Independent practices
Single- and multi-provider 837P billing with specialty coding logic.
Medical Billing Software
Medical Billing Software Development
We build billing software that captures the charge, codes it correctly, and files a clean EDI 837 claim through your clearinghouse — so payment arrives faster and denials stop eating your margin.
HIPAA-ReadyEDI X12 5010NCCI EditsAudit Logged
Trusted by global innovators
Where billing software makes or loses money
Medical billing lives or dies on the details between the visit and the claim: did the charge get captured, was the CPT paired with a supported ICD-10 diagnosis, did the modifier survive, did the claim pass the clearinghouse's front-end edits? Off-the-shelf billing tools often miss these until a payer rejects the claim weeks later, by which point the AR clock has been running.
We build billing software that catches problems at charge capture, not at rejection. Coding assistance, NCCI edit checks, and payer-specific scrubbing run before the EDI 837 leaves the system, and the clearinghouse handshake is tracked end to end so nothing disappears into an acknowledgment gap.
What it is
Turning care delivered into revenue collected
Medical billing software translates a clinical encounter into a payable claim — capturing the charge, applying the right codes, submitting to the payer, and posting what comes back. Its job is to get the maximum legitimate reimbursement with the least manual rework.
The difference between a good and a bad billing system shows up in the rejection queue. We build for a high first-pass rate by catching coding and edit problems before the claim ever leaves the building.
From charge capture to clean claim
Coding integrity, charge capture, and clearinghouse submission in one workflow — instead of a coder, a spreadsheet, and a portal.
What we build into your billing platform
Each capability ties a billing outcome to the code set, edit, or integration that makes it work in production.
Charge capture & coding integrity
Encounter-linked charge capture with CPT, HCPCS Level II, ICD-10-CM, and modifier validation, plus NCCI procedure-to-procedure edits and medical-necessity checks so charges are complete and correct before coding is finalized.
AI-assisted coding suggestions
Suggested CPT/ICD-10 codes from the clinical note with confidence scoring, flagging unbundling risks and missing modifiers while keeping a certified coder in the loop for sign-off.
Clearinghouse-ready EDI 837
Professional (837P) and institutional (837I) claim files built to the 5010 standard and submitted through Availity, Change Healthcare, or Waystar, with 999 and 277CA acknowledgment tracking so no claim is lost in transit.
Payment posting & reconciliation
835 remittance auto-posting with CARC/RARC reason-code handling, contractual adjustments, and underpayment flags reconciled against expected fee schedules.
Eligibility & claim status
270/271 eligibility verification before the visit and 276/277 claim-status checks after submission, so staff stop calling payers to chase where a claim stands.
Statements & patient payments
Clear patient statements after insurance adjudicates, with payment plans and PCI-aware card processing to collect the balance without a separate tool.
Where it runs
Billing use cases we build for
Billing service bureaus
Multi-tenant billing across many client practices on shared rails.
Ambulatory surgery centers
Institutional 837I billing with facility and implant charge logic.
Labs & diagnostics
High-volume claims with panel coding and payer-specific edits.
Behavioral health
Time-based coding, authorization tracking, and session billing.
Digital health startups
Billing embedded in telehealth and RPM products from launch.
Where billing software pays for itself
Clean claims and fast posting are the whole game. We instrument both so improvement is measurable — targets are validated against your baseline in discovery.
95%+
First-pass clean-claim rate we design toward
837P/I
Professional & institutional claim support
NCCI
Edit checks run before submission
Compliance-First Healthcare App Development Services Backed by Global Standards
15-Minute Scoping Call01
HIPAA
Health Insurance Portability and Accountability Act
Protect PHI with privacy-first architecture, encrypted storage and transmission, strict access controls, and traceable audit logs.
02
GDPR
General Data Protection Regulation
Implement lawful consent flows, data minimization, retention controls, and secure processing for sensitive health data.
03
FHIR
Fast Healthcare Interoperability Resources
Enable standardized health data exchange across apps, care teams, and systems through robust FHIR-ready APIs.
04
HL7
Health Level Seven International
Support enterprise-grade interoperability with HL7-based integrations for records, events, and clinical messaging workflows.
05
HITRUST
Health Information Trust Alliance
Align security programs to healthcare-specific control and risk management practices trusted by providers and ecosystem partners.
06
HITECH
Health Information Technology for Economic and Clinical Health Act
Design with breach notification readiness, digital record safeguards, and operational controls that support regulated care programs.
07
SaMD
FDA Software as a Medical Device
Plan software quality, traceability, and documentation pathways for products that may require SaMD review and submission.
08
MDR (EU)
Medical Device Regulation (European Union)
Prepare EU market-ready processes for risk classification, evidence tracking, and lifecycle governance under MDR expectations.
09
SAMHSA
Substance Abuse and Mental Health Services Administration
Apply confidentiality controls and consent-aware sharing models for behavioral and mental health data experiences.
Standards we build against
Billing standards & code sets
X12 837X12 835CPT / HCPCSICD-10-CMNCCIHIPAA
Our Process
How we deliver a billing build
Coding rules, clearinghouse enrollment, and payment posting run as parallel tracks toward a predictable go-live.
1.
Billing workflow discovery
We map your specialties, fee schedules, payer mix, and current rejection reasons, then design coding and scrubbing rules that reflect how your practice actually bills.
Specialty-aware
2.
Charge capture & coding core
We build charge capture, the coding assistant, and NCCI/medical-necessity edits, validating against your historical claims to catch what leaks today.
Coding integrity
3.
Claims & payment posting
EDI 837 submission through your clearinghouse and 835 auto-posting with reconciliation, tested against payer-assisted files before go-live.
Clean claims
4.
Go-live & rejection monitoring
Phased launch with rejection dashboards, denial alerts, and reconciliation reports, plus tuning as new payers come online.
Always audit-ready
Featured case study
Read Case StudyLera Health: compliant women's health platform
Related proof of compliant delivery: Lera Health isn't a billing product, but building its privacy-first data layer and auditable workflows shows how we handle PHI, integrations, and regulated data — the same discipline your billing pipeline needs.
Why Partner With Us
15-Minute Scoping CallWhy teams pick Agnotic for billing software
We combine coding fluency, EDI depth, and compliance-first engineering so your billing platform ships clean and stays clean.
Compliance-First by Default
HIPAA and X12 5010 standards designed in from sprint one, with audit trails on every charge and claim edit.
Coding & EDI Fluency
CPT, ICD-10-CM, HCPCS, NCCI edits, and 837 loops are our baseline, not a discovery cost we pass to you.
Fast to First Clean Claim
Milestone-driven delivery that gets a working claim into a payer-assisted test lane early.
Built for Your Specialty
Billing logic tuned to your service lines — from primary care to complex procedural and lab billing.
Our relevant experience
Billing engineering that survives the payer
Frequently Asked Questions
A core build — charge capture, coding checks, 837 submission, and 835 posting — typically starts in the low six figures. Multi-tenant billing-company platforms and deep specialty logic extend the range. We scope against your specialties and payer mix and share a range in discovery.
Ready to bill cleaner and collect faster?
Tell us your specialties and current rejection reasons. We'll return a billing-software plan with coding scope, clearinghouse approach, and a realistic timeline.
contact@agnotic.com
Partnerships
contact@agnotic.com