Eligibility
Coverage checked before work piles into avoidable denials.
ERP and enterpriseHealthcare billingFlagship
07 / 21
SiriusSolutions:revenuecyclemanagement
A revenue cycle management system that carries each claim from eligibility check to payment follow-up in one pipeline for ~400 US clinics.
Engagement
Sirius Solutions: revenue cycle management
Sirius Solutions Global bills for around 400 US clinics. Every delayed or denied claim is money clients wait longer to collect — so the pipeline from eligibility to payment had to be one system, not a handoff chain.
One pipeline, every claim accounted for — from first check to final payment.
Who feels a stalled claim
Billing teams
Fewer claims stalling between eligibility, coding, submit and follow-up.
Clinic clients
Faster collection when denials surface early enough to fix.
Managers
The whole pipeline visible at a glance — not status buried in inboxes.
The claim pipeline
Eligibility → coding → submit → follow-up → paid — one continuous path.
Coding & submit
Claims move forward without disappearing between teams.
Follow-up
Denials and delays surface while they can still be fixed.
Pipeline view
Managers see ~400 clinics’ revenue cycle as one operation.
How we approached it
Treat revenue cycle as one product, not five disconnected tools.
Step 01 / 04
Follow the claim
Every stall between steps was mapped before the pipeline UI was designed.
Step 02 / 04
Make denials early news
Late discovery is expensive. The system surfaces issues while remediation is still possible.
Step 03 / 04
Aim at best-practice targets
Clean claim rate and days in AR framed against HFMA/MGMA benchmarks — not vanity dashboards.
Step 04 / 04
Scale to clinic volume
Built for Sirius’s footprint across hundreds of US clinics, not a pilot desk.
Outcome
Fewer claims stall between steps, denials surface early, and managers see the whole pipeline — for a client serving around 400 US clinics.
The need
Sirius Solutions Global bills for around 400 US clinics. Every delayed or denied claim is money its clients wait longer to collect.
What we built
A revenue cycle management system that carries each claim from eligibility check to payment follow-up in one pipeline.
Fewer claims stall between steps
Denials surface early, while they can still be fixed
Managers see the whole pipeline at a glance
Proof metrics
Verified
~400
US clinics served by the client
Industry benchmark
95%+
clean claim rate, the best-practice target
Source · HFMA and MGMA
Industry benchmark
< 40 days
in accounts receivable, the best-practice target
Source · MGMA
How to read the numbers
- Verified. Measured on the named deployment.
- Industry benchmark. Published third-party reference; our delivery tracked in line with them.
- By design. A property built into the product.
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