Sold by: Health Roads Inc
Deployed on AWS
AI-powered, HIPAA-compliant RCM platform for community-based organizations. Automates Medicaid billing for ECM, housing, justice-involved programs. Deploys in weeks, not months.
Overview
SocialRCM® RCM for Community-Based Organizations
SocialRCM® bridges the gap between services your team delivers and the reimbursement your organization is owed. Purpose-built for CBOs billing Medicaid.
The Problem
CBOs delivering Medicaid-supported Enhanced Care Management, Community Supports, and Justice Involved programs face a billing nightmare: complex bundle codes, DHCS-specific 837P/837I requirements, and no RCM software built for their workflow. Claims go unbilled or get rejected. Revenue left on the table.
The Solution
SocialRCM transforms fragmented billing workflows into a streamlined, compliant revenue stream. It sits between your source data (EHR, case management, or service records) and the health plan - validating, constructing, and managing compliant claims without requiring you to change how your team works.
Key Capabilities
- HIPAA compliant billing ECM, CS, and BHS codes
- 837P and 837I claim generation & submission
- Real-time eligibility verification (API + batch EDI 270/271)
- Remittance (835) reconciliation & reporting
- Justice-involved population billing workflows
- Encounter data submission
- Revenue dashboards for leadership, managers, and billing staff
- AI-driven claim validation catches errors before submission
Proven Results
- 95%+ claims success rate | <5% rejection rate
- 3 weeks from contract to first claim
- $300K stuck Medicaid claims recovered for one client in 30 days
- Billing cycle time reduced 30-50%
Why SocialRCM is Different
Purpose-built for CBOs - not hospitals. Medicaid-native, handling eligibility gaps and justice-involved populations. Fast to launch - Health Roads configures payer contracts and credentials. AI with guardrails - HIPAA and nonprofit compliant with full audit trail. You own your revenue - SocialRCM is a tool, not a network.
Implementation services available via Private Offer.
Highlights
- 95%+ claims success rate with <5% rejection target - AI validates every claim before submission, catching errors upstream before they become denials or lost revenue.
- 95%+ claims success rate with <5% rejection target - AI validates every claim before submission, catching errors upstream before they become denials or lost revenue.
- Go live in as little as 3 weeks - Health Roads handles configuration, payer setup, and training so your team can focus on mission, not IT
Details
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Delivery method
Deployed on AWS
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Pricing
Pricing is based on actual usage, with charges varying according to how much you consume. Subscriptions have no end date and may be canceled any time.
Additional AWS infrastructure costs may apply. Use the AWS Pricing Calculator to estimate your infrastructure costs.
Dimension | Description | Cost/unit |
|---|---|---|
Collected Revenue Tier 1 | 8% of the collected revenue, billed every month, for the first $100K revenue per month | $0.08 |
Collected Revenue Tier 2 | 7% of the collected revenue, billed every month, for the next $100K revenue per month | $0.07 |
Collected Revenue Tier 3 | 6% of the collected revenue, billed every month, for the remaining revenue, per month | $0.06 |
Dimensions summary
You pay a percentage of the revenue this platform collects for you each month. Pricing works in three tiers based on your monthly collected revenue. The first block of monthly revenue bills at the Tier 1 rate. The next block bills at the Tier 2 rate. Any revenue above those blocks bills at the Tier 3 rate. The percentage steps down as your monthly collected revenue grows. Billing occurs every month based on actual collections, so your cost scales directly with the revenue captured.
Top-of-mind questions for buyers
Collected revenue is the money the platform actually captures for you through billing and claims processing each month. You are billed on real collections, not on claims submitted or expected reimbursement. If a claim is not collected, it does not add to your billable revenue for that month.
No. The tiers stack, so each block of revenue bills at its own rate. Your first block of monthly revenue bills at the Tier 1 rate. The next block bills at the Tier 2 rate. Only revenue above those blocks bills at the Tier 3 rate. The transition happens automatically as collections rise.
Your cost tracks actual monthly collections. In a low-collection month, you pay the tier percentages only on what was captured. If nothing is collected in a given month, that month generates no percentage-based charge under these dimensions.
www.health-roads.com
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Support
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Email: support@health-roads.com | Phone: (510)439-1695 | Support URL:
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