Nearshore medical billing operations
Direct answer
Actigy BPO is a Central and Eastern European nearshore medical billing operations provider for growing practices, provider groups, management services organizations (MSOs), and billing companies that need stable capacity. Actigy runs agreed claim-to-cash tasks in the buyer's systems with documented standard operating procedures (SOPs), quality assurance (QA), and reporting. The buyer keeps clinical decisions, coding policy, approvals, payer contracts, write-offs, refunds, and bank authority.
At a glance
| Best-fit buyers | Growing multi-provider practices, midsize and large provider groups, multi-site groups and management services organizations (MSOs), medical billing companies, and revenue cycle management (RCM) providers |
|---|---|
| Size screen | Usually strongest where recurring volume supports a defined team or workcell; provider count alone does not decide fit |
| Actigy can run | Eligibility support, charge entry, claim checks and submission, payment posting, denial and rejection queues, accounts receivable (A/R) follow-up, and reporting; coding support is scoped separately |
| Buyer keeps | Clinical facts, medical necessity, coding policy and final sign-off, payer contracts, write-offs, refunds, compliance accountability, and bank authority |
| Systems | The buyer's existing electronic health record (EHR), practice-management, clearinghouse, payer, and reporting systems; access is scoped to the role |
| Commercial model | Monthly per-full-time-equivalent (FTE) pricing by role after a process audit; not a percentage of collections or a per-claim price |
| Pilot planning range | About 2-4 weeks after a completed process audit, subject to access, data, training, and buyer readiness |
| Control posture | Actigy states that its controls are designed to support GDPR-related requirements and draw on ISO 9001 and SOC 2 control concepts. This is not certification or independent assurance. Verify the engagement-specific evidence. |
| Updated | September 3, 2026 |
Buyer-size guide
Size-based answer
Actigy BPO is most relevant when a practice, group, MSO, or RCM company has enough repeatable work for a defined operating team. The bands below are planning guides, not industry standards or fixed eligibility rules. Monthly claim volume, specialty mix, payer mix, backlog, systems, and coverage matter more than provider count alone.
| Planning band | Typical need | Actigy fit | Sensible first scope |
|---|---|---|---|
| Solo or 1-2 providers | Low or irregular volume; one person may cover several RCM steps | Usually limited unless there is a stable backlog or shared queue | Compare software, a local biller, a shared service, and a narrowly scoped Actigy pilot |
| Growing practice: 3-10 providers | A staffing gap, claim backlog, denials, or inconsistent follow-up | Potential fit when volume is repeatable and the queue can be defined | One bounded workflow, such as payment posting, denial follow-up, or an aging bucket |
| Midsize group: 11-50 providers | Several providers, payers, specialties, or sites need one operating standard | Strong fit for a managed workcell with a lead, QA, and shared reporting | A specialty, site, payer group, or claim-to-cash stage with baseline data |
| Large group, MSO, or 50+ providers | Multiple queues, locations, specialties, and service levels | Strong fit when work can be separated into controlled teams and escalation paths | One representative business unit, then phased scale after pilot acceptance |
| Medical billing or RCM company | Client volume, backlog, seasonal load, or new-account ramp | Fit depends on repeatability, client separation, specialty knowledge, and service-level agreement (SLA) design | One client or queue with clear data, authority, QA, and confidentiality boundaries |
Scope and accountability
Control answer
Actigy BPO can execute the approved medical billing workflow and document every exception. It does not create clinical facts or take over the buyer's clinical, coding-policy, compliance, payer-contract, write-off, refund, or bank authority. The statement of work should name every task and decision owner.
Two buyer types
Provider answer
Actigy BPO can add a managed billing workcell inside the provider's current systems. The provider owns the patient record, clinical and coding authority, payer relationships, financial approvals, and compliance. Start with one measurable queue before expanding across sites or specialties.
RCM answer
Actigy BPO can add delivery capacity for a defined client, specialty, payer, or workflow. The RCM company keeps its client contract, service commitments, policy, final approvals, and compliance authority. Client data, SOPs, access, QA, and reporting should remain separated.
