RCM Healthcare Solutions

RCM Healthcare Solutions is a healthcare technology company founded in 2015 that specializes in claims denial management and revenue cycle optimization. The company operates their Medical Claims Management (MCM) software platform, which identifies and corrects claim denials for doctors, hospitals, and ancillary providers.

The company's MCM platform processes EDI 837 and 835 data files to automatically identify common denial issues including coding errors, missing prior authorizations, and incomplete patient information. The cloud-hosted solution runs on AWS infrastructure with HIPAA-compliant data encryption and includes a pre-programmed rules engine designed to generate revenue from day one of implementation. The platform creates automated work queues that route denial issues to appropriate staff for resolution.

The leadership team brings over 70 combined years of healthcare experience, including backgrounds from major health systems like Steward Healthcare, Community Health Systems, and Health Management Associates. The company addresses specific denial categories including medical necessity documentation, upcoding prevention, unbundling issues, and timely filing compliance.

Organizations should consider RCM Healthcare Solutions when they need a focused claims denial management solution rather than a comprehensive revenue cycle platform. The company's specialized approach to identifying and correcting specific denial types—particularly coding issues, authorization problems, and documentation gaps—may benefit providers struggling with these specific challenges.

Expect an implementation process centered around EDI file ingestion and automated work queue generation. The platform's pre-programmed denial logic means organizations can begin identifying recoverable revenue quickly, though customization capabilities for unique payer requirements or organizational workflows are not detailed.

RCM Healthcare Solutions operates exclusively in healthcare revenue cycle management with specific emphasis on hospitals, health systems, and ancillary medical providers. The company's platform addresses healthcare-specific compliance requirements including HIPAA data security, ICD-10 coding specificity, Medicare medical necessity guidelines, and payer-specific prior authorization workflows. Their leadership brings direct experience from major health systems including Steward Healthcare, St. Vincent's Healthcare, and Community Health Systems, with expertise spanning 1,000 to 8,000-bed systems and revenues up to $12 billion.

The ideal client is a mid-to-large hospital, health system, or high-volume medical practice with significant claim denial volumes and established EDI 837/835 processing infrastructure. Organizations benefit most when they have identifiable patterns in denial reasons—particularly around coding accuracy, prior authorization gaps, or documentation issues—that can be addressed through automated identification and workflow routing.