MedAura Medical Billing manages claim submission, coding review, eligibility verification, payment posting, denial follow-up, A/R recovery and monthly revenue reporting for practices in all 50 states. You keep your EHR, your staff and your clinical workflow. We run the billing operation behind them.
Start with a Free Billing Audit. It shows you where claims are being delayed, denied, underpaid or left sitting in aging A/R, before you commit to changing billing vendors.
New Jersey based, billing nationwide · AAPC and AHIMA certified coders · Works inside your existing EHR · HIPAA compliant, BAA before access · 5% of collections, no setup fee

Most revenue is not lost to one large mistake. It leaks through small breakdowns spread across eligibility verification, incomplete documentation, coding errors, payer-specific edits, slow claim follow-up, unreviewed underpayments and weak denial tracking. None of these produce an alert. Three of the four cost centers below never appear on a denial report at all.
Incomplete demographics, invalid member IDs, missing modifiers, diagnosis pointer conflicts and payer format errors stop claims at the clearinghouse. A rejected claim never reached adjudication and never started its filing clock, which means it can be fixed the same day. Left in a queue nobody works, it ages silently.
Authorization gaps, medical necessity documentation, coding errors, bundling edits and coordination of benefits problems reduce or delay reimbursement. Many carry adjustment reason codes that are administrative and reversible. When nobody has capacity to read the code, the denial gets adjusted off as a write-off. That is a decision, not an outcome.
Claims sitting past 30, 60 and 90 days need structured follow-up by payer, documented payer notes, appeal tracking and escalation. Aging reports sorted by balance rather than by filing deadline are how small claims closest to expiry sit at the bottom of the list until they cross the deadline and become unrecoverable.
A claim is submitted, accepted and paid. The balance closes and everything looks successful. But the allowed amount was less than the rate your contract specifies for that code. Nobody compared the two, so nobody noticed. This is the largest silent loss in most practices, because every indicator says the claim went well.
MedAura provides outsourced medical billing and full revenue cycle management for practices that want a trained billing team running claims, denials, posting, A/R follow-up and reporting. You keep the clinical workflow. We handle the revenue operation behind it.
We confirm active coverage, plan type, co-pay, deductible status, authorization requirements and any behavioral or specialty carve-out before the visit, so the claim is built against the plan that will actually adjudicate it.
Explore Eligibility Verification ServicesCertified coding specialists review ICD-10-CM, CPT, HCPCS, modifiers and payer-specific requirements before submission, and flag documentation gaps back to the provider rather than coding around them.
Explore Medical Coding ServicesCharges are entered from the documented encounter and reconciled against the appointment schedule, so a completed visit that never produced a claim is caught in days rather than discovered at year end.
Explore Charge Entry ServicesEvery claim is checked against NCCI edits, modifier logic, diagnosis pointer alignment, place of service, provider identifiers and payer-specific formatting before it leaves. Clearinghouse acknowledgements are retained as proof of timely filing.
Explore Claim Submission and ScrubbingWe post ERAs and EOBs line by line, reconcile against the deposit, record contractual adjustments and patient responsibility against the correct claim, and flag underpayments and payer take-backs instead of absorbing them.
Explore Payment Posting ServicesWe identify denial root causes by CARC and RARC code, correct and resubmit what is reversible, file written appeals with supporting documentation, track payer responses and build prevention rules for recurring denial patterns.
Explore Denial Management ServicesWe work aging claims by payer, age bucket, denial status and filing deadline rather than by balance size, so the claims closest to expiry are touched first. Legacy A/R from a previous vendor is worked, not written off.
Explore A/R Recovery ServicesBenefit checks, clinical packet submission, unit and expiry tracking, renewals and peer-to-peer escalation, scoped per payer and per service so covered care does not become a patient balance.
Explore Prior Authorization ServicesPayer enrollment, CAQH maintenance, NPI and taxonomy setup, revalidation tracking and panel status monitoring, so a provider is not seeing patients against a payer who will not pay for them.