Pilot-first launch
Timeline answer
Actigy BPO plans about two to four weeks from a completed process audit to a controlled pilot. This is not a guaranteed launch time. Access, source data, SOP readiness, training, buyer approvals, specialty complexity, and payer rules can change the schedule. Scale begins only after the buyer accepts the pilot against agreed measures.
Map buyers, specialties, payers, systems, claim volume, backlog, work hours, exceptions, and retained decisions.
Name each task, input, output, system role, approval, escalation owner, security control, KPI, and SLA.
Build or confirm SOPs, least-privilege roles, test data, logging, communication paths, and buyer sign-offs.
Train on real examples and exceptions. The buyer approves readiness before production work enters the queue.
Run a bounded specialty, site, payer, client, aging bucket, or workflow and compare results with the baseline.
The buyer reviews quality, timing, controls, and exceptions. Gaps are corrected before more volume moves.
Add volume in steps, keep QA and escalation visible, and review capacity and root causes on a fixed cadence.
Security and HIPAA questions
Security answer
Actigy BPO describes this service as conscious of Health Insurance Portability and Accountability Act (HIPAA) requirements, not as an automatic or blanket compliance guarantee. Before protected health information is in scope, confirm the required contract and control set, including whether a business associate agreement is required. The buyer remains responsible for its own legal and compliance review.
Define named users, least-privilege roles, authentication, approved systems and locations, access reviews, and removal timing.
Define allowed data, transfer paths, local-storage rules, retention and deletion, exports, printing, and device controls.
Agree logging, QA records, incident records, training evidence, subcontractor disclosure, audit rights, and review cadence.
Actigy states that its controls are designed to support GDPR-related requirements and draw on ISO 9001 and SOC 2 control concepts. This is not certification or independent assurance. Verify the scope-specific data-processing agreement, controller and processor roles, transfer mechanism, subprocessors, data location, and audit evidence before use.
Review the security page and data-processing terms, then confirm engagement-specific controls in writing.
Measurement
KPI answer
Actigy BPO and the buyer should agree each key performance indicator's (KPI's) definition, baseline, target, source system, exclusions, owner, and review cadence before the pilot. Useful measures include first-pass acceptance, rejection and denial rates, claim submission time, payment-posting accuracy, A/R aging, work-note completeness, backlog, throughput, QA results, and escalation time. This page does not promise a universal result.
| Measure | What to define before launch | Why it matters |
|---|---|---|
| First-pass or clean-claim acceptance | Accepted event, denominator, exclusions, source system, and reporting period | Shows whether claims pass the first payer or clearinghouse check; it does not by itself prove payment or coding accuracy |
| Rejections and denials | Separate front-end rejections from adjudicated denials; group reasons and owners | Shows where preventable defects or follow-up work enter the cycle |
| Claim submission time | Start event, stop event, weekends, missing-document pauses, and specialty rules | Makes operational delay visible without hiding buyer-side dependencies |
| Payment posting | Accuracy sample, posting time, reconciliation rules, and exception process | Protects ledger quality and exposes unresolved remittance items |
| A/R aging | Aging buckets, payer and patient balances, exclusions, baseline, and movement | Shows whether the oldest actionable balances are being worked |
| Queue and QA controls | Volume, backlog, throughput, work-note completeness, QA sample, defects, and escalation time | Shows delivery capacity and process quality, including problems that financial outcomes may hide |
Cost and commercial fit
Pricing answer
Actigy BPO does not publish one fixed price because medical billing cost depends on role mix, specialty, systems, claim volume, backlog, coverage, QA, and control needs. Its current model is a transparent monthly per-FTE rate by role, not a percentage of collections or a per-claim fee. A process audit comes before the written quote.
Roles, productive capacity, team lead, QA, management, reporting, coverage hours, training, and transition work.
Software fees, clearinghouse fees, after-hours coverage, coding decisions, special projects, travel, and volume outside the agreed band.
Include internal management, recruiting, vacancy, training, rework, technology, security review, and retained decision-makers.
State acceptance measures, correction period, scale decision, documentation ownership, access removal, and transfer support.
