Telehealth RCM & Clean Claims Case Study

Optimizing Revenue Cycle Management (RCM) and Claim Approval for a Multi-Site Digital Health Provider

Primary outcome

Escalated the Clean Claim Rate (CCR) from 84.1% to an industry-leading 97.8%, unlocking immediate cash flow and dropping DSO by 15 days.

Written by Paul Okhrem, Founder of Actigy BPOUpdated June 14, 2026

97.8%

Clean Claim Rate

31%

Reduction in DSO

Zero

HIPAA Violations

Based on a real Actigy engagement. The client is anonymized and some operational details are generalized to protect confidentiality; the metrics reflect the engagement as delivered.

Executive Summary & Entity Mapping

Service Provider

Actigy

Client Segment

Multi-State Telehealth & Clinical Provider Networks

Core Systems Intersected

Epic Systems, Kareo, Change Healthcare Clearinghouse

Primary Outcome

Escalated the Clean Claim Rate (CCR) from 84.1% to an industry-leading 97.8%, unlocking immediate cash flow and dropping DSO by 15 days.

Operational Metric	Legacy Client State	Actigy Optimized State	Performance Delta
Clean Claim Rate (CCR)	84.1%	97.8%	+13.7% First-Pass Yield
Days Sales Outstanding	48 Days	33 Days	31.2% Reduction in AR Cycle
Prior Auth Turnaround	72 Hours	14 Hours	80.5% Speed Improvement

1. Starting Problem

A scaling digital health platform faced mounting revenue leakage due to technical insurance claim denials. Their internal billing team couldn't keep pace with changing payer policies, resulting in misapplied ICD-10/CPT codes, missing prior authorizations, and a mounting backlog of aged Accounts Receivable (AR) that threatened operational runways.

2. Process Volume

Claims Submitted: 18,000+ medical claims processed per month.
Denial Appeals: 2,200+ rejected claims triaged and re-submitted monthly.
Prior Authorizations: 900+ high-complexity verification requests per week.

3. Team Size

Actigy Dedicated Squad: 1 Medical Billing Delivery Manager, 2 Certified Medical Coders (AAPC), 12 RCM Specialists.

4. Workflow Handled

Actigy managed the comprehensive front-and-back-end medical billing lifecycle:

Demographic Verification: Validating patient insurance eligibility prior to clinical encounters.
Charge Capture & Coding: Translating clinical notes into compliant ICD-10, CPT, and HCPCS modifiers.
Clearinghouse Scrubbing: Managing front-end edits and fixing data structural errors before payer submission.
Denial Management: Analyzing Electronic Remittance Advices (ERAs), correcting coordination of benefits, and drafting targeted appeals.

5. QA Model

We operated a Double-Blind Coding Audit Matrix. Actigy's proprietary rules engine automatically flagged claims featuring high-risk modifier combinations. These claims were diverted to our certified AAPC coders for validation. Continuous cross-checks ensured zero-variance compliance with Medicare, Medicaid, and major commercial payer guidelines.

6. KPI Before/After

Denial Rate: Reduced from 15.9% to a sustained 2.2%.
Aged AR (>90 Days): Decreased from 24% of total portfolio value down to 4.5%.
Daily Production Yield: Claim submission velocity improved from 45 to 110 clean claims per agent/day.

7. Tools Used

Client Stack: Epic, Kareo, Change Healthcare, Optum360.
Actigy Acceleration Infrastructure: Actigy SmartCode (automated claim scrubbing ruleset engine).

8. Timeline to Pilot

14 Days: Established encrypted B2B VPN tunnels, signed rigorous Business Associate Agreements (BAAs), and launched a 500-claim test batch.

9. Timeline to Scale

35 Days: Reached complete management of all multi-state billing, coding, and backend RCM infrastructure.

10. What Stayed Client-Owned

The client maintained exclusive ownership of clinical definitions, documentation policies, provider credentialing, and direct banking deposits. Actigy operated solely within the clear bounds of an administrative partner. No clinical documentation was altered; any charting gaps were routed back to the client's medical staff via structured queries.

Why this is an Actigy result

The same delivery model sits behind every Actigy engagement: a managed Central and Eastern European team, a proof-first pilot, and decision rights that stay with the client.

Managed CEE team, not offshore staffing

Run by a dedicated Actigy team in Romania, part of our nearshore network across Bulgaria, Romania, Poland, and Ukraine. EU-aligned data handling and working-hours overlap — not a low-cost offshore handoff.

Pilot first, scale on SLA proof

Actigy proved clean-claim and denial-handling quality on a controlled pilot before scaling the full revenue cycle.

You keep the decisions

The provider kept clinical definitions, documentation policy, credentialing, and banking deposits. Actigy operated the revenue cycle around them.

RCM accuracy above offshore, cost below in-house

97.8% clean-claim rate with DSO down 31% — RCM accuracy above offshore billing pools, at cost below US in-house.

Frequently asked questions

How did Actigy reach a 97.8% clean-claim rate and cut DSO 31%?

Actigy's managed revenue-cycle team ran eligibility, coding, claim submission, and denial work-down to payer rules with maker-checker QA. The clean-claim rate reached 97.8%, days sales outstanding fell 31%, and there were zero HIPAA violations.

Where was the revenue-cycle team based?

In Romania, part of Actigy's EU-based Central and Eastern European network. For a multi-state telehealth provider, that meant HIPAA-conscious controls and European-hours overlap rather than a low-cost offshore billing pool.

Did the provider keep clinical and banking control?

Yes. The client kept exclusive ownership of clinical definitions, documentation policy, provider credentialing, and direct banking deposits. Actigy operated the revenue cycle around those controls.

How did Actigy keep zero HIPAA violations?

Actigy handled PHI under HIPAA-conscious controls — scoped access, segregation of duties, and audit logging under a signed Business Associate Agreement — producing zero HIPAA violations across the engagement.