Explore Credentialing ServicesPatient statements generated from the actual remittance rather than estimated, with clear balance explanations, multiple payment options, No Surprises Act compliant good faith estimates and a defined collections workflow.
Explore Patient Billing ServicesClean claim rate, denial trends by payer and reason code, A/R aging, payer performance, collections against expected reimbursement, and follow-up activity, delivered monthly and reviewed with your account manager.
Explore RCM ReportingPractice size does not change the work. It changes the operating model: how many payers are in play, how many fee schedules have to be maintained, and how much reporting detail is useful rather than noise.
One provider, a short payer list, and usually one person handling billing between other duties. The risk is coverage, not volume. When that person is out, denial follow-up stops and nothing signals it until cash flow drops six weeks later.
Enough volume that a missed pattern compounds quickly, and rarely enough to justify a full billing department with a coder, an A/R specialist and a denial specialist. This is the segment MedAura is built around.
Multiple fee schedules running at once, where the same CPT code can carry a different contracted rate by specialty, provider and location. We centralize billing with multi-provider taxonomy mapping and report by service line.
Professional and facility components bill separately and can be denied independently. High claim volume, UB-04 institutional claims, cross-department accuracy and reporting that splits by location, provider and service line.
A clean billing operation depends on front-end accuracy, payer-rule awareness, fast submission, disciplined follow-up and transparent reporting. This is how the work runs.

Real-time eligibility and benefit checks through EDI 270 and 271 transactions, with plan type, co-pay, deductible status and authorization requirements confirmed before the visit so front-end errors never reach a claim.
Authorization requirements identified per payer and per service, clinical packets submitted, units and expiry dates tracked, and renewals filed before they lapse. Scoped during onboarding because requirements vary by payer and engagement.
Certified coders review ICD-10-CM, CPT, HCPCS and modifier assignment against the documentation and payer policy. Anything ambiguous or requiring a clinical judgment goes back to the provider for review rather than being coded around.
Claims are validated against NCCI edits, modifier logic, diagnosis pointers, place of service and payer-specific formatting, then transmitted electronically with the clearinghouse acknowledgement retained as proof of timely filing.
ERAs and EOBs are posted line by line and mapped to CARC and RARC codes, reconciled against the deposit, and compared to your contracted rate before the balance closes.
Denials are sorted by reason code rather than balance. Reversible administrative denials are corrected and resubmitted. Clinical denials receive a written appeal with supporting documentation, and payer responses are tracked to resolution.
Patient statements are generated from the posted remittance, not estimated, with clear balance explanations, multiple payment methods and a defined follow-up sequence that does not damage the patient relationship.
A paid claim is not automatically a correctly paid claim. Before a remittance posts to your ledger, MedAura compares the allowed amount to your contracted rate for that code and that payer. If the two do not match, the claim is flagged rather than quietly closed.
Most billing companies stop at whether the claim was paid. Running the second check means holding every payer contract in usable form and maintaining loaded fee schedules as contracts get amended. We maintain them, and the output is a variance report you can read against your own remittances.
| CPT | Your contracted allowable | Payer allowed | Variance | Action taken |
|---|---|---|---|---|
| 99213 | $118.40 | $118.40 | $0.00 | Posted and closed |
| 99213 | $118.40 | $96.75 | -$21.65 | Reprocessing request filed with contract citation |
| 20610 | $284.00 | $284.00 | $0.00 | Posted and closed |
| 20610 | $284.00 | $213.00 | -$71.00 | Third occurrence this quarter. Escalated as a contract issue. |
Illustrative example. Your audit reports your own codes and your own payers.
When an in-network payer allows less than your contracted rate, that is a short payment, not a negotiation. We raise it as a documented reprocessing request citing the contract term and the specific claim line, then track it to resolution. A short payment that posts and closes is unrecoverable in practice, because nothing downstream will ever look at it again.
Out-of-network claims have no contracted rate to check against, so the first payment is an opening position rather than a determination. We submit with documentation supporting the level of service, respond to the payer methodology rather than accepting it, and use available dispute routes including the federal independent dispute resolution process where the No Surprises Act applies.
