Optimizing Revenue Cycle Management: Approach to Healthcare Billing

Healthcare organizations often struggle with complex revenue cycle operations — manual claims handling, delayed reimbursements, and data silos between EHR and payer systems. ELC Consulting helps providers, payers, and revenue cycle teams automate claim processing, insurance verification, and payment reconciliation by integrating Epic or Cerner systems with AWS HealthLake, SageMaker, and Comprehend Medical using FHIR/HL7 standards.

We bring interoperability, analytics, and automation into one API-driven solution — allowing providers to focus on patient care, not paperwork.

Use cases: AI Use Cases in Claims & Billing with AWS: Predictive Claim Denial Management

AI model analyzes claim patterns to predict denials before submission. Pre-submission validation reduces errors. Improves first-pass acceptance rates, reducing payer delays. Example AWS Workflow: Amazon SageMaker trains a model on historical claim denials. The model flags high-risk claims before submission to Epic. AWS Lambda triggers auto-correction before sending claims. Automated Payment Reconciliation with ERA Processing AI auto-matches payments (EDI 835) with claims (EDI 837). Auto-posts adjustments & identifies payment discrepancies. Reduces manual reconciliation time. Example AWS Workflow: AWS extracts payer remittance advice (ERA 835) into HealthLake. AI matches payments to submitted claims in Epic Resolute. Discrepancies (underpayments, overpayments) are flagged. Intelligent Claim Correction with NLP AI scans unstructured claim documents for missing data. Corrects errors before claims are sent to payers. Reduces rework & accelerates payment cycles. Example AWS Workflow: AWS Comprehend Medical extracts CPT, HCPCS, ICD-10 codes from scanned clinical notes. AI auto-fills missing codes in claim submissions. Independent solution now available for implementation & consultation.