HRN is the data intelligence layer that shows you exactly what you're owed, exactly why you're not getting it, and exactly what to do about it — state by state, MCO by MCO, claim by claim. Not faster billing. Not another AI copilot. Not an outsourced revenue cycle.
You've heard the pitch before. "We'll find your money." "AI-powered revenue optimization." "End-to-end claims management." Here's what those companies actually are — and what we built instead.
When your data passes through our intelligence engine, patterns emerge that are invisible to any single hospital, any billing team, or any off-the-shelf AI tool.
At one facility, we found an 18-percentage-point gap in collection rates between two contracted MCOs. Nobody inside the hospital knew it existed. One MCO was paying; the other wasn't. That gap alone was worth seven figures.
35–60% of denied claims are never resubmitted. But 57% of those that are appealed get overturned. We identify which denials are worth fighting, which MCOs overturn at the highest rates, and what evidence each one requires.
$3.8 million in claims at one facility that were never paid and never received an explanation. They had simply gone silent. No billing team has time to chase ghost claims — our intelligence engine surfaces them automatically.
Uncompensated care has a pattern. It shows up differently in every state, at every MCO, at every facility — but it follows patterns. We built the system that reads them.
Every engagement follows the same four phases. Each builds on the last. By month three, you have a self-sustaining revenue navigation system — and we're the ones running it.
We analyze your encounter data against Medicaid eligibility records to surface every gap — missed coverage, expired PAs, retroactive eligibility, self-pay mismatches.
Every week, we deliver a Navigation Report with specific recovery actions — claims to file, denials to appeal, PAs to submit — prioritized by dollar value and deadline.
Recovery data reveals root-cause process failures. We redesign registration workflows, denial management, and eligibility verification — so you stop losing revenue at the source.
The system runs itself — with us behind it. Monthly CFO reports prove ROI. Quarterly Medicaid policy updates keep your team ahead of regulatory changes in your state.
155.6M Medicaid claims (2018–2024), 162K facilities, 207,638 coverage determinations, 98,186 ICD-10 codes, 35M+ PubMed articles
Every Medicaid fee schedule code, every MCO provider manual rule, every state-specific coverage policy. Kansas live with 10,045 KMAP codes and 3 MCO manuals analyzed.
Your actual claims, your actual denials, your actual MCO payment patterns — overlaid on national and state intelligence for recovery models specific to your hospital.
This is a continuous system, not a consulting project. But the heavy lifting is ours. Here's what the week actually looks like for each side.
Monday morning, your team runs three standard EHR exports and sends them to us. That's it.
We run analytics across denials, eligibility gaps, and filing deadlines — cross-referencing your state's MCOs against your open encounters and Medicaid policy rules.
Your team receives a Navigation Report and Patient Action Worklist — every action item prioritized by dollar value and deadline urgency. Ready to execute.
We're available for questions, help with appeals, and assist on any recovery actions that need extra navigation through MCO portals or state Medicaid policy.
Every recovery action is tracked. Results feed back into the next cycle. Your monthly CFO report shows exactly what was recovered, what's in progress, and ROI.
↻ This cycle repeats every week, 52 weeks a year
We carry the analytical workload so your team can focus on patient care.We work with standard data exports your EHR already produces. No APIs to configure, no systems to connect, no vendor calls to schedule. If your EHR can export a CSV, we're ready to start.
No ambiguity. You'll know exactly what you're getting, when you're getting it, and what to do with it.
| Deliverable | Frequency | What It Does |
|---|---|---|
| Revenue Leakage Assessment | At Kickoff | Baseline analysis of where revenue is being lost — eligibility gaps, denial patterns, filing risks — with dollar estimates |
| Navigation Report | Weekly | Prioritized list of recovery actions across all your state's MCOs, with dollar estimates and deadline dates |
| Patient Action Worklist | Weekly | Excel file your team works directly — each row is one patient, one action, one deadline |
| CFO Scorecard | Monthly | Executive summary: dollars recovered, pipeline, trends, ROI calculation vs. engagement cost |
| Medicaid Policy Brief | Quarterly | Regulatory changes, MCO updates, and rate shifts in your state — translated into action items for your revenue team |
| Process Redesign Specs | As Needed | When root-cause patterns emerge, we deliver specific workflow changes to stop leakage at the source |
A 30-minute data review is all it takes. We'll show you what our intelligence engine reveals about your Medicaid revenue — the gaps, the patterns, and the recovery opportunity — before you commit to anything.
Schedule Your Data ReviewFree. No integration. No IT project. You'll see the numbers first.