The Practice
A nurse-practitioner-led behavioral health practice in Massachusetts, providing psychiatric and mental health care, including Spravato treatment. The practice bills a broad mix of Massachusetts commercial, Medicaid, Medicare, and behavioral-health carve-out payers.
The Challenge
The practice engaged RCM Staff at a difficult moment: it was migrating its entire billing operation from one platform stack to another while claims still needed to go out the door every day. At onboarding, the picture looked like this:
- $73,382 in insurance A/R, with $12,607 (17%) sitting over 90 days, plus an additional patient balance backlog.
- A mid-flight system migration from TherapyNotes + Claim.MD to IntakeQ + OfficeAlly, with real risk of a billing gap during the transition.
- Remittances scattered across payer portals. Electronic remittance (ERA/835) files were spread across PaySpan, Availity, OptumPay, and individual portals, with many payers not yet enrolled for automated posting.
- A complex Massachusetts payer mix: MBHP/Carelon, Tufts, Harvard Pilgrim, BCBS MA, MassHealth, WellSense, Commonwealth Care Alliance, and more, each with its own enrollment and follow-up quirks.
What RCM Staff Did
RCM Staff took ownership of the full revenue cycle and built a repeatable daily rhythm around it, while running the platform migration in parallel.
- 24-hour claim turnaround. Primary and secondary claims created from the queue within 24 hours, with eligibility confirmed on the date of service before billing.
- Same-day rejection and denial work. Rejections worked from the queue within 24 hours. ERA/EOB denials worked on receipt, with recurring root causes (service location identifiers, invalid subscriber data, duplicates) fed back to the practice.
- Aged-A/R recovery. A/R worked oldest-first, prioritizing 120-day balances down through the 61 to 90 day buckets to pull down the backlog inherited at onboarding.
- Clean platform migration. Coordinated the move to IntakeQ + OfficeAlly so new claims billed from the new system by March 31, 2026, with open claims in the legacy system worked to closure in parallel.
- Remittance automation. Enrolled ERA for payer after payer so that 835s now route automatically into IntakeQ via OfficeAlly, replacing manual portal retrieval across 15+ Massachusetts payers.
- Weekly owner check-ins. A standing weekly call kept the practice owner informed on rejections, A/R, posting, and migration status throughout.
Services Included
Untangling a Messy Remittance Workflow
One of the biggest sources of friction was remittance. Electronic remittance (ERA/835) files arrived from different places for different payers. Some came through PaySpan, some only inside payer portals, and some payers sent paper only. Posting was inconsistent and hard to reconcile.
RCM Staff mapped where every payer's remittance actually came from, then guided the practice to a single, predictable posting pipeline: enroll ERA through OfficeAlly so 835s route automatically into IntakeQ, and define a clear manual path for the payers that still send paper.
The result: electronic remittances for 15+ Massachusetts payers now post automatically through one pipeline, and the few paper-only payers follow a documented manual process. This replaced a scattered, payer-by-payer routine that was slowing down posting and reconciliation.
The Results
Over the first three months, and despite a full platform migration running underneath the work, the inherited backlog came down and cash collection climbed.
| Measure | At onboarding (March 2026) | Current | Direction |
|---|---|---|---|
| Avg days to payment (billed → paid) | ~84 days | 17 days (May) | −80% |
| Monthly payments posted | $16,323 | $35,424 | 2.2× |
| Inherited insurance A/R (total) | $73,382 | $63,756 | −13% |
| Inherited A/R over 90 days | $12,607 (17%) | $6,993 (11%) | −45% |
| ERA / remittance posting | Manual, portal-by-portal | Automated for 15+ payers | Streamlined |
The aged A/R inherited at onboarding was the priority, and it was nearly halved. Over-90 balances fell from $12,607 to $6,993 (17% down to 11% of the book) while monthly cash posted more than doubled. The practice collected more without letting receivables age, all through a live system migration that typically causes A/R to spike.
Why It Worked
The practice did not just hand off claims. It handed off a transition. RCM Staff absorbed the operational risk of a live platform migration, kept claims flowing, and turned a scattered remittance process into an automated one, all while bringing down aged A/R.
- U.S. healthcare RCM experience applied directly to Massachusetts behavioral health payer behavior.
- Documented, repeatable workflows with defined turnaround times rather than ad-hoc effort.
- A compliance-aligned delivery model built around HIPAA-conscious handling of practice and patient information.
- Direct owner communication through a standing weekly review.
Security & Compliance Alignment
RCM Staff supports healthcare clients through a compliance-aligned delivery model that combines trained people, controlled tools, and documented processes. Work is performed under a signed Business Associate Agreement, with HIPAA-conscious workflows, access controls, and accountability built into day-to-day operations. See our HIPAA compliance approach and Trust Center for more.
Disclaimer: Client identity withheld for confidentiality. Figures are drawn from this engagement's billing reports and A/R data (onboarding baseline March 2026 through May 2026). Results reflect one practice's experience and are not a guarantee of specific financial outcomes. RCM Staff provides revenue cycle support services and does not replace licensed clinical or professional judgment.