Revenue Protection Engines & Technical Services

The Challenge:

Legacy EHR systems often store data in proprietary formats that don't align with USCDI v3 requirements. Practices need to identify gaps in data capture, coding standards, and structural compliance before they can remediate and qualify for Medicare Advantage VBC bonuses.

Our Approach:

We perform automated schema validation against USCDI v3 constraints, map your terminology to LOINC/SNOMED CT standards, and identify missing data classes like SDOH, Sexual Orientation, and Gender Identity.

Deliverables:

• Detailed Gap Analysis Report

• Schema Validation Results

• Terminology Mapping Matrix

• Missing Data Class Identification

• Prioritized Remediation Plan

• Cost & Timeline Estimates

The Challenge:

Most EHR systems export data in SQL dumps, CSV files, or HL7 v2 messages—formats that cannot be directly exchanged via modern interoperability networks. Manual conversion is error-prone and non-scalable. Additionally, storing transformed data creates additional HIPAA liability.

Our Approach:

We deploy our Python/FastAPI Normalization Engine to automatically convert your legacy formats into FHIR R4/R5. The engine is Stateless by Design (transforms in memory, never stores PHI), uses Pydantic validation, automated terminology binding to USCDI v3 data classes (SDOH, SOGI, clinical fields), and configurable transformation rules.

Deliverables:

• Deployed Normalization Engine

• FHIR Mapping Specification

• Validated FHIR Resource Feeds

• Terminology Binding Configuration

• Real-time Validation Dashboard

• API Documentation & Integration Guide

The Challenge:

Network participation requires certificate management, IHE profile implementation, security configuration, and extensive testing. Most practices don't know what’s required or how to get their systems and data ready before approaching a network or EHR vendor.

Our Approach:

We provide advisory and readiness support: we assess your current technical posture, document requirements for typical network participation (X.509, mTLS, IHE profiles like XCPD/XCA/XDS), identify gaps in your data and security setup, and deliver a clear readiness plan. When you’re ready to connect, you (or your EHR vendor) use that plan to engage the network of your choice.

Deliverables:

• Network Readiness Assessment Report

• Technical Requirements Checklist (certificates, IHE profiles, security)

• Gap Analysis vs. Typical Network Participation Requirements

• Data & Infrastructure Readiness Recommendations

• Readiness Roadmap for When You Engage a Network

• Ongoing Advisory (optional)

The Challenge:

Payers are increasingly requiring FHIR-based prior authorization to meet the 72-hour mandate. Practices still using fax or legacy portals see delays and rejections. Lost prior auths mean lost revenue and fragmented care.

Our Approach:

We deliver FHIR-native prior auth and referral interoperability: we strengthen your care network with electronic referral and prior-auth workflows, integrate with hospitals and post-acute partners, and deliver in weeks—not months. Revenue protection with audit-ready documentation.

Deliverables:

• FHIR-Based Prior Auth Workflow Design

• Referral Interoperability with Payers & Partners

• 72-Hour Mandate Readiness Documentation

• Closed-Loop Referral Status & Tracking

• Evidence Packets for Payer & Audit Readiness

The Challenge:

Texas SB 1188 authorizes penalties for practices whose vendors cache Texas patient data offshore. Many practices don't know where their data is stored. One violation can cost $25,000.

Our Approach:

We assess your infrastructure and vendor data flows, identify offshore exposure, and deliver migration or remediation plans so your Texas patient data stays domestic. We document evidence for state or auditor inquiries.

Deliverables:

• Texas SB 1188 Data Residency Assessment

• Vendor & Infrastructure Data-Flow Mapping

• Domestic-Only Migration Plan (if needed)

• Evidence Documentation for Audits

• Ongoing Residency Monitoring Recommendations