Sometimes the payer confirms it is paying exactly what the contract says. At that point appealing will not fix it, because the problem is the rate you agreed to. What changes a rate is evidence: which codes, how many claims, how much revenue, across which quarters. You get that as a standing report. Most practices enter a renegotiation with an impression. You would enter with a number.
See your variance. The Free Billing Audit reports the gap between what your contracts promise and what your payers actually sent.
Get a Free Billing AuditBefore recommending anything, we review your current revenue cycle to find where money is delayed, denied, underpaid or written off too early. The findings are yours whether or not you engage us.
MedAura charges 5% of monthly collections. One rate, billed on what actually lands in your account, which means we are paid on collections rather than on activity. A claim that never gets paid costs you nothing in billing fees.
What sits outside the 5% and is scoped separately: provider credentialing and enrollment, prior authorization management, and practice management or front-desk support. High-volume facility and hospital billing is quoted on volume rather than percentage.
No setup fee, no long-term lock-in, and no charge for the Free Billing Audit
Outsourcing becomes the right call when payer count, claim volume or denial backlog has outgrown the hours one person can give it. Below that line, in-house billing is genuinely fine. Above it, the work does not get done badly. It stops getting done in the places nobody is watching.
| Factor | In-house billing | Outsourced with MedAura |
|---|---|---|
| Cost structure | Salary, benefits, billing software, training and workspace. Fixed regardless of what you collect. | 5% of collections. Moves with what you actually receive. |
| Coverage | Stops during PTO, illness and turnover | Continuous, with a backup specialist assigned to every account |
| Denial follow-up | First task dropped when the day gets busy | A standing daily queue worked by reason code |
| Underpayment detection | Rarely run, because it requires maintained fee schedules | Run against the contracted rate on every remittance before posting |
| Payer rule updates | Tracked manually, if anyone has time | Monitored across many practices and payer mixes |
| Credentialing and enrollment | Usually nobody owns it until a claim denies | Tracked, with revalidation dates monitored |
| Adding a specialty or a state | Hire and train, measured in weeks | Configured at onboarding |
| Reporting | Whatever the billing software produces by default | Monthly close, A/R aging by payer, denial trends, variance report |
| Cost of one vacancy | Weeks of stalled A/R while you recruit and train | Not applicable |
The honest side of it. An in-house biller sits in your office. You can walk over, ask about one patient and change the priority order that afternoon. That immediacy is real and outsourcing does not replicate it. What outsourcing gives you instead is that the work continues when that person is not there, and that somebody is checking the payments nobody else checks.
Two or more concerning answers and the arithmetic has already turned.
Claims already in flight keep moving. The transition runs alongside live billing, not instead of it, so there is no week where submissions stop or A/R goes unworked.
| Stage | What happens | Owner |
|---|---|---|
| Day 0 | BAA signed, kickoff call, scope confirmed, Free Billing Audit findings reviewed as the baseline | MedAura onboarding lead |
| Days 1 to 3 | EHR and clearinghouse access granted, payer mix mapped, contracted fee schedules loaded | Joint |
| Days 4 to 6 | Credentialing and enrollment status verified, gaps identified and filed, A/R aging report pulled | MedAura credentialing |
| Day 7 | Test claims submitted and payer responses validated before full volume moves | MedAura billing |
| Days 8 to 10 | Full claim volume live, denial protocols active, legacy A/R worked in parallel | MedAura billing |
| Days 11 to 14 | First ERAs posted, contracted-rate variance check running, first payments landing | MedAura posting |
| Day 30 | First monthly review: clean claim rate, A/R aging, denial trends, variance findings | Joint |
Specialty does not change how the revenue cycle runs. It changes which rules apply inside it. Each specialty has one or two distinctive billing objects that drive most of its denials, and we bill to those rather than to a generic template.
Global maternity package splits, antepartum visit counts, delivery-only codes, and gynecologic surgical bundling with ICD-10 mapping and authorization tracking.
Catheterization, electrophysiology and echocardiography coding, device monitoring intervals, diagnostic bundling edits and DRG considerations.
