrypted storage and transmission, and strict access controls.
Enabling standardized health data exchange through robust, modern API mappings.
Supporting enterprise-grade interoperability for clinical messaging and record workflows.
We combine deep technical expertise with industry-specific knowledge to deliver solutions that aren't just functional, but transformational.
We implement rigorous security protocols and compliance standards (HIPAA, GDPR, SOC2) across all industrial solutions to protect sensitive data.
Our architectures are built to handle massive data loads and user bases, ensuring seamless performance whether you're serving ten or ten million.
Leveraging our suite of internal tools and proven frameworks, we reduce development cycles and get your product to market 40% faster.
Beyond simple wrappers, we build deep-learning integrations and predictive analytics directly into the core of your industry-specific workflows.
We deliver in stages, so each step proves value before the next one starts. Timing depends on your systems and scope, and we agree it on the scoping call.
We map your current revenue cycle, systems and denial patterns, and agree on the first release.
We connect your EHR, clearinghouse and payer channels, with secure data flows and audit logging.
We run real claim scenarios end to end in a test environment, including rejections, denials and remittances.
We roll out by department or location, train your team and keep the old process as a fallback until results are confirmed.
We tune rules and models with your live denial and payment data, then add the next set of improvements.
Short facts on the regulations behind revenue cycle software, each linked to its official source.
HIPAA adopts ASC X12 standard transactions for electronic claims (837), payment and remittance advice (835), eligibility inquiries (270/271) and claim status (276/277).
Source: 45 CFR Part 162 (eCFR)HIPAA names ICD-10-CM as the standard code set for diagnoses, and HCPCS and CPT-4 for physician and other health care services.
Source: 45 CFR Part 162 (eCFR)The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) requires impacted payers to implement a Prior Authorization API to support electronic prior authorization.
Source: CMSThe HIPAA Security Rule requires administrative, physical and technical safeguards for electronic protected health information, which includes claims and payment data.
Source: 45 CFR Part 164 Subpart C (eCFR)We don't just build products; we forge lasting partnerships. See how we've helped industry leaders transform their vision into technical reality.
“I can clearly see how Agnotic has a unique way of handling end-to-end development. They are always active on quick chat and provide support quickly.”
Aaron Phelan
Founder, Benchmark
“Agnotic combines deep technical expertise with strong domain knowledge. They understand the business context, anticipate challenges, and make collaboration smooth and effective.”
John Pasmore
Founder, Latimer
“Agnotic is the best technical team we evaluated. Their engineering excellence made our work dramatically easier and allowed us to stay focused on what matters most for maternal care outcomes. They took full ownership of the technical execution, and we are always happy to continue working together.”
Kim Smith
Founder, My Lauren
Detailed pages for each part of the revenue cycle we build.
End-to-end revenue cycle platforms built around your workflow.
Billing platforms for practices and billing companies.
Claim build, scrubbing, submission and status tracking.
Coding assistance and edit checks that coders confirm.
AI that sorts denials by cause and drafts appeals for review.
Electronic prior authorization and status tracking.
The safeguards we build into every healthcare product.
Explore other production-grade engineering platforms we deliver across healthcare.
The technical patterns behind this platform translate naturally into adjacent verticals.
Tell us where revenue is slipping today, and we will scope a first release with you on a scoping call.
contact@agnotic.com
Partnerships
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