Revenue Protection Engines & Technical Services

The Challenge:

Legacy EHR vendors are stalling on USCDI v3—the enforced federal baseline—while Covered Entities absorb the compliance risk. Proprietary data formats, incomplete terminology bindings, and missing data classes (SDOH, SOGI, clinical notes) block both federal compliance and Medicare Advantage VBC bonus capture.

Our Approach:

We perform automated schema validation against USCDI v3 constraints, score data class completeness, map vocabulary gaps across LOINC, SNOMED CT, and RxNorm, and quantify your Vendor Compliance Gap. Every assessment extends into a v3→v5 SVAP forward-path and v7 positioning roadmap.

Deliverables:

• USCDI v3/v5 Gap Assessment Report

• Data Class Completeness Scoring Matrix

• Terminology Mapping Matrix

• Missing Data Class Identification

• Prioritized Remediation Plan

• Cost & Timeline Estimates

• v3→v5 SVAP Readiness Roadmap with v7 Forward-Path

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. This engagement is designed as an entry point into a broader compliance relationship: data residency is one dimension of a complete compliance posture — TEFCA readiness, USCDI v3 alignment, and 42 CFR Part 2 governance are adjacent risks that typically surface during the same infrastructure audit.

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

• Compliance Exposure Summary (adjacent TEFCA, USCDI, and Part 2 risks identified during audit)

The Challenge:

FQHCs and behavioral health organizations are the most underserved by healthcare AI vendors—and also stand to benefit the most from automation. But AI requires clean, normalized, FHIR-structured data. Organizations that haven't completed their interoperability foundation work will be locked out of this market as it forms.

Our Approach:

We help you evaluate the data pipeline infrastructure AI workflows require: validated FHIR-ready data models, real-time API performance benchmarking, data quality scoring for AI readiness, and governance documentation for AI model input data lineage.

Deliverables:

• AI Data Pipeline Readiness Assessment

• FHIR Resource Coverage and Quality Scorecard

• Real-Time API Performance Benchmark Report

• Data Lineage and Governance Documentation for AI Inputs

• Roadmap: from data readiness to AI-enabled workflows