Psychotherapy time bands, behavioral carve-out routing, session limits, parity appeals and IOP or PHP per diem billing.
Global surgical periods, implant and device coding, laterality and bilateral modifiers, and payer-specific bundling rules.
Professional and technical component splits, contrast coding, teleradiology place of service and advanced imaging prior authorization.
Screening versus diagnostic endoscopy distinction, modifier PT application, anesthesia pairing and prior authorization tracking.
Excision, biopsy and lesion removal coding by size and site, Mohs staging, and the cosmetic versus medically necessary boundary.
Place of service 20, S codes, after-hours and observation coding, and walk-in eligibility verification at the point of service.
Injection and infusion coding, J-codes, session-based billing, and units and frequency limits by payer.
HCPCS coding, written orders prior to delivery, capped rental month tracking, CMN renewals and RR, NU and KX modifier application.
CPT and PLA code assignment, panel unbundling edits, medical necessity documentation and payer-specific validation.
Ambulatory surgical procedure coding, implant carve-outs, multiple procedure reduction and ASC-specific payer claim validation.
Do not see your specialty? We bill for it. Ask during the audit.
See all specialtiesNo migration, no new software, no workflow change. MedAura bills inside the EHR and practice management system you already run, using the access level you grant. Your templates, your front desk process and your clinical documentation stay exactly as they are.
We can work through your existing clearinghouse or set one up, and we keep every submission acknowledgement as proof of timely filing rather than relying on the payer's record of receipt.
Your data stays yours. If the relationship ends, you receive a full export of your billing data, open A/R and claim history. That is in the agreement, not just on this page.
Not listed? The question is whether we can get appropriate access and pull the reports, not whether we have billed in it before. Bring it up during your Free Billing Audit.
Get a Free Billing AuditMedAura Medical Billing operates from Piscataway, New Jersey and bills for practices across all 50 states. Being based here is not incidental: the payer environment our team knows best is the one our New Jersey clients deal with every day.
For New Jersey practices that means billing directly to Horizon Blue Cross Blue Shield of New Jersey, AmeriHealth New Jersey, Aetna, Cigna and UnitedHealthcare Oxford, along with the NJ FamilyCare managed care plans including Horizon NJ Health, UnitedHealthcare Community Plan, WellCare and Aetna Better Health of New Jersey. Each carries its own submission requirements, appeal routes and documentation expectations, and the difference between knowing them and looking them up is measured in weeks of A/R.
Outside New Jersey, two things genuinely differ state to state. Medicaid program rules vary by state and by managed care plan within each state. Telehealth billing follows the licensure requirement of the patient location rather than the provider location. Both are configured during onboarding, alongside state-level payer edits, modifier policies and billing frequency limits.
A Business Associate Agreement is executed before anyone at MedAura touches protected health information. Not after onboarding, not alongside the first invoice. Before access.
You get a monthly close and a standing report on the metrics that actually predict cash flow. Not a dashboard you interpret alone, and not a number that only appears when it is good.
| Metric | What it tells you | What triggers a conversation |
|---|---|---|
| Clean claim rate | The share of claims accepted on first submission without rework | A sustained drop, or one payer falling behind the rest |
| Days in A/R | How long money sits between date of service and payment | An upward trend across two consecutive months |
| Net collection rate | What you collected against what was actually collectible after contractual adjustments, not against what you billed | Any gap the variance report does not explain |
| Denial rate by payer | Which payer is denying, and under which reason codes | A new reason code appearing repeatedly |
| A/R over 90 days | The share of open A/R approaching or past filing deadlines | Any increase, since this is the least recoverable bucket |
| Contracted-rate variance | Total underpaid dollars identified and recovered | A recurring variance on the same code and payer |
Find out what your payers actually owe you. The Free Billing Audit reviews your claims and remittances and returns a written summary: A/R aging by payer, denial patterns by reason code, claims approaching a filing deadline, rejections failing before adjudication, and payments that landed below your contracted rate. It costs nothing and obligates nothing, and the findings are yours either way.