Revenue Intelligence
Maps where every claim dollar enters, stalls, and leaks. Covers AR aging analysis by payer and provider, denial pattern mapping by reason code, clean claim rate monitoring, charge lag tracking from service date to submission, and a monthly financial health score delivered to the CEO. This is the diagnostic and visibility layer. Nothing is assumed. Every gap is named and quantified before anything is changed.
Mirlo Systems maps AR aging, denial patterns by reason code, clean claim rates against industry benchmarks, and charge lag from service date to submission. The CEO sees where revenue enters, stalls, and leaks before a single system is touched.
Detailed mapping of aging claim balances across commercial and government payers. Isolates bottlenecks and late payment trends with exact dollar values attached to each aging bucket.
Categorizes historical denials by reason code and carrier rule. Quantifies recovery potential for challenged claims and establishes measurable clean claim rate targets.
A direct monthly financial review delivered to leadership. Tracks days in AR, clean claim rates, and recovery progress against baseline metrics with zero fluff.
Denial Prevention and Recovery
Addresses the problem before the payer ever sees the claim, and recovers what gets through. Covers pre-submission claim scrubbing against payer-specific rules, pre-authorization flagging for high-risk claims, first pass resolution rate tracking, denial categorization by type and recovery probability, appeal generation for the most common denial codes, and timely filing deadline tracking. The 65% of denied claims that are never reworked get worked. Every one of them.
Scrubs claims against payer-specific rules and prior authorization requirements prior to transmission. Prevents clearinghouse rejections and carrier denials before submission.
Classifies incoming denials by reason code and recovery probability. Routes routine items with structured corrective actions so billers work with full context.
Generates appeal documentation packages for the most frequent denial codes with required clinical notes attached, recovering stalled collections.
Monitors filing limits across all open claims and flags approaching cutoff dates, preventing unforced write-offs from delayed follow-up.
AR and Collections Operations
The daily operational engine that runs without adding headcount. Covers automated follow-up on claims in 30, 60, and 90 day aging buckets, payer status checks, escalation triggers when claims hit critical thresholds, real time eligibility verification across 2,700 payers, secondary payer identification and coordination, and daily AR aging reports. Every aging claim gets worked every single day.
Runs daily follow-up across 30, 60, and 90 day aging buckets. Tracks claim status and escalates stalled balances before claims cross into long-term risk.
Verifies patient coverage and benefit eligibility across 2,700 payers prior to service dates, eliminating eligibility-related rejections.
Coordinates secondary and tertiary claims, manages coordination of benefits, and accelerates balance collection across payer tiers.
Monitors claim adjudication cycles and triggers operational escalations when claims sit past standard payer turnaround times.
Client Retention and Team Operations
Protects the revenue that has already been recovered. Covers a branded client performance portal with real time billing data, automated monthly performance reports sent directly to clients, payment posting, charge entry validation, workload distribution, and staff performance tracking by claim volume and resolution rate. Clients who can see their numbers clearly stay longer. Staff who are not buried in repetitive work stay longer too.
Sends clear monthly reports directly to provider clients with transparent collection numbers, clean claim rates, and AR velocity that demonstrate ongoing value.
Validates charge entries and processes ERA remittance files with accuracy, reducing payment posting lag and manual reconciliation errors.
Distributes claim volume across billing specialists based on complexity and specialty, preventing backlog spikes and staff burnout.
Measures productivity and resolution rates by biller and claim category, maintaining accountability and operational clarity across the team.
Frequentlyasked questions
Mirlo Systems builds custom AI systems inside your billing operation. That means fixing your denial rate, recovering aging AR, improving your clean claim rate, and making your operation less dependent on any one staff member. Every system is built around your specific payer mix, denial patterns, and claim volume.
Mirlo Systems works with CEOs and founders of medical billing companies doing between $1M and $30M in annual revenue with five to 150 staff. If you serve medical practices or specialty clinics, are paid a percentage of net collections, and are dealing with a denial rate above 8 percent or AR older than 45 days, this is built for your situation.
Most billing companies move their denial rate from the 9 to 15 percent range down to under 5 percent within the first 90 days. Days in AR typically moves from 50 to 60 days down to under 35. Clean claim rate reaches 97 percent or above within the first quarter. For a company doing $5M in revenue at a 12 percent denial rate, that is close to $350,000 in previously challenged claims now being collected.
Every engagement draws from all eight service areas as needed: custom AI development, workflow automation, process automation, AI-powered analytics and reporting, AI integration, conversational AI, voice agents, and ongoing system maintenance. Each system is built around your specific payer mix, denial patterns, and claim volume.
Meaningful movement in denial rate is typically visible within 30 to 45 days of going live. The full 90-day window is the standard measurement period for the performance guarantee. Days in AR follows as claim quality improvements move through the aging buckets. The CEO receives a direct weekly briefing throughout the entire sprint.
Yes. If your denial rate does not drop by at least 30 percent within 90 days of going live, Mirlo Systems works without additional charge until it does. The guarantee requires clean access to your current systems and adherence to the implementation plan established in week one.
Mirlo Systems connects directly into the practice management systems and clearinghouses you already use, including athenahealth, eClinicalWorks, AdvancedMD, Kareo, Waystar, and Availity. No migration required. The AI systems sit on top of your existing infrastructure and start working immediately.
Mirlo Systems works with a limited number of clients at any given time. Every engagement requires close attention during the first 90 days. If your denial rate is above 8 percent, your AR is older than 45 days, or your staffing situation is creating operational risk, book a diagnostic call to find out what Mirlo Systems would build.
Pricing is discussed on the diagnostic call based on your specific denial rate, AR position, and revenue. The right frame is not what Mirlo Systems costs. The right frame is what the current situation is already costing every month. A billing company doing $5M in revenue at a 12 percent denial rate is losing $600,000 per year in challenged claims. The investment is measured against that number.
Book a 20-minute diagnostic call at cal.com/mirlo-systems/diagnostic-call. The call covers your current denial rate, days in AR, and where the biggest recovery opportunity sits in your operation. No pitch deck. No generic presentation. You leave the call knowing specifically what Mirlo Systems would build and what result you can expect.
Stop losing recoverable revenue.
Mirlo Systems builds the AI systems your billing operation is missing and guarantees the result in 90 days.