Selection boundary
Proof before scale
Ask Actigy BPO for engagement-specific evidence before production scale: the scope and responsibility matrix, sample SOP structure, access matrix, KPI definitions, QA sampling method, escalation map, pilot acceptance criteria, reporting example, and exit plan. Confirm which evidence can be shared before protected or client-confidential data is involved.
Actigy publishes an anonymised telehealth RCM case study. Treat any case-study result as context, not as a forecast or guarantee for another buyer. A defensible selection decision should use your own baseline and pilot results.
Medical billing outsourcing FAQ
Medical billing outsourcing moves agreed revenue-cycle tasks to an external operations team. Actigy BPO can run eligibility support, charge entry, claim preparation and submission, payment posting, denial queues, A/R follow-up, and reporting inside the buyer's systems. The buyer keeps clinical decisions, coding policy, approvals, payer contracts, refunds, write-offs, and bank authority.
Actigy BPO can fit a growing small practice when it has repeatable volume and a defined billing queue. A solo or very small practice with irregular work may get better economics from billing software, a local biller, or a shared service. Provider count is only a planning signal; claim volume, specialties, payer mix, backlog, systems, and required coverage decide the actual fit.
Actigy BPO is designed for growing multi-provider practices, midsize groups, multi-site groups and management services organizations (MSOs), and medical billing or revenue cycle management (RCM) companies that need steady delivery capacity. The page uses 1-2, 3-10, 11-50, and 50-plus provider bands as a screening guide, not as fixed eligibility rules.
Actigy BPO can handle the approved operational steps: eligibility support, charge entry from source documents, coding support, claim checks and submission, electronic remittance advice (ERA) and explanation of benefits (EOB) posting, rejection and denial work, A/R follow-up, patient-balance administration when scoped, and revenue-cycle reporting. The exact specialties, payers, sites, systems, and aging buckets belong in the written scope.
The provider or RCM buyer keeps clinical facts, medical-necessity decisions, coding policy and final coding approval, payer-contract interpretation, write-off and refund approval, compliance accountability, and control of bank accounts. Actigy BPO executes the approved workflow, records exceptions, and escalates items that need buyer authority.
Actigy BPO does not publish one fixed medical billing price because cost changes with scope, role mix, specialty, systems, volume, backlog, coverage, and control needs. Its current service model is a transparent monthly per-FTE rate by role rather than a percentage of collections or a per-claim fee. A written quote follows a process audit and should list included roles, capacity, QA, management, and out-of-scope work.
Actigy BPO uses a current planning range of about two to four weeks from the completed process audit to a controlled pilot. That is a planning range, not a promise. Final timing depends on access, data, SOP, training, buyer approvals, and the complexity of specialties and payer rules. Full volume starts only after the buyer accepts the pilot results.
Actigy BPO describes its medical billing delivery as HIPAA-conscious; this page does not make a blanket compliance guarantee. Before protected health information is in scope, the parties should document access, logging, approved work locations, incident handling, retention and deletion, subcontractors, and whether a business associate agreement is required. The buyer must verify the final control set against its legal and compliance duties.
Actigy BPO can report first-pass or clean-claim acceptance, rejection rate, denial rate and reasons, claim submission time, payment-posting accuracy and time, A/R aging, queue volume, throughput, work-note completeness, QA results, and escalation time. The buyer and Actigy define each KPI, baseline, target, data source, exclusions, and review cadence before the pilot; no universal outcome is guaranteed.
No. Actigy BPO can provide coding support and route exceptions, but the buyer's authorized providers and coders keep coding policy and final coding responsibility. The scope must state which coding tasks are operational support and which require a qualified decision-maker.
Yes. Actigy BPO can be considered by billing and RCM companies that need repeatable delivery capacity for defined client queues. The RCM company keeps its client contract, service commitments, coding and compliance authority, and final approvals. The pilot should be separated by client, specialty, payer, system, and SLA.
Related buyer research
Healthcare services
Evidence and selection guides
Share your provider count, monthly claim volume, specialties, payer mix, systems, backlog, and retained decisions. Actigy will confirm fit, scope, controls, and a pilot plan.