Cortex Solutions manages end-to-end billing for healthcare providers — eligibility through final payment — with automation doing the repetitive work and experienced specialists handling everything that needs judgment.
No black boxes. You see the same dashboard we work from, and a named lead who answers for it.
The money is usually already earned. It leaks out in the quiet places: a stale eligibility check, a modifier nobody caught, a denial that aged past the appeal window while the front desk was busy being a front desk.
A written-off denial is a decision nobody meant to make. We work every one to resolution or a documented reason.
Bad demographics and unverified benefits create rework that costs more than the claim.
One biller resigning shouldn’t put a quarter of your cash flow at risk. Coverage should be structural.
A monthly PDF of totals isn’t management. You need cause, owner, and next step.
We run the full cycle for most clients. If you only need denials and legacy A/R worked, that’s a real engagement too.
Verification before the visit, benefit detail your staff can actually read to the patient, and authorizations tracked to approval.
Experienced coders review documentation for specificity and modifier accuracy, and flag missed charges back to the provider.
Payer-specific edits applied before the claim leaves, so rejections get caught in minutes instead of weeks.
Every denial is categorized by root cause, appealed on the payer’s timeline, and fed back upstream so it stops recurring.
Accurate posting with contractual variance checks, plus patient statements and support that sound like your organization, not a collector.
Weekly performance review, payer trend analysis, underpayment detection against your contracted rates.
Switching billers, or sitting on aged claims nobody has touched in months? We’ll work the old book in parallel while we run the new one.
Transitions are where organizations get hurt. Ours is sequenced so claims keep going out the door the entire time.
We review your A/R aging, denial history, fee schedule, and payer mix, then tell you plainly where the money is sitting.
EHR and clearinghouse access, payer edit rules, workflow ownership, escalation paths, and your reporting cadence.
We take live claims while your existing process winds down. Nothing goes dark, nothing gets dropped between systems.
Weekly metrics, monthly review with your named account lead, and root-cause fixes pushed back into the front end.
We use AI and rules-based automation for the high-volume, low-judgment work — status checks, eligibility, document intake, denial triage. It never decides a code, writes an appeal, or talks to your patients on its own. A person reviews the work that carries risk.
We build this side of the business ourselves, which is why it improves as your payers change rather than aging in place. And we work inside the system you already own: no rip-and-replace, no new PM system to learn, no data held hostage if you ever leave.
Ask how it would work in your EHR →Run continuously against payers instead of once a week by hand.
Every denial classified by root cause and routed to the right specialist the day it lands.
Rules learned from your denial history, applied before submission.
Judgment work stays with experienced staff. You always have a named human to call.
Commercial, Medicare, Medicaid, and managed care — each with its own rules, timelines, and reasons to say no. We build the workflow around your actual payer mix.
Solo, small group, and multi-specialty organizations under one tax ID.
Implant carve-outs, multi-procedure reductions, and auth-heavy caseloads.
Visit limits, unit-based billing, and authorization cycles that never stop.
Institutional claims, per-diem and case-rate contracts, and complex coordination of benefits.
Cortex Solutions LLC was started on a simple observation: the large RCM firms are excellent at scale and mediocre at attention. Clients become a queue. Questions become tickets. The person who knows your account changes every quarter.
We built the opposite. A deliberately small book of clients, each with a named lead who knows your payers, your providers, and your aging by heart — supported by automation that gives a small team the throughput of a much larger one.
Our automation is engineered in-house, not licensed and hoped for. When a payer changes a rule or your remits stop posting cleanly, it gets fixed here that week — not filed as a ticket with a software vendor and waited on. And nothing about your transition is improvised: your workflow gets built around what your payers actually pay, not a template.
We don’t ask for long lock-ins. We’d rather earn the next month than trap you in the next three years. If your metrics aren’t moving, you should be able to leave, and you should be able to take your data with you.
No. We work inside the system you already use. If you’re between systems, we’ll advise, but we don’t sell software and we don’t require a migration.
Most clients keep their front-desk and patient-facing people and hand us the back-office volume. We’ll tell you honestly which roles we replace and which we make more effective.
Percentage of collections for full-cycle work, so we only do well when you get paid. Project scopes for A/R cleanup and assessments. We quote after we’ve seen your actual volume — never off a template.
A signed BAA before any access, least-privilege credentials scoped to the work, access logging, and staff trained on HIPAA annually. We’re glad to walk your compliance officer through it.
Fair question, and we’d rather answer it than dodge it. The company is new; the people aren’t. Between our founders you get twenty years of revenue cycle operations and healthcare data engineering, applied directly to your account rather than delegated down a chain. No multi-year lock-in, and metrics reported weekly from day one. Judge us on the trend, not the pitch.
Send us an A/R aging summary and a denial report. We’ll come back with a written read on where your money is stuck, what it’s worth to fix, and what we’d do first. No obligation, no pressure to switch.