Service line 02 - Credits

Credits Optimization

Credits self-sort. Refunds trigger themselves. PLB matching included.

Credit balances are a compliance clock and a staffing sink at the same time: patient and payer refund deadlines run while people hand-sort a queue that never empties. This engagement puts a framework under credit management in Epic - CER-driven identification and routing, LPP mapping for every credit context, and refund requests generated from the credit workview without a person deciding each one. PLB adjustments are matched to the credits they resolve as part of the base scope.

If your remittance posting doesn't put PLBs where credit handling can use them, that is a separate service - PLB Posting Configuration - and it's the prerequisite, not an upgrade.

In most organizations HB routes its complex credits to PB, so the PB build carries the weight. The HB side is an audit-and-fix, priced accordingly.

What we deliver

Credit workflow design

Identification across the billing system
CER routing
Automated workqueues segmented by purpose: patient refund, payer refund, transfer and offset, unapplied, secondary pending, posting correction, PLB allocation, exceptions

Automation

LPP mapping per credit context
Refund request automation from the credit workview
PLB-to-credit matching

Enablement

Test cases and guided validation
Weekly live training
Full build documentation and plain-English user guides

How the engagement runs

The framework is fixed. The routing is built to how your teams divide the work.

Discovery confirms the credit contexts in play, the top payers by credit volume, and how resolution work is divided among posting, refund, and follow-up teams. The workqueues are built to that division, not to a template.

Discovery

4 wks

Build

12 wks

Test

4 wks

Go-live support

6 wks

Audit and fix

4 wks

What we measure

Technical outcomes, at baseline and 90 days after go-live.

Auto-routed shareCredits routed to a purpose-specific queue on creation, without manual sorting.

Refunds self-initiatedRefund requests generated without a person initiating them.

Days to resolutionFrom credit creation to resolution.

Pricing

ServiceFixed fee

Credits Optimization - PBIncludes PLB credit matching

$200,000

Credits Optimization - HBAudit and fix

$35,000

PLB Posting Configuration - PB

$100,000

PLB Posting Configuration - HB

$100,000

Examples

Credits PB + Credits HB

$229,750

Credits PB + PLB Posting PB

$285,000

Each fee covers one billing system, one service area, one operational owner. Every line is a separate service; the second service in a contract is 15% off, the third and beyond 20%.

Modifiers

Two or more services in one contract: 15% off the second, 20% off the third and each additional, applied to the lower-priced services
Each additional service area, same operational owner: +15%
Each additional operational owner: +30%
Payers beyond five, where payer count drives build: flat per-payer add

Assumptions

One billing system, one service area, one operational owner per fee
One client analyst participates 1-2 hours per week for knowledge transfer; client resources do not perform build or testing
Production and a recent-clone environment available for the duration
Current configuration, test accounts, representative files, and SME access provided within 10 business days of start
Any clearing-vendor engagement required by scope is complete before start
Up to five payers included where payer count drives build
Epic's build wizard is used for the foundation

Warranty

One-year warranty on all in-scope deliverables, covering configuration degradation from Epic upgrades or defects within the original scope. Full build documentation, plain-English user guides, and recorded training delivered at go-live.

Book a scoping call

Scoping confirms credit contexts, payer mix, and whether PLB posting is